Pregnancy outcomes following different surgical approaches of myomectomy

Tian, Yonglu; Long, Tengfei; Dai, Yinmei

doi:10.1111/jog.12532

Cited by 55 publications

(40 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In terms of safety during pregnancy, we found that the incidence rate of pregnancy complications was 10.8%, similar to that of myomectomy (6.8–13%) 19, 20, 44, 47, 48 . The most common complications of pregnancy in this study were placenta previa and placenta implantation.…”

Section: Discussionsupporting

confidence: 69%

Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study

Wang

Chen

et al. 2017

Sci Rep

View full text Add to dashboard Cite

To explore the impact of high-intensity focused ultrasound (HIFU) ablation of uterine fibroids in nulliparous women on subsequent pregnancy and delivery. A retrospective analysis was conducted of nulliparous women who received HIFU treatment at Chongqing Medical University, Chongqing,China, from January 1, 2010, to January 1, 2015. A total of 189 cases were enrolled, the median follow-up time was three years. Among them,there were 131 cases pregnancy with a total of 133 times,the pregnancy rate was 69.3% (131/189),and the spontaneous conception rate was 95.4% (125/131). Of 131 pregnant women, 19 were on-going pregnancy, terminated pregnancy 114 times,which include 93 times successfully delivery with a 76.3% (87/114) full-term birth rate,and the cesarean section rate was 72.0% (67/93). Of 94 newborns,the average birth weight was (3.3 ± 0.4)kg (range:1.5–4.8 kg), and a pair of them were identical twins. The incidence of complications during pregnancy and delivery were 10.8% (10/93) and 7.5% (7/93),respectively,except one woman failed on-going pregnancy and one woman suffered hysterectomy due to the complications,others all successful pregnant and delivered. Multiple-factor regression analysis found that age and infertility history were the important factors that may affect pregnancy after HIFU (P < 0.01). Nulliparous women who undergo HIFU treatment for uterine fibroids can subsequently have successful pregnancy and delivery safely.

show abstract

Section: Discussionsupporting

confidence: 69%

Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study

Wang

Chen

et al. 2017

Sci Rep

View full text Add to dashboard Cite

show abstract

“…[12] Furthermore, the pregnancy rate was significantly higher in the TAM group than that in the LM group, although there was no significant difference between these two types of surgical approach in terms of myoma number, myoma size, age, and whether the uterine cavity was distorted or not. The reason for why the TAM group resulted in a higher pregnancy rate remains unclear, although this might be attributable to the slightly larger myoma diameter in this group of women (7 [5.3–8.0] cm, 6 [5.0–7.0] cm, P = 0.050) in the TAM group.…”

Section: Discussionmentioning

confidence: 99%

Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women

Tian

Wang

et al. 2017

Chinese Medical Journal

Self Cite

View full text Add to dashboard Cite

Background:The relationship between intramural myomas and fertility remains unclear. The main debate rests on whether cavity-distorting intramural myomas (CDMs) adversely affect fertility more than non-CDMs. We aimed to compare the effects of enucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility.Methods:We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group (n = 45) and CDMs group (n = 38). We then compared postoperative infertility rates, spontaneous pregnancy rates, pregnancy outcomes, live birth rates, and obstetric complications. For continuous variables, we calculated the mean ± standard deviation, median and interquartile range, and analyzed the data using Student's t-test and the Mann-Whitney U-test. For categorical variables, the Pearson's Chi-square test, the continuity correction test, and Fisher's exact test were used.Results:Patients’ demographics and myoma characteristics were comparable between the two groups. The overall spontaneous pregnancy rate increased from 0% to 68.42% following myomectomy. The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group (50.00% vs. 23.53%, t = 5.579, P = 0.018), whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group (47.62% vs. 70.59%, t = 4.067, P = 0.044). Compared with the enucleation of non-CDM, the enucleation of CDM patients was a protective factor for the fertility restoration (risk ratio [RR] = 3.717, 95% confidence interval [CI]: 1.284–10.753, P = 0.015), although postoperative fertility restoration declined with age (RR = 1.141, 95% CI: 1.005–1.295, P = 0.041).Conclusions:Intramural myomas are associated with impaired fertility. Women experiencing unexplained infertility, and possessing intramural myomas, have a better chance of conception following myomectomy, and these benefits are more obvious for younger patients and patients with CDM.

