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