Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis

Abstract

Background To evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy. Methods Retrospective cohort study including all women with a history of myomectomy (operated group) or uterine myomas during pregnancy (unoperated group) who delivered in a tertiary center between January, 2011 and December, 2017. The operated group included women who had a myomectomy history with or without myomas during the ongoing pregnancy. The unoperated group included women with uterine myoma(s) seen on at least one ultrasound during pregnancy without history of myomectomy. The primary outcome was preterm birth < 37 weeks, and the secondary outcome spontaneous preterm birth < 37 weeks. To control for confounding factors, a propensity score approach was used. Two sensitivity analysis were performed, one repeating the analysis using the propensity score after excluding operated women with persistent myomas and one using a classical multivariable logistic regression model. Results The cohort included 576 women: 283 operated women and 293 unoperated women. The rate of preterm birth was similar in the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). No difference in preterm birth risk was shown between unoperated and operated women in the cohort matched on the propensity score: OR 0.86; 95%CI [0.47–1.59]. These results were consistent for spontaneous preterm birth (OR 1.61; 95%CI [0.61–4.23]) and for the sensitivity analyses. Conclusion In women with a leiomyomatous uterus, a history of myomectomy is not associated with a reduced preterm birth risk.

Impact of myomectomy on the obstetric complications: A large cohort study in Japan

“…However, a planned cesarean section due to a history of myomectomy may have resulted in an earlier gestational age at delivery compared with vaginal delivery. Furthermore, similar to this study, Rault et al reported that a history of myomectomy does not increase the risk of preterm birth 5 …”

“…Furthermore, similar to this study, Rault et al reported that a history of myomectomy does not increase the risk of preterm birth. 5 There are several reports of uterine rupture and myomectomy during pregnancy. In a single-center cohort study, Tinelli et al analyzed 270 myomectomy cases and reported that myomectomy was a risk factor for uterine rupture.…”

Clinicopathological features and prognostic factors for uterine myoma

“…However, although myomectomy has achieved some clinical efficacy, patient prognosis following this procedure still varies. 9,10 This shift in clinical intervention policy has also highlighted the importance of early diagnosis using a combination of clinical manifestation information and imaging examinations. 11,12 This study showed that age equal to or greater than 60 was a risk factor affecting uterine myoma prognosis.…”

Unraveling the Efficacy of Therapeutic Interventions for Short Cervix: Insights from a Retrospective Study for Improved Clinical Management

“…Preterm birth has also been linked to placental, uterine, or fetal abnormalities such as placental abruption, placenta previa, polyhydramnios, uterine malformations, uterine fibromas, and fetal structural or chromosomal defects [20][21][22][23]. There is a lack of agreement over whether prior uterine surgery (curettage, hysteroscopy, myomectomy, and multiple previous cesarean surgeries) increases the risk of preterm birth or not, and although systematic reviews have found only modest associations, they were unable to account for all possible confounders [24][25][26][27].…”