Perinatal outcomes of women undergoing cesarean delivery after prior myomectomy

Gimovsky, Alexis C.; Frangieh, Michael; Phillips, Jaclyn; Vargas, Maria V.; Quinlan, Scott; Macri, Charles J.; Ahmadzia, Homa K.

doi:10.1080/14767058.2018.1542680

“…In a previous comparison study about delivery outcomes between pregnancies following myomectomy and myoma-complicated pregnancies, the latter showed better outcomes, including fewer cesarean sections, preterm births, and less blood loss, than outcomes of pregnancies after myomectomy, which were similar to the results of this study 21 A recent retrospective cohort study 23 revealed that women with a history of myomectomy were associated with increased risks of intraoperative transfusion, bowel injury, and a cesarean hysterectomy.…”

Section: Discussionsupporting

confidence: 87%

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

Lee

¹

,

Ko²,

Na

³

et al. 2020

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Background: Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.Methods: We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis.Results: During the study period, 38,402 women with diagnosed myoma(s), 9,890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16 and aOR 7.46, 95% CI 6.97-7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54 and aOR 1.58, 95% CI 1.35-1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5-25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18-105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy. Conclusions: Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.

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“…A recent study of Gimovsky included 34,002 women of which 367 had a prior myomectomy versus 33,635 controls. The rate of intraoperative transfusion in the prior myomectomy group was 1.4% vs. 0.4% (131/33,635) in the control group [21].…”

Section: Pregnancy Plannermentioning

confidence: 82%

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2023

Int J Women’s Health Care

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Endometriosis is defined as the presence of endometrial glands or stroma outside the uterus, commonly diagnosed in women of childbearing age frequently with subfertility. Endometriosis is associated with the presence of uterine fibroids, which are benign tumors of the smooth muscle cells of the uterus, in 20-25% of cases. It is unclear whether fibroids interfere with fertility and pregnancy. The association of the two pathologies makes us ask the question of which is the best therapy to use. Sometimes medical therapy is not effective or has contraindications, surgery can be burdened with secondary effects that can impair fertility. In recent years, new techniques have been introduced to integrate conventional therapies, which involve the use of different forms of energy. Among these energies, an important place is occupied by microwaves (MW). MW creates an electromagnetic field that transforms kinetic energy into heat that induces cell death by coagulation necrosis. We have chosen to use MW thermal ablation to treat fibroids during laparoscopic surgery for endometriosis due to the fact that laparoscopic removal of myomas significantly lengthens the surgical time and increases possible complications.

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“…In a previous comparison study about delivery outcomes between pregnancies following myomectomy and myoma-complicated pregnancies, the latter showed better outcomes, including fewer cesarean sections, preterm births, and less blood loss, than outcomes of pregnancies after myomectomy, which were similar to the results of this study. 22 A recent retrospective cohort study 23 revealed that women with a history of myomectomy were associated with increased risks of intraoperative transfusion, bowel injury, and a cesarean hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

Lee

¹

,

Ko²,

Na

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.Methods: We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis.Results: During the study period, 38,402 women with diagnosed myoma(s), 9,890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16 and aOR 7.46, 95% CI 6.97-7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54 and aOR 1.58, 95% CI 1.35-1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5-25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18-105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy. Conclusions: Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.

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Perinatal outcomes of women undergoing cesarean delivery after prior myomectomy

Cited by 13 publications

References 24 publications

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

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Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

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