Clinical Profile and Surgical Management of Uterine Fibroids at Omdurman Maternity Hospital, Sudan: A Retrospective Study (July 2020 – February 2021)

Clinical Profile and Surgical Management of Uterine Fibroids at Omdurman Maternity Hospital, Sudan: A Retrospective Study (July 2020 – February 2021) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Profile and Surgical Management of Uterine Fibroids at Omdurman Maternity Hospital, Sudan: A Retrospective Study (July 2020 – February 2021) Talal Hashim A. Elhasan, Omer Ahmed Elrhima, Lamyaa El Hassan, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7547351/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: The study aimed to determine the anatomical location of uterine fibroids and describe the clinical characteristics of Sudanese women undergoing surgical intervention at Omdurman Maternity Hospital. Methods: A retrospective hospital-based study was carried out over a 7-month period from July 2020 to February 2021 including 73 cases of uterine fibroids, that had been surgically excised. Information regarding sociodemographic, clinical and anatomical location was extracted from hospital records and patient interviews. The data were analyzed using SPSS version 24 and expressed as frequencies and percentages. Results: The largest number of cases were in women aged 35-39 years comprising an overall percentage of 43.8%. The most common type was intramural fibroids (30.0%), followed by mixed subserosal and submucosal fibroids (25.8%). Posterior wall fibroid location was most common (30.1%) and defined as multiple wall involvement (34.3%). The number of cases presenting with heavy menstrual bleeding were the majority (62.0%), abdominal lump (23.0%) and pressure symptoms (12.0%). Conclusion: The results of predominantly intramural and posterior wall fibroids represent a pattern in the cohort of Sudanese women who presented with symptomatic disease requiring surgical intervention. Knowledge of distributions of fibroid anatomy can also enhance recognition for diagnosis and help in advance surgical planning in resource constrained contexts. uterine fibroids leiomyoma anatomical location posterior wall Sudan Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Uterine fibroids or uterine leiomyomas, the most common female reproductive system benign tumors, develop from the myometrial smooth muscle cells [1]. Fibroids are benign histologically but extremely diverse in size and quantity, varying from microscopic lesions to big palpable masses in excess of 7.5 cm [2]. Although few patients with Uterine fibroids will experience malignant transformation to leiomyosarcoma, the risk of transformation has been described as much less than 0.1% [2]. Although benign, Uterine fibroids will result in a significant morbidity attributed to, but not limited to, abnormal uterine bleeding, pelvic pain or pressure, urinary symptoms, infertility, and adverse pregnancy outcomes including recurrent miscarriage [3]. Uterine fibroids are not completely understood, largely because the causes are considered to be genetic, hormonal and environmental [4]. Furthermore, studies using epidemiological methods have reported a higher incidence rate of fibroids in women of African descent (as compared to Caucasian women), as well as an earlier diagnosis. Estimates indicate that by age 50, 80% of African-American women, and 70% of Caucasian women will have developed fibroids [5][6]. In Sudan Mahmoud et al. reported a prevalence of 21.2%, for women of reproductive age [11], which is also consistent with Navarro et al. study reporting a prevalence of 21.4% in non-pregnant, premenopausal women [8]. Factors such as lifestyle and reproductive history also inform fibroid risk. Nulliparity, early menarche, delayed first pregnancy, obesity, and diet, particularly high red meat consumption, are associated with increased risk of fibroid development, while parity and smoking are protective factors [9] [10] [11]. Additionally, to this, patterns of fibroid growth may differ by age and race; Peddada et al. noted differences in patterns of growth in their longitudinal MRI study and noted that in white women growth slowed with age, whereas it did not slow with age in adults and children. This underscores the effects of ethnicity and hormonal function, along with tumor biology, have addendum effects that are complex and vary as fibroids grow both in historical tissue morphology and behavior [15]. Due to the considerable clinical and public health burden of fibroids, especially among African populations where published data are limited, studies will need to be region specific. The current study looks to evaluate the clinical presentation, anatomical location, surgical management and perioperative morbidity of uterine fibroids in Sudanese women undergoing surgery at the Omdurman Maternity Hospital. This is an important area of study to better inform the clinical presentation of fibroids in women living in the region and support the development of diagnostic and therapeutic strategies for women with uterine fibroids in this region. Materials and Methods Study Design and Setting This retrospective cross-sectional study was set to take place in Omdurman Maternity Hospital, a tertiary care facility in the Omdurman Province- Sudan, between July 1st, 2020 and November 28th, 2021. The data were collected from the electronic medical records, and patient interviews were conducted