Interpretation (in light of other evidence)
As this is the first systematic review on uterine hemangioma in
pregnancy, a comparison of our findings with literature is difficult.
Establishing the diagnosis of a uterine hemangioma before delivery seems
beneficial for maternal outcome, as we found a lower number of
postpartum hemorrhages and peripartum hysterectomies in this patient
group. This highlights the importance of delivery planning to anticipate
the peripartum bleeding risk. On the one hand, antenatal diagnosis is
relatively straightforward and can be made by standard 2D ultrasound.
Once identified the patient can be referred to a tertiairy care center
for more comprehensive care. On the other hand however, this could lead
to overtreatment, as in the case where a hysterectomy was performed at
17 weeks of gestation because of the assumed risk of uterine rupture.
Furthermore, subsequent pregnancies may lead to more morbidity since
four of the included patients were multiparous and half of them
developed a severe postpartum hemorrhage with the need for hysterectomy.
Data on obstetrical antecedents were provided for only one patient, who
had an uneventful pregnancy followed by a spontaneous post-term delivery
complicated by placental retention and a postpartum
hemorrhage.17