Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea.
Taiwan J Obstet Gynecol. 2021 Jan;60(1):41-44. doi: 10.1016/j.tjog.2020.11.007.
We intended to identify the risk factors of intraoperative hemorrhage on occasions of a combined operation of myomectomy with cesarean section for patients with uterine leiomyoma.
A retrospective cohort study was done of all patients who underwent cesarean myomectomy for intramural leiomyoma at a single university hospital. Cases identified with subserosal leiomyoma, placental disorder, and comorbid conditions related to coagulopathy were excluded. All the included cases were classified into intraoperative hemorrhage and non-hemorrhage group. Obstetric and demographic factors and parameters of leiomyoma were compared between two groups.
A total of 302 women underwent cesarean myomectomy during the study period. Among these women, 212 pregnant women met the inclusion criteria. Intraoperative hemorrhage occurred in 43 women (20.3%). There was no significant intergroup difference in the number of removed leiomyomas. Multiple logistic regression analysis demonstrated that lower segmental location (odds ratio [OR], 2.827; 95% confidence interval [CI], 1.033-7.734, P = 0.043) and the diameter (OR, 1.167; 95% CI, 1.044-1.305, P = 0.006) were significant independent risk factors for hemorrhage during cesarean myomectomy. The combination of ≥ 8 cm diameter or lower segmental position of the leiomyoma yielded a specificity of 79.3% for operative hemorrhage during cesarean myomectomy. The negative predictive value of this combination was 88.7% for operative hemorrhage with a prevalence of 20%.
The large size and lower segmental position of the leiomyoma are significantly risk factors for intraoperative hemorrhage during cesarean myomectomy. If the leiomyoma is located in the uterine fundus or body and its diameter is less than 8 cm, the removal of leiomyoma may be considered at the time of cesarean section.
我们旨在确定在子宫肌瘤患者剖宫产联合子宫肌瘤剔除术中发生术中出血的危险因素。
对单所大学医院行剖宫产子宫肌瘤剔除术的所有患者进行回顾性队列研究。排除阔韧带、胎盘异常及与凝血障碍相关的合并症患者。将所有纳入的病例分为术中出血组和非出血组。比较两组的产科和人口统计学因素及子宫肌瘤参数。
在研究期间，共有 302 名女性接受了剖宫产子宫肌瘤剔除术。其中 212 名孕妇符合纳入标准。术中出血发生于 43 名女性（20.3%）。两组间剔除的子宫肌瘤数量无显著差异。多因素逻辑回归分析显示下段位置（比值比[OR]，2.827；95%置信区间[CI]，1.033-7.734，P=0.043）和肌瘤直径（OR，1.167；95%CI，1.044-1.305，P=0.006）是剖宫产子宫肌瘤剔除术中出血的显著独立危险因素。当肌瘤直径≥8cm或下段位置时，剖宫产子宫肌瘤剔除术术中出血的特异性为 79.3%。在 20%的发生率下，该组合对术中出血的阴性预测值为 88.7%。
肌瘤较大且下段位置是剖宫产子宫肌瘤剔除术中出血的显著危险因素。如果肌瘤位于子宫底或体部且直径小于 8cm，则可考虑在剖宫产时剔除肌瘤。