where necessary. Study Population and Criteria The study population consisted of women diagnosed with uterine fibroids after being evaluated clinically as well as radiologically and received surgical intervention within the study period. Only cases with histopathological proven fibroids were included. Patients without confirmed diagnosis or not receiving surgery, as well as patients with incomplete or missing data were excluded. Ethical Considerations Ethical approval was obtained from the Sudan Medical Specialization Board Council of Obstetrics & Gynecology. Verbal informed consent was obtained from all participants after explaining to them the aim of the study, emphasizing that all the information will be treated confidentially, and their participation was voluntary. All data were anonymized and used for research purposes only. Data Collection A pretested, standardized data collection form was developed based on the study objectives. Information was obtained from medical records and, when necessary, from direct patient interviews. Data collection was carried out by the principal investigator, with trained registrars from the Department of Obstetrics and Gynecology assisting. Study Variables Sociodemographic characteristics (age, occupation, height, weight, and body mass index), clinical data (parity and presenting symptoms), and potential risk factors (age at menarche, family history, lifestyle factors) were all considered independent variables. Fibroid characteristics (number, type, size, and anatomical location), surgical procedure type (abdominal myomectomy, subtotal or total transabdominal hysterectomy, hysterectomy with bilateral salpingo-oophorectomy), intraoperative and postoperative complications, and duration of postoperative hospital stay were dependent variables. Statistical Analysis Data were entered and organized using Microsoft® Excel 2023 (Microsoft Corporation, Redmond, WA, USA) and analyzed with IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as frequencies and percentages with 95% confidence intervals. Inferential statistics were applied as appropriate, with a p-value of <0.05 considered statistically significant. Results Demographic and Reproductive Characteristics There were a total of 73 women, all had histologically verified uterine fibroids and underwent treatment. The age group with the largest number of women was 35–39 years (43.8%), followed by 40–44 years (52.1%). Only 4.1% were aged ≥45 years (Figure 1, Table 1). Unemployed women comprised the majority, with more than half (57.5%). Overall, the majority of women were nulliparous (70.0%), while 27.4% were multiparous and 1.4% were grand multiparous (Table 1). Clinical Presentation Heavy menstrual bleeding (61.4%) was the most common presenting symptom in participants. Abdominal mass/distension were the second most reporting symptom (23.3%), while pressure symptoms accounted for 12.3%, and infertility accounted for 3.0% (Figure 2, Table 2). Fibroid Characteristics The location of posterior wall fibroids was the most documented position in participant's medical records (30.1%) (Figure 3, Table 3). Fibroid size, number, and exact site varied significantly, although often there was no agreement within the medical record in documenting these criteria. Surgical Management The surgical management was generally trans-abdominal myomectomy, in 91.8% of cases. Hysteroscopic myomectomy was performed in only 2.7% of cases, subtotal/total abdominal hysterectomy was performed in 4.1% of cases, and total hysterectomy with bilateral salpingo-oophorectomy was performed in 1.4% of cases (Figure 4, Table 4). Blood Transfusion Requirements Most of the women (90.4%) did not require blood transfusion. Blood transfusion of 1–4 units was required in 4.1% of the cases, while 5.5% of women required >4 units transfusion, intraoperatively or post operatively (Figure 5, Table 5). Postoperative Complications and Hospital Stay Most patients (89.0%) had no complications after surgery. Bleeding occurred in 5.5% of cases, wound infection in 1.4%, and hypotension in 1.4% (Figure 6, Table 6). Hospital stay was <6 days in 61.6% of patients, whereas 37.9% remained hospitalized for ≥6 days (Table 6). Discussion This investigation assessed the clinical presentation, surgical treatment, and outcome in between 73 women with uterine fibroids treated surgically in Omdurman Maternity Hospital from July 2020 to February 2021. The most common presenting symptom was heavy menstrual bleeding (heavy) (61.4%), followed by abdominal mass (23.3%), pressure symptom (12.3%) and in infertility (3.0 %). These rates are comparable to Akhter et al., (which reported menstrual abnormalities in 74 % and abdominal masses in 40% of cases [1]). By contrast, Gavli et al. documented a higher infertility rate (23.5%) [9], likely reflecting differences in population characteristics, race, and ethnicity. Most patients were aged 35–39 years (43.8%) and nulliparous (70.0%), similar to reports from Nigeria [7] and Bangladesh [1]. This pattern supports the well-established association between uterine fibroids and later reproductive age, with higher prevalence among women of African descent [3] [5] [8] . Trans-abdominal myomectomy was the predominant surgical procedure (91.8%), consistent with findings from Ezeama et al. (90.3%) [7]. Surgical choice depended on patient age, fertility goals, and fibroid characteristics Because of insufficient