Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Matern Fetal Neonatal Med. 2022 Nov;35(22):4332-4337. doi: 10.1080/14767058.2020.1849114. Epub 2020 Nov 25.
To compare the prevalence of placental abnormalities in pregnancy following different modes of operative myomectomy.
A retrospective cohort study, including all women after myomectomy that gave birth in a single tertiary care center from February 2011 to January 2019. Data was collected from the patients' medical files and completed by telephone questionnaire. Patients were stratified to 3 groups, according to the mode of operative myomectomy (laparotomy, laparoscopy, hysteroscopy). Groups were compared for women demographics, fibroid's characteristics, operative management, post-operative placental evaluation and delivery characteristics. Primary outcome was defined as the need for any intervention for placental separation during the third phase of the delivery.
Two hundred forty one women met inclusion criteria. Complete follow-up was achieved in 199 (82.57%) women, of whom 82, 89, and 28 underwent laparoscopic, laparotomy and hysteroscopic myomectomy, respectively. There were no in-between groups differences in women's age, BMI, and gravidity. Disruption of the endometrial cavity during laparoscopy and laparotomy was reported in 3 (3.6%) and 7 (7.8%) cases, respectively ( = .21). During the subsequent pregnancy following myomectomy, placenta accreta spectrum disorder was suspected in only one woman in each of the study groups ( = .63). Placenta previa was low and comparable between groups. Vaginal delivery rate was significantly higher in the hysteroscopy group, as compared to the laparoscopy or the laparotomy groups [11 (36.3%) vs. 5 (6.1%) vs. 4 (4.5%); = .001], with significantly lower need for manual lysis of the placenta [11(39.0%) vs. 51 (62.1%) vs. 62 (69.7%); = .01] and further interventions for blood loss control.
Subsequent pregnancy following surgical myomectomy was not found to be associated with higher prevalence placental abnormality. Furthermore, other than manual lysis, the different modes of myomectomy did not necessitate any further intervention for complications associated with abnormal placentation requiring intervention.
Subsequent pregnancy following surgical myomectomy is not associated with higher prevalence of placental abnormality.
比较不同手术子宫肌瘤切除术方式后妊娠胎盘异常的发生率。
这是一项回顾性队列研究，纳入 2011 年 2 月至 2019 年 1 月在一家三级保健中心接受子宫肌瘤切除术并分娩的所有女性。数据从患者的病历中收集，并通过电话问卷调查完成。根据手术子宫肌瘤切除术（剖腹手术、腹腔镜手术、宫腔镜手术）的方式，将患者分为 3 组。比较组间的女性人口统计学特征、肌瘤特征、手术管理、产后胎盘评估和分娩特征。主要结局定义为在分娩的第三阶段需要任何干预以促进胎盘分离。
241 名女性符合纳入标准。199 名（82.57%）女性完成了完整随访，其中 82 名、89 名和 28 名女性分别接受了腹腔镜、剖腹手术和宫腔镜子宫肌瘤切除术。组间女性年龄、BMI 和孕次无差异。腹腔镜和剖腹手术中均有 3 例（3.6%）和 7 例（7.8%）发生子宫内膜腔破坏（ = .21）。在随后的子宫肌瘤切除术后妊娠中，仅在研究组的每个组中发现 1 例胎盘植入谱系疾病（ = .63）。胎盘前置较低，且各组间无差异。与腹腔镜组或剖腹手术组相比，宫腔镜组阴道分娩率显著更高[11（36.3%）比 5（6.1%）比 4（4.5%）； = .001]，胎盘手动剥离的需求显著降低[11（39.0%）比 51（62.1%）比 62（69.7%）； = .01]，需要进一步干预以控制出血。
手术子宫肌瘤切除术后的后续妊娠并未发现与更高的胎盘异常发生率相关。此外，除手动剥离外，不同的子宫肌瘤切除术方式也不需要任何进一步的干预，以避免与异常胎盘有关的并发症需要干预。
手术子宫肌瘤切除术后的后续妊娠与胎盘异常的发生率无关。
