子宫肌瘤患者子宫肌瘤剔除术史对早产风险的影响：倾向评分分析。
Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis.
机构信息
Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France.
Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France.
出版信息
BMC Pregnancy Childbirth. 2020 Nov 23;20(1):720. doi: 10.1186/s12884-020-03413-w.
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.
背景
评估有子宫肌瘤切除术史的女性与妊娠期间有子宫肌瘤的女性相比，早产风险是否有所改变。
方法
回顾性队列研究纳入 2011 年 1 月至 2017 年 12 月在一家三级中心分娩的所有有子宫肌瘤切除术史（手术组）或妊娠期间有子宫肌瘤（未手术组）的女性。手术组包括在妊娠期间有子宫肌瘤切除术史和（或）持续存在子宫肌瘤的女性。未手术组包括在妊娠期间至少有一次超声检查发现子宫肌瘤但无子宫肌瘤切除术史的女性。主要结局是早产<37 周，次要结局是自发性早产<37 周。为了控制混杂因素，采用倾向评分法。进行了两次敏感性分析，一次是在排除持续存在子宫肌瘤的手术组妇女后，使用倾向评分重复分析，另一次是使用经典多变量逻辑回归模型进行分析。
结果
该队列包括 576 名女性：283 名手术组妇女和 293 名未手术组妇女。两组的早产率相似：未手术组为 12.6%，手术组为 12.0%（p=0.82）。在基于倾向评分匹配的队列中，未手术组和手术组妇女的早产风险无差异：比值比 0.86；95%置信区间[0.47-1.59]。这些结果与自发性早产（比值比 1.61；95%置信区间[0.61-4.23]）和敏感性分析结果一致。
结论
在有子宫肌瘤的女性中，子宫肌瘤切除术史与降低早产风险无关。
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