resources, minimally invasive techniques such as laparoscopic myomectomy or uterine artery embolization were not available [13] [14]. The most common complication was intraoperative hemorrhage (15.1% of cases), followed by postoperative hypotension (2.7% of cases), and wound infection (1.4% of cases). These rates are lower than those of Ezeama et al. [7], possibly due to surgical skills, patient preparations, or reporting of complications. Blood transfusions were required in 8.2% of cases, most often exceeding four units. The majority of patients (87.7%) were discharged within three days, consistent with reports from Bushaqer et al. [4]. The limitations of this study were mostly related to sample size, as a result of COVID-19 implementation changes for elective surgery. In conclusion, this study has highlighted the significant burden of symptomatic uterine fibroids in women in Sudan, the reliance on open surgical management, and lack of minimally invasive or fertility preservation options. Access to advanced surgical techniques can improve patient outcomes in a resource limited area. Conclusion Uterine fibroids continue to be a major gynecological problem in Sudanese women, as they most often present with heavy menstrual bleeding and abdominal mass. Surgical treatment (trans-abdominal myomectomy) was the acceptable management, as the complication rates were low, most women had a short hospital stay, and the same can be applied in similar low-resource area. Additionally, it is also important to address how we can increase the availability of minimally invasive and fertility-sparing procedures for women and to encourage the conduct of multicenter studies to improve management, especially in similar low-resource areas. Declarations Acknowledgement The authors sincerely thank the staff and administration of Omdurman Maternity Hospital, Sudan, for their support and assistance during this study, particularly in facilitating access to clinical data and patient records. Conflict of Interest The authors declare no conflict of interest. Funding No external funding was received for this study. Availability of data and material Available upon reasonable request from the corresponding author. Authors’ contributions M.E. conceived and designed the study, supervised data collection, and drafted the initial manuscript. T.M 1 ., O.E., L.E., N.A., A.E., T.M 3 . contributed to data collection, patient interviews, and database management. M.E. performed the statistical analysis and assisted in interpretation of the results. T.M 1 . O.E., I.A. contributed to literature review, manuscript editing, and critical revisions for intellectual content. All authors read and approved the final version of the manuscript. References Akhter N, Sultana R, Rahman M. Clinical profile and management option of fibroid uterus patient. CMOSH Med J. 2015;14(2):12–5. Available from: https://www.banglajol.info/index.php/CMOSHMCJ/article/view/25717/17244 Gavli M, Patel HR, Anand N, Patel R. A retrospective study on sociodemographic and clinical profile of patients underwent for myomectomy. Int J Health Sci Res. 2015;5(2):106–10. https://doi.org/10.52403/ijhsr Bulun SE. Uterine fibroids. N Engl J Med. 2013;369(14):1344–55. https://doi.org/10.1056/NEJMra1209993 Bushaqer NT, Al-Ansari AA, Al-Bahrani BJ. Intra and postoperative morbidity associated with myomectomy. Bahrain Med Bull. 2016;38(4):1–5. Available from: https://www.bahrainmedicalbulletin.com/December_2016/INTRA_DECEMBER%202016.pdf Buttram VC, Reiter RC. Uterine leiomyomata: Etiology, symptomatology, and management. Fertil Steril. 1981;36(4):433–45. https://doi.org/10.1016/S0015-0282(16)45673-6 Faerstein E, Szklo M, Rosenshein NB. Risk factors for uterine leiomyoma: A practice-based case-control study. I. African-American heritage, reproductive history, body size, and smoking. Am J Epidemiol. 2001;153(1):1–10. https://doi.org/10.1093/aje/153.1.1 Ezeama CO, Ikechebelu JI, Obiechina NJA, Ezeama NN. Clinical presentation of uterine fibroids in Nnewi, Nigeria: A 5-year review. Niger J Med. 2012;21(3):317–21. PMID: 23440007 Stewart EA. Uterine fibroids. Lancet. 2001;357(9252):293–8. https://doi.org/10.1016/S0140-6736(00)03622-9 Chiaffarino F, Parazzini F, La Vecchia C, Chatenoud L, Di Cintio E, Marsico S. Diet and uterine myomas. Obstet Gynecol. 1999;94(3):395–8. https://doi.org/10.1016/S0029-7844(99)00305-1 Laughlin SK, Stewart EA. Uterine leiomyomas: Individualizing the approach to a heterogeneous condition. Obstet Gynecol. 2011;117(2 Pt 1):396–403. https://doi.org/10.1097/AOG.0b013e31820780e3 Mahmoud MZ, Omer A, Adam M, Musa M, Babikir E, Sulieman A. P30.02: Study of uterine fibroids incidence in Sudan. Ultrasound Obstet Gynecol. 2014;44(S1):358–8. https://doi.org/10.1002/uog.14574 Marshall LM, Spiegelman D, Manson JE, Goldman MB, Barbieri RL, Stampfer MJ, et al. Risk of uterine leiomyomata among premenopausal women in relation to body size and cigarette smoking. Epidemiology. 