show abstract

“…However, if thermal denaturation and necrosis affect the surrounding tissues, unexpected complications such as weakening of tissues, formation of dead spaces, thinning of the muscle layer, and scarring can occur. [7][8][9][10]16,17,19,22) These complications can also adversely affect subsequent pregnancies. Because uterine rupture occurred in 3 women who had been treated for pedunculated subserous myoma using resection, coagulation, and hemostasis with an electrocauterizer and one woman with endometriosis in the posterior uterine wall, which had only been cauterized with an electrocauterizer, even application of coagulation and hemostasis processes to the uterine surface can apparently produce thermal denaturation and necrosis deep in the muscle layer.…”

Section: Precautions For Uterine Myomectomy and Technical Training Prmentioning

confidence: 99%

“…However, if thermal denaturation and necrosis affect the surrounding tissues, unexpected complications, such as weakening of tissues, formation of dead spaces, and thinning of the muscle layer, may occur. [7][8][9][10] These complications may adversely impact subsequent pregnancies. Surgeons often receive feedback regarding the short-term outcomes and complications of surgery.…”

Section: Introductionmentioning

confidence: 99%

Uterine rupture and placenta accreta spectrum following laparoscopic myomectomy in Japan: A message from obstetricians to gynecologic laparoscopists

Takeda

Makino

2019

Hypertens Res Pregnancy

View full text Add to dashboard Cite

Laparoscopic myomectomy (LSM) is a procedure often requested by patients because of its minimal invasiveness. This procedure has, therefore, been widely performed in recent years. However, there is a need for more reports from the obstetric field to determine the effects of this procedure on subsequent pregnancies. In this regard, we searched Japanese medical literature databases for articles on Japanese cases of uterine rupture, placenta increta, or placenta percreta in pregnancy following myomectomy. This review article aims to analyze the retrieved data to clarify the issues involved and to provide useful feedback to gynecologists by sharing information with them on such issues.There were 32 cases with available detailed data between 2000 and 2017. There were 7 cases of uterine rupture in pregnancy following laparotomic myomectomy (LTM), comprising 1 full-term case (14.3%), 5 preterm cases (71.4%), and 1 case at 16 gestational weeks (abortion period, less than 22 gestational weeks) (14.3%). On the other hand, there were 25 cases of uterine rupture in pregnancy following LSM, comprising 2 full term cases (8.0%), 18 preterm cases (72.0%), and 5 abortion cases (at 7, 10, 16, 19, and 21 gestational weeks) (20.0%). There was no distinct difference between the frequencies of uterine rupture following LTM and LSM in relation to the abortion period or the preterm period. Cases of uterine rupture following LSM included 3 cases who had undergone subserous myomectomy in which electrocauterization alone was used for resection and hemostasis. In 4 cases, the submucosal myoma had been enucleated, with exposure of the endometrium.Placenta accreta spectrum disorders occurred in the scar region in the following cases: placenta accreta, 7 cases; placenta increta, 3 cases; and placenta percreta, 12 cases. Three cases were described as having myometrial laceration or separation or incomplete uterine rupture. There were 5 cases of complete uterine rupture (at 16, 18, 18, 22, and 37 gestational weeks) accompanied by intraabdominal hemorrhage. In the other 20 cases, incomplete uterine rupture was diagnosed at the time of cesarean section. Total abdominal hysterectomy or Poro's operation was performed in 11 cases during surgery.In comparison with uterine rupture in pregnancy following cesarean section, uterine rupture in pregnancy following myomectomy often occurs at an earlier stage, and thus requires caution. Pregnancies and deliveries after myomectomy carry the risks of uterine rupture and the development of placenta accreta spectrum disorders. Precautions in the management strategies for such pregnancies and deliveries, as well as the gist of the feedback given to gynecologists, are discussed herein.

show abstract

Pregnancy outcomes following different surgical approaches of myomectomy

Abstract: LM is a feasible treatment for women who have fertility requirements but suffer from leiomyoma. Although LM does not increase the rate of uterine rupture in the subsequent pregnancy, it is advisable for surgeons to limit the use of electrosurgery.

Cited by 55 publications

References 34 publications

Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study

Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study

Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women

Uterine rupture and placenta accreta spectrum following laparoscopic myomectomy in Japan: A message from obstetricians to gynecologic laparoscopists

Contact Info

Product

Resources

About