Department of Obstetrics and Gynecology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea.
Department of Obstetrics and Gynaecology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea.
Taiwan J Obstet Gynecol. 2021 Jan;60(1):99-102. doi: 10.1016/j.tjog.2020.11.015.
Although adenomyomectomy for fertility-sparing is an expanding procedure worldwide, there is no guideline or consensus about how to manage the pregnant women who have previously received conservative surgery for adenomyosis. The aim of this study is to evaluate antenatal care and delivery outcomes in pregnant women after adenomyomectomy.
Between May 2011 and May 2019, the medical record was reviewed in all delivery of pregnant women received adenomyomectomy performed by a single surgeon by a uniform surgical technique. The evaluating parameters consisted of antenatal care outcomes, delivery outcomes, intrapartum outcome, and neonatal outcomes.
Twenty-two patients were evaluated to monitor pregnancy and delivery outcomes after the adenomyomectomy. Mean age of delivery was 37.0 years old (SD = 3.1, range 32-45, median 37). All were delivered by cesarean section. Mean gestational age was 36.2 weeks (SD = 3.6, range 27.4-39.4, median 37.3). The mean birth weight was 2560.9 g (SD = 771.8, range 1100-3920, median 2550) and the number of preterm births admitted for prematurity care was seven (31.8%, 7/22). Placental abnormality was found in the four cases, which included two placenta accreta and two previa. However, there were no cases of hysterectomy or intervention. We identified one case of uterine rupture during pregnancy (4.5%, 1/22) at 27 weeks of gestation. Except for preterm birth, adverse neonatal outcomes were not found in this study.
Delivery of pregnant women who received adenomyomectomy can obtain safe perinatal outcomes under close monitoring of preterm labor and surveillance of catastrophic pregnancy related complications.
尽管全球范围内对于保留生育功能的子宫腺肌瘤切除术的应用日益广泛，但对于接受过腺肌瘤保守手术的孕妇，如何进行管理，目前尚无指南或共识。本研究旨在评估腺肌瘤切除术后孕妇的产前护理和分娩结局。
本研究回顾性分析了 2011 年 5 月至 2019 年 5 月期间，由同一位外科医生采用统一手术技术为腺肌瘤患者施行保留生育功能手术的所有分娩孕妇的病历资料。评估参数包括产前护理结局、分娩结局、分娩期结局和新生儿结局。
共 22 例患者接受了腺肌瘤切除术，以监测其妊娠和分娩结局。分娩时的平均年龄为 37.0 岁（标准差=3.1，范围 32-45 岁，中位数 37 岁），均行剖宫产术分娩。平均孕龄为 36.2 周（标准差=3.6，范围 27.4-39.4 周，中位数 37.3 周）。平均出生体重为 2560.9 g（标准差=771.8，范围 1100-3920 g，中位数 2550 g），早产儿需接受早产护理的人数为 7 人（31.8%，7/22）。4 例患者发现胎盘异常，包括 2 例胎盘植入和 2 例前置胎盘。然而，没有患者需要行子宫切除术或介入治疗。我们发现 1 例孕妇在妊娠 27 周时发生子宫破裂（4.5%，1/22）。除了早产外，本研究未发现其他不良新生儿结局。
在密切监测早产和监测灾难性妊娠相关并发症的情况下，接受腺肌瘤切除术的孕妇可以获得安全的围产期结局。