1997;8(6):592–7. https://doi.org/10.1097/00001648-199809000-00007 Navarro A, Bariani MV, Yang Q, Al-Hendy A. Understanding the impact of uterine fibroids on human endometrium function. Front Cell Dev Biol. 2021;9:633180. https://doi.org/10.3389/fcell.2021.633180 Parker WH, Fu YS, Berek JS, Hackett RA. Uterine fibroids. In: Berek JS, editor. Berek & Novak’s gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 471–500. Peddada SD, Laughlin SK, Miner K, Guyon JP, Haneke K, Vahdat HL, et al. Growth of uterine leiomyomata among premenopausal Black and White women. Proc Natl Acad Sci U S A. 2008;105(50):19887–92. https://doi.org/10.1073/pnas.0808188105 Tables Table 1. Demographic and reproductive characteristics of women with surgically managed uterine fibroids (n = 73) Characteristic Frequency (n) Percentage (%) Age Group (years) 35–39 32 43.8 40–44 38 52.1 ≥45 3 4.1 Employment Status Not employed 42 57.5 Employed 31 42.5 Parity Nulliparous 51 70.0 Multiparous 20 27.4 Grand multiparous 1 1.4 Unknown 1 1.4 Table 2. Clinical presentation of uterine fibroid cases (n = 73) Presenting Symptom Frequency (n) Percentage (%) Heavy menstrual bleeding 45 61.4 Abdominal mass 17 23.3 Pressure symptoms 9 12.3 Infertility 2 3.0 Table 3. Location of fibroids (n = 73) Location Frequency (n) Percentage (%) Posterior wall 22 30.1 Other/unspecified locations 51 69.9 Table 4. Surgical procedures performed for uterine fibroids (n = 73) Type of surgery Frequency (n) Percentage (%) Trans-abdominal myomectomy 67 91.8 Hysteroscopic myomectomy 2 2.7 Subtotal/total abdominal hysterectomy 3 4.1 Total hysterectomy with bilateral salpingo-oophorectomy 1 1.4 Table 5. Blood transfusion requirements among patients (n = 73) Blood transfusion Frequency (n) Percentage (%) No transfusion 66 90.4 1–4 units 3 4.1 >4 units 4 5.5 Table 6. Postoperative complications and length of hospital stay (n = 73) Postoperative complications Frequency (n) Percentage (%) No complications 65 89.0 Bleeding 4 5.5 Wound infection 1 1.4 Hypotension 1 1.4 Hospital stay after surgery Frequency (n) Percentage (%) <6 days 45 61.6 ≥6 days 28 37.9 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7547351","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":514767367,"identity":"a49164fd-0459-4ea5-9d3b-d9c32d6cd46e","order_by":0,"name":"Talal Hashim A. 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22:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7547351/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7547351/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91515870,"identity":"aafd1e82-13bd-4688-a4e2-965abfe952f3","added_by":"auto","created_at":"2025-09-17 09:19:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19666,"visible":true,"origin":"","legend":"\u003cp\u003eAge distribution of women with uterine fibroids\u003c/p\u003e\n\u003cp\u003ePie chart showing the proportion of cases across different age groups, with the highest frequency in the 35–39 years group.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7547351/v1/00ff5a515e8dacf22051f191.png"},{"id":91515871,"identity":"f9752ff7-3770-4438-903b-4cb6db52a622","added_by":"auto","created_at":"2025-09-17 09:19:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32569,"visible":true,"origin":"","legend":"\u003cp\u003eThe clinical presentation of Uterine Fibroids\u003c/p\u003e\n\u003cp\u003eDistribution of symptoms reported by participants, including heavy menstrual bleeding, abdominal lump, pressure symptoms, and infertility\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7547351/v1/a4a9ea06eba500a3d82e8c15.png"},{"id":91515872,"identity":"369ca51e-6d25-49b4-8927-4a7ede86e68c","added_by":"auto","created_at":"2025-09-17 09:19:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":23679,"visible":true,"origin":"","legend":"\u003cp\u003eLocation of uterine fibroids among study participants\u003c/p\u003e\n\u003cp\u003eDistribution of fibroid types by uterine wall involvement, highlighting posterior wall predominance.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7547351/v1/788d5b7dd29f656f36529f68.png"},{"id":91514956,"identity":"a23cfa3e-5742-49c0-aef8-9e067dd8c8a4","added_by":"auto","created_at":"2025-09-17 09:11:14","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":31962,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical procedures performed\u003c/p\u003e\n\u003cp\u003eProportion of different surgical interventions for uterine fibroids, including abdominal myomectomy, subtotal hysterectomy, and total abdominal hysterectomy.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7547351/v1/b128008564a0ec6a7e29376c.png"},{"id":91515874,"identity":"b96d746a-6952-4353-9c51-03cb2189749a","added_by":"auto","created_at":"2025-09-17 09:19:14","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":22667,"visible":true,"origin":"","legend":"\u003cp\u003eBlood transfusion requirements\u003c/p\u003e\n\u003cp\u003eFrequency and distribution of units of blood transfused intraoperatively and postoperatively.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7547351/v1/e00171eb1306a286b62b6d96.png"},{"id":91514960,"identity":"ebb54d0c-2589-4421-913a-53940c4fb599","added_by":"auto","created_at":"2025-09-17 09:11:14","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":22645,"visible":true,"origin":"","legend":"\u003cp\u003eThe postoperative complications\u003c/p\u003e\n\u003cp\u003eDistribution of specific complications observed following surgical management of uterine fibroids.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7547351/v1/84442a191be6e5b36d152e8c.png"},{"id":91517391,"identity":"48543e14-47e6-453d-8ba4-64dd14c0ca3e","added_by":"auto","created_at":"2025-09-17 09:35:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":922462,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7547351/v1/230de73c-4919-4ec1-b9eb-121caca50261.