Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital-Linkou Medical Centre, Chang Gung University College of Medicine, Taoyuan, Taiwan.
BJOG. 2018 Mar;125(4):495-500. doi: 10.1111/1471-0528.14798. Epub 2017 Aug 28.
To evaluate the obstetric and surgical outcomes of a novel transendometrial approach for myomectomy during caesarean section in subsequent pregnancies.
Longitudinal panel study.
Chang Gung Memorial Hospital, Taiwan, with approximately 5000 births per annum.
Pregnant women complicated with uterine myoma.
Sixty-three pregnant women who received transendometrial myomectomy during the first caesarean delivery reported a subsequent live pregnancy and planned an elective repeat caesarean delivery.
Obstetric outcomes consisted of gestational age at birth, newborn weight, Apgar score, birthweight adequacy, uterine rupture, placental abruption, placenta praevia, placenta accreta, spontaneous preterm birth and preterm premature rupture of membranes. Surgical outcomes consisted of surgical time, blood loss, blood transfusion, postoperative fever, length of hospital stay and mean adhesion score.
The mean gestational age at birth and newborn weight at the subsequent caesarean section were superior to those at the first caesarean delivery. Spontaneous preterm birth, small-for-gestational-age infants and preterm premature rupture of membranes occurred more often in the first pregnancy than in the subsequent pregnancy. The mean surgical time was shorter for the subsequent caesarean delivery than for the first caesarean delivery combined with myomectomy. The other surgical composite outcomes of blood loss, blood transfusion, postoperative fever, length of hospital stay and mean adhesion score were similar across the two stages of caesarean deliveries.
The novel transendometrial approach for caesarean myomectomy may improve the obstetric outcomes of subsequent pregnancy without causing any additional immediate and long-term adverse surgical outcomes.
Transendometrial caesarean myomectomy may improve future obstetric outcomes.
评估剖宫产术中经子宫内膜途径子宫肌瘤切除术对后续妊娠的产科和手术结局。
纵向面板研究。
中国台湾长庚纪念医院，每年约有 5000 例分娩。
患有子宫肌瘤的孕妇。
63 名在首次剖宫产时接受经子宫内膜子宫肌瘤切除术的孕妇报告了后续活产妊娠，并计划选择性再次剖宫产。
产科结局包括出生时的胎龄、新生儿体重、阿普加评分、出生体重充足率、子宫破裂、胎盘早剥、前置胎盘、胎盘植入、自发性早产和胎膜早破。手术结局包括手术时间、出血量、输血、术后发热、住院时间和平均粘连评分。
后续剖宫产的平均胎龄和新生儿体重优于首次剖宫产。首次妊娠中自发性早产、小于胎龄儿和胎膜早破的发生率高于后续妊娠。后续剖宫产的平均手术时间短于首次剖宫产联合子宫肌瘤切除术。在两次剖宫产中，出血量、输血、术后发热、住院时间和平均粘连评分等其他手术综合结局相似。
剖宫产术中经子宫内膜途径子宫肌瘤切除术可能改善后续妊娠的产科结局，而不会造成任何额外的近期和长期不良手术结局。
经子宫内膜剖宫产子宫肌瘤切除术可能改善未来的产科结局。
