Kasuga Yoshifumi, Lin Bao-Liang, Kim Seon-Hye, Higuchi Takayuki, Iwata Sokichi, Nakada Sakura
Department of Obstetrics and Gynecology, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan.
Department of Gynecology, Kawasaki Municipal Ida Hospital, Kawasaki, Kanagawa, Japan.
Gynecol Minim Invasive Ther. 2020 Apr 28;9(2):54-58. doi: 10.4103/GMIT.GMIT_94_19. eCollection 2020 Apr-Jun.
There are no data describing the correlation between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women after transcervical resection myomectomy (TCR-M). The aim of the study is to investigate the correlations between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women who had previously undergone TCR-M.
This was a retrospective, single-center study. We reviewed the records of 34 pregnant women who had previously undergone TCR-M for submucosal myoma and perinatal care in our hospital between January 2012 and January 2019. We examined surgical and pregnancy outcomes and evaluated correlations between placenta implantation at prior myomectomy locations and perinatal outcomes in women who delivered after 22 gestational weeks ( = 24).
Median maternal age at conception was 38 years (range, 28-44) and median duration between TCR-M and conception was 1.4 years (range, 0.3-5.8). There were 24 deliveries after 22 gestational weeks and 10 pregnancy losses. Among these 24 deliveries, the median gestational age at delivery was 39 weeks (range, 34-41); median birthweight, 3025 g (range, 2092-4012); and median blood loss at delivery, 573 g (range, 100-3000). There were no cases of placenta accreta and uterine rupture. Placenta implantation at a prior myomectomy location was detected in 14/24 women using transabdominal ultrasonography. Median blood loss was significantly higher in the implantation than in the nonimplantation group ( < 0.01).
Our one-step TCR-M is useful for women with submucosal myoma. However, we suggest that clinicians should review and check the association between prior myomectomy locations and placenta implantation.
目前尚无数据描述经宫颈肌瘤切除术（TCR-M）后孕妇先前肌瘤切除部位的胎盘植入与围产期结局之间的相关性。本研究的目的是调查先前接受TCR-M的孕妇先前肌瘤切除部位的胎盘植入与围产期结局之间的相关性。
这是一项回顾性单中心研究。我们回顾了2012年1月至2019年1月期间在我院因黏膜下肌瘤接受TCR-M及围产期护理的34例孕妇的记录。我们检查了手术和妊娠结局，并评估了孕周≥22周（n = 24）分娩的妇女先前肌瘤切除部位的胎盘植入与围产期结局之间的相关性。
受孕时孕妇的中位年龄为38岁（范围28 - 44岁），TCR-M与受孕之间的中位间隔时间为1.4年（范围0.3 - 5.8年）。孕周≥22周的分娩有24例，妊娠丢失10例。在这24例分娩中，分娩时的中位孕周为39周（范围34 - 41周）；中位出生体重为3025 g（范围2092 - 4012 g）；分娩时的中位失血量为573 g（范围100 - 3000 g）。没有胎盘植入和子宫破裂的病例。使用经腹超声在14/24例妇女中检测到先前肌瘤切除部位有胎盘植入。植入组的中位失血量显著高于未植入组（P < 0.01）。
我们的一步法TCR-M对黏膜下肌瘤患者有用。然而,我们建议临床医生应复查并检查先前肌瘤切除部位与胎盘植入之间的关联。