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Profile and Surgical Management of Uterine Fibroids at Omdurman Maternity Hospital, Sudan: A Retrospective Study (July 2020 – February 2021)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUterine fibroids or uterine leiomyomas, the most common female reproductive system benign tumors, develop from the myometrial smooth muscle cells [1]. Fibroids are benign histologically but extremely diverse in size and quantity, varying from microscopic lesions to big palpable masses in excess of 7.5 cm [2]. Although few patients with Uterine fibroids will experience malignant transformation to leiomyosarcoma, the risk of transformation has been described as much less than 0.1% [2]. Although benign, Uterine fibroids will result in a significant morbidity attributed to, but not limited to, abnormal uterine bleeding, pelvic pain or pressure, urinary symptoms, infertility, and adverse pregnancy outcomes including recurrent miscarriage [3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUterine fibroids are not completely understood, largely because the causes are considered to be genetic, hormonal and environmental [4]. Furthermore, studies using epidemiological methods have reported a higher incidence rate of fibroids in women of African descent (as compared to Caucasian women), as well as an earlier diagnosis. Estimates indicate that by age 50, 80% of African-American women, and 70% of Caucasian women will have developed fibroids [5][6]. In Sudan Mahmoud et al. reported a prevalence of 21.2%, for women of reproductive age [11], which is also consistent with Navarro et al. study reporting a prevalence of 21.4% in non-pregnant, premenopausal women [8].\u003c/p\u003e\n\u003cp\u003eFactors such as lifestyle and reproductive history also inform fibroid risk. Nulliparity, early menarche, delayed first pregnancy, obesity, and diet, particularly high red meat consumption, are associated with increased risk of fibroid development, while parity and smoking are protective factors [9] [10] [11]. Additionally, to this, patterns of fibroid growth may differ by age and race; Peddada et al. noted differences in patterns of growth in their longitudinal MRI study and noted that in white women growth slowed with age, whereas it did not slow with age in adults and children. This underscores the effects of ethnicity and hormonal function, along with tumor biology, have addendum effects that are complex and vary as fibroids grow both in historical tissue morphology and behavior [15].\u003c/p\u003e\n\u003cp\u003eDue to the considerable clinical and public health burden of fibroids, especially among African populations where published data are limited, studies will need to be region specific. The current study looks to evaluate the clinical presentation, anatomical location, surgical management and perioperative morbidity of uterine fibroids in Sudanese women undergoing surgery at the Omdurman Maternity Hospital. This is an important area of study to better inform the clinical presentation of fibroids in women living in the region and support the development of diagnostic and therapeutic strategies for women with uterine fibroids in this region.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cross-sectional study was set to take place in Omdurman Maternity Hospital, a tertiary care facility in the Omdurman Province- Sudan, between July 1st, 2020 and November 28th, 2021. The data were collected from the electronic medical records, and patient interviews were conducted where necessary.\u003c/p\u003e\n\u003cp\u003eStudy Population and Criteria\u003c/p\u003e\n\u003cp\u003eThe study population consisted of women diagnosed with uterine fibroids after being evaluated clinically as well as radiologically and received surgical intervention within the study period. Only cases with histopathological proven fibroids were included. Patients without confirmed diagnosis or not receiving surgery, as well as patients with incomplete or missing data were excluded.\u003c/p\u003e\n\u003cp\u003eEthical Considerations\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Sudan Medical Specialization Board Council of Obstetrics \u0026amp; Gynecology. Verbal informed consent was obtained from all participants after explaining to them the aim of the study, emphasizing that all the information will be treated confidentially, and their participation was voluntary. All data were anonymized and used for research purposes only.\u003c/p\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eA pretested, standardized data collection form was developed based on the study objectives. Information was obtained from medical records and, when necessary, from direct patient interviews. Data collection was carried out by the principal investigator, with trained registrars from the Department of Obstetrics and Gynecology assisting.\u003c/p\u003e\n\u003cp\u003eStudy Variables\u003c/p\u003e\n\u003cp\u003eSociodemographic characteristics (age, occupation, height, weight, and body mass index), clinical data (parity and presenting symptoms), and potential risk factors (age at menarche, family history, lifestyle factors) were all considered independent variables. Fibroid characteristics (number, type, size, and anatomical location), surgical procedure type (abdominal myomectomy, subtotal or total transabdominal hysterectomy, hysterectomy with bilateral salpingo-oophorectomy), intraoperative and postoperative complications, and duration of postoperative hospital stay were dependent variables.