Doppler ultrasound as an additional parameter for the evaluation of myomas and the indication of myomectomy during pregnancy.

Objective: Pregnancies with myomas are known to have an increased risk for complications such as abruptio placentae, dysfunctional labor, growth of the tumor, necrosis and delivery problems, but prediction is still difficult based on clinical and real-time ultrasound evaluations alone.

Methods: We evaluated 15 patients with submucosal, intramural and subserous myomas, respectively.

Results: We found that in the submucosal myomas, the resistance index in the spiral and radial arteries decreased from 0.80-0.95 to 0.60-0.75 when choriogonadin and aspirin were given. In 3 cases in whom the resistance index increased before delivery, intrauterine growth retardation and the need for surgical delivery occurred. In 9 cases with intramural myomas, a normal decrease in the resistance indexes was seen, but 6 cases had a sharper drop related to necrosis. In 3 of the 5 cases with myomectomies, there were not only signs of necrosis but also of sarcomatous degenerations on histology. The cases with subserous myomas had no complications and the classical physiologic conversion pattern on Doppler evaluations.

Conclusion: We feel that the Doppler results helped us with the management issues and gave insights into the typical pathophysiologic sequences, but the clinical role of Doppler flow analysis in pregnancies with myomas needs to be further evaluated.