Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan.
Tottori University Hospital, Tottori, Japan.
Int J Gynaecol Obstet. 2023 Sep;162(3):977-982. doi: 10.1002/ijgo.14767. Epub 2023 Mar 30.
The authors conducted a large-scale cohort study using the Japan Society of Obstetrics and Gynecology's perinatal registry database to determine the effect of myomectomy on perinatal outcomes.
This retrospective cohort study enrolled 203 745 women who gave birth between January and December 2020 in Japan. The participants were classified into two groups based on their history of myomectomy (open/laparoscopic) to investigate fertility treatment, delivery information, obstetric complications, maternal treatment, infant information, fetal appendages, obstetric history, underlying disease, infectious disease, drugs used, and case information regarding maternal and infant death.
In total, 1161 pregnant women had a history of myomectomy and 202 584 did not. Compared with the nonmyomectomy group, the myomectomy group had a higher occurrence rate of uterine rupture (0.9% vs 0.06%, P < 0.01) and placenta accreta (1.5% vs 0.5%, P < 0.01). In addition, history of myomectomy (odds ratio [OR], 2.62 [95% confidence interval (CI), 1.500-4.226]; P < 0.001) was found to be an independent factor for placenta accrete and uterine rupture (OR, 14.4 [95% CI, 6.75-27.02]; P < 0.001). Furthermore, myomectomy increased the risk of uterine rupture by 14 times.
Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture.
作者利用日本妇产科协会的围产儿登记数据库进行了一项大规模队列研究，以确定子宫肌瘤切除术对围产期结局的影响。
本回顾性队列研究纳入了 2020 年 1 月至 12 月在日本分娩的 203745 名妇女。根据是否有子宫肌瘤切除术（开腹/腹腔