\u003c/p\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eData were entered and organized using Microsoft® Excel 2023 (Microsoft Corporation, Redmond, WA, USA) and analyzed with IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as frequencies and percentages with 95% confidence intervals. Inferential statistics were applied as appropriate, with a p-value of \u0026lt;0.05 considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic and Reproductive Characteristics\u003c/p\u003e\n\u003cp\u003eThere were a total of 73 women, all had histologically verified uterine fibroids and underwent treatment. The age group with the largest number of women was 35\u0026ndash;39 years (43.8%), followed by 40\u0026ndash;44 years (52.1%). Only 4.1% were aged \u0026ge;45 years (Figure 1, Table 1). Unemployed women comprised the majority, with more than half (57.5%). Overall, the majority of women were nulliparous (70.0%), while 27.4% were multiparous and 1.4% were grand multiparous (Table 1).\u003c/p\u003e\n\u003cp\u003eClinical Presentation\u003c/p\u003e\n\u003cp\u003eHeavy menstrual bleeding (61.4%) was the most common presenting symptom in participants. Abdominal mass/distension were the second most reporting symptom (23.3%), while pressure symptoms accounted for 12.3%, and infertility accounted for 3.0% (Figure 2, Table 2).\u003c/p\u003e\n\u003cp\u003eFibroid Characteristics\u003c/p\u003e\n\u003cp\u003eThe location of posterior wall fibroids was the most documented position in participant\u0026apos;s medical records (30.1%) (Figure 3, Table 3). Fibroid size, number, and exact site varied significantly, although often there was no agreement within the medical record in documenting these criteria.\u003c/p\u003e\n\u003cp\u003eSurgical Management\u003c/p\u003e\n\u003cp\u003eThe surgical management was generally trans-abdominal myomectomy, in 91.8% of cases. Hysteroscopic myomectomy was performed in only 2.7% of cases, subtotal/total abdominal hysterectomy was performed in 4.1% of cases, and total hysterectomy with bilateral salpingo-oophorectomy was performed in 1.4% of cases (Figure 4, Table 4).\u003c/p\u003e\n\u003cp\u003eBlood Transfusion Requirements\u003c/p\u003e\n\u003cp\u003eMost of the women (90.4%) did not require blood transfusion. Blood transfusion of 1\u0026ndash;4 units was required in 4.1% of the cases, while 5.5% of women required \u0026gt;4 units transfusion, intraoperatively or post operatively (Figure 5, Table 5).\u003c/p\u003e\n\u003cp\u003ePostoperative Complications and Hospital Stay\u003c/p\u003e\n\u003cp\u003eMost patients (89.0%) had no complications after surgery. Bleeding occurred in 5.5% of cases, wound infection in 1.4%, and hypotension in 1.4% (Figure 6, Table 6). Hospital stay was \u0026lt;6 days in 61.6% of patients, whereas 37.9% remained hospitalized for \u0026ge;6 days (Table 6).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis investigation assessed the clinical presentation, surgical treatment, and outcome in between 73 women with uterine fibroids treated surgically in Omdurman Maternity Hospital from July 2020 to February 2021. The most common presenting symptom was heavy menstrual bleeding (heavy) (61.4%), followed by abdominal mass (23.3%), pressure symptom (12.3%) and in infertility (3.0 %). These rates are comparable to Akhter et al., (which reported menstrual abnormalities in 74 % and abdominal masses in 40% of cases [1]). By contrast, Gavli et al. documented a higher infertility rate (23.5%) [9], likely reflecting differences in population characteristics, race, and ethnicity.\u003c/p\u003e\n\u003cp\u003eMost patients were aged 35\u0026ndash;39 years (43.8%) and nulliparous (70.0%), similar to reports from Nigeria [7] and Bangladesh [1]. This pattern supports the well-established association between uterine fibroids and later reproductive age, with higher prevalence among women of African descent [3] [5] [8]\u003csup\u003e.\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eTrans-abdominal myomectomy was the predominant surgical procedure (91.8%), consistent with findings from Ezeama et al. (90.3%) [7]. Surgical choice depended on patient age, fertility goals, and fibroid characteristics Because of insufficient resources, minimally invasive techniques such as laparoscopic myomectomy or uterine artery embolization were not available [13] [14].\u003c/p\u003e\n\u003cp\u003eThe most common complication was intraoperative hemorrhage (15.1% of cases), followed by postoperative hypotension (2.7% of cases), and wound infection (1.4% of cases). These rates are lower than those of Ezeama et al. [7], possibly due to surgical skills, patient preparations, or reporting of complications. Blood transfusions were required in 8.2% of cases, most often exceeding four units. The majority of patients (87.7%) were discharged within three days, consistent with reports from Bushaqer et al. [4].\u003c/p\u003e\n\u003cp\u003eThe limitations of this study were mostly related to sample size, as a result of COVID-19 implementation changes for elective surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, this study has highlighted the significant burden of symptomatic uterine fibroids in women in Sudan, the reliance on open surgical management, and lack of minimally invasive or fertility preservation options. Access to advanced surgical techniques can improve patient outcomes in a resource limited area.