Uterine Fibroids And Obstetric Outcomes Among Women Living In Sub-Saharan Africa: Systematic Review And Meta-Analysis

Abstract

Introduction: Uterine fibroid is a serious public health problem affecting about 80% of women globally. Apart from adverse pregnancy outcomes, it affects quality of life of women. This thesis investigated uterine fibroids and obstetric outcomes among women living in Sub-Saharan Africa through a systematic review and meta-analysis. The study specifically, assessed the risk factors of uterine fibroids such as; age, parity menarche, body mass index and family history. It further assessed fibroid types, number of fibroids, fibroid location, and the maternal and foetal outcome of pregnancy among women with fibroid in Sub-Saharan Africa. Method: This study employed a systematic review to synthesize empirical evidence on uterine fibroid. Several relevant databases such as PubMed, Google Scholar, Lilacs, Cochrane Library, Hinari and African Journals online were searched for studies without language restriction. The search retrieved 909 articles electronically from the data bases and 6 articles from gray literature. Overall, 898 articles were screened for eligibility. In all, 18 articles met the eligibility criteria and were included in the review. Data were extracted using the Critical Appraisal Skills Programme form and Risk of bias assessment of the included studies was done using Hoy et al Risk of bias assessment tool for observational studies. A meta-analysis of the data was done using the Review manager software. Heterogeneity was assessed. Results: A total of 909 articles were retrieved, and 898 were screened for eligibility after duplicates were removed. Forty-two (42) full-text articles were assessed for eligibility; of which 18 were eligible for systematic review. Findings from the review has established that the prevalence of uterine fibroid is highest among women aged 30 – 39 years, 51.0% (95% CI: 47.0 – 56.0). Nulliparous women had the highest prevalence of fibroids, 50%(95% CI: 36.0 – 64.0). Intramural fibroids were the commonest type of fibroids seen among SSA women, 49.12%. However, fibroid sizes were poorly assessed. We have also found a statistically significant association between fibroids and postpartum haemorrhage (PPH), vaginal bleeding, Caesarean section (C/S), abdominal pain, placenta previa/abruptio, and low APGAR score as compared with women without uterine fibroids. However, the study has shown no significant association between UF and fetal malpresentation, miscarriage/abortion, preterm, intrauterine growth restriction (IUGR), premature rapture of membrane (PROM), stillbirth and low birth weight. Conclusion: Uterine fibroids are associated with adverse pregnancy outcomes such as antepartum haemorrhage, postpartum haemorrhage, increased caesarean section rate, low APGAR score and abdominal pain. However, the information included in this study are insufficient.