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUterine fibroids continue to be a major gynecological problem in Sudanese women, as they most often present with heavy menstrual bleeding and abdominal mass. Surgical treatment (trans-abdominal myomectomy) was the acceptable management, as the complication rates were low, most women had a short hospital stay, and the same can be applied in similar low-resource area. Additionally, it is also important to address how we can increase the availability of minimally invasive and fertility-sparing procedures for women and to encourage the conduct of multicenter studies to improve management, especially in similar low-resource areas.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank the staff and administration of Omdurman Maternity Hospital, Sudan, for their support and assistance during this study, particularly in facilitating access to clinical data and patient records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;No external funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003cbr\u003eM.E. conceived and designed the study, supervised data collection, and drafted the initial manuscript. T.M\u003csup\u003e1\u003c/sup\u003e., O.E., \u0026nbsp; L.E., N.A., A.E., T.M\u003csup\u003e3\u003c/sup\u003e. \u0026nbsp; contributed to data collection, patient interviews, and database management. M.E. performed the statistical analysis and assisted in interpretation of the results. T.M\u003csup\u003e1\u003c/sup\u003e. O.E., I.A. \u0026nbsp;contributed to literature review, manuscript editing, and critical revisions for intellectual content. All authors read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAkhter N, Sultana R, Rahman M. Clinical profile and management option of fibroid uterus patient. CMOSH Med J. 2015;14(2):12\u0026ndash;5. Available from: https://www.banglajol.info/index.php/CMOSHMCJ/article/view/25717/17244\u003c/li\u003e\n\u003cli\u003eGavli M, Patel HR, Anand N, Patel R. A retrospective study on sociodemographic and clinical profile of patients underwent for myomectomy. Int J Health Sci Res. 2015;5(2):106\u0026ndash;10. https://doi.org/10.52403/ijhsr\u003c/li\u003e\n\u003cli\u003eBulun SE. Uterine fibroids. N Engl J Med. 2013;369(14):1344\u0026ndash;55. https://doi.org/10.1056/NEJMra1209993\u003c/li\u003e\n\u003cli\u003eBushaqer NT, Al-Ansari AA, Al-Bahrani BJ. Intra and postoperative morbidity associated with myomectomy. Bahrain Med Bull. 2016;38(4):1\u0026ndash;5. Available from: https://www.bahrainmedicalbulletin.com/December_2016/INTRA_DECEMBER%202016.pdf\u003c/li\u003e\n\u003cli\u003eButtram VC, Reiter RC. Uterine leiomyomata: Etiology, symptomatology, and management. Fertil Steril. 1981;36(4):433\u0026ndash;45. https://doi.org/10.1016/S0015-0282(16)45673-6\u003c/li\u003e\n\u003cli\u003eFaerstein E, Szklo M, Rosenshein NB. Risk factors for uterine leiomyoma: A practice-based case-control study. I. African-American heritage, reproductive history, body size, and smoking. Am J Epidemiol. 2001;153(1):1\u0026ndash;10. https://doi.org/10.1093/aje/153.1.1\u003c/li\u003e\n\u003cli\u003eEzeama CO, Ikechebelu JI, Obiechina NJA, Ezeama NN. Clinical presentation of uterine fibroids in Nnewi, Nigeria: A 5-year review. Niger J Med. 2012;21(3):317\u0026ndash;21. PMID: 23440007\u003c/li\u003e\n\u003cli\u003eStewart EA. Uterine fibroids. Lancet. 2001;357(9252):293\u0026ndash;8. https://doi.org/10.1016/S0140-6736(00)03622-9\u003c/li\u003e\n\u003cli\u003eChiaffarino F, Parazzini F, La Vecchia C, Chatenoud L, Di Cintio E, Marsico S. Diet and uterine myomas. Obstet Gynecol. 1999;94(3):395\u0026ndash;8. https://doi.org/10.1016/S0029-7844(99)00305-1\u003c/li\u003e\n\u003cli\u003eLaughlin SK, Stewart EA. Uterine leiomyomas: Individualizing the approach to a heterogeneous condition. Obstet Gynecol. 2011;117(2 Pt 1):396\u0026ndash;403. https://doi.org/10.1097/AOG.0b013e31820780e3\u003c/li\u003e\n\u003cli\u003eMahmoud MZ, Omer A, Adam M, Musa M, Babikir E, Sulieman A. P30.02: Study of uterine fibroids incidence in Sudan. Ultrasound Obstet Gynecol. 2014;44(S1):358\u0026ndash;8. https://doi.org/10.1002/uog.14574\u003c/li\u003e\n\u003cli\u003eMarshall LM, Spiegelman D, Manson JE, Goldman MB, Barbieri RL, Stampfer MJ, et al. Risk of uterine leiomyomata among premenopausal women in relation to body size and cigarette smoking. Epidemiology. 1997;8(6):592\u0026ndash;7. https://doi.org/10.1097/00001648-199809000-00007\u003c/li\u003e\n\u003cli\u003eNavarro A, Bariani MV, Yang Q, Al-Hendy A. Understanding the impact of uterine fibroids on human endometrium function. Front Cell Dev Biol. 2021;9:633180. https://doi.org/10.3389/fcell.2021.633180\u003c/li\u003e\n\u003cli\u003eParker WH, Fu YS, Berek JS, Hackett RA. Uterine fibroids. In: Berek JS, editor. Berek \u0026amp; Novak\u0026rsquo;s gynecology. 14th ed. Philadelphia: Lippincott Williams \u0026amp; Wilkins; 2007. p. 471\u0026ndash;500.\u003c/li\u003e\n\u003cli\u003ePeddada SD, Laughlin SK, Miner K, Guyon JP, Haneke K, Vahdat HL, et al. Growth of uterine leiomyomata among premenopausal Black and White women. Proc Natl Acad Sci U S A. 2008;105(50):19887\u0026ndash;92. https://doi.org/10.1073/pnas.0808188105\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Demographic and reproductive characteristics of women with surgically managed uterine fibroids (n = 73)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003e35\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003e40\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e52.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003e\u0026ge;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003eNot employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e57.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e42.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003eGrand multiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.2353%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.4118%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3529%;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Clinical presentation of uterine fibroid cases (n = 73)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"474\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresenting Symptom\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHeavy menstrual bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbdominal mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePressure symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInfertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Location of fibroids (n = 73)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePosterior wall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther/unspecified locations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e69.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Surgical procedures performed for uterine fibroids (n = 73)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrans-abdominal myomectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e91.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHysteroscopic myomectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtotal/total abdominal hysterectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal hysterectomy with bilateral salpingo-oophorectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Blood transfusion requirements among patients\u0026nbsp;(n = 73)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood transfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo transfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e90.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u0026ndash;4 units\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;4 units\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u003c/strong\u003e Postoperative complications and length of hospital stay\u0026nbsp;(n = 73)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e89.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWound infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypotension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay after surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;6 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e61.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;6 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e37.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"uterine fibroids, leiomyoma, anatomical location, posterior wall, Sudan","lastPublishedDoi":"10.21203/rs.3.rs-7547351/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7547351/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThe study aimed to determine the anatomical location of uterine fibroids and describe the clinical characteristics of Sudanese women undergoing surgical intervention at Omdurman Maternity Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA retrospective hospital-based study was carried out over a 7-month period from July 2020 to February 2021 including 73 cases of uterine fibroids, that had been surgically excised. Information regarding sociodemographic, clinical and anatomical location was extracted from hospital records and patient interviews. The data were analyzed using SPSS version 24 and expressed as frequencies and percentages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe largest number of cases were in women aged 35-39 years comprising an overall percentage of 43.8%. The most common type was intramural fibroids (30.0%), followed by mixed subserosal and submucosal fibroids (25.8%). Posterior wall fibroid location was most common (30.1%) and defined as multiple wall involvement (34.3%). The number of cases presenting with heavy menstrual bleeding were the majority (62.0%), abdominal lump (23.0%) and pressure symptoms (12.0%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe results of predominantly intramural and posterior wall fibroids represent a pattern in the cohort of Sudanese women who presented with symptomatic disease requiring surgical intervention. Knowledge of distributions of fibroid anatomy can also enhance recognition for diagnosis and help in advance surgical planning in resource constrained contexts.\u003c/p\u003e","manuscriptTitle":"Clinical Profile and Surgical Management of Uterine Fibroids at Omdurman Maternity Hospital, Sudan: A Retrospective Study (July 2020 – February 2021)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 09:11:10","doi":"10.21203/rs.3.rs-7547351/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7420dc1a-400b-4b2b-aed5-cd0de46a2c62","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T09:08:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 09:11:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7547351","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7547351","identity":"rs-7547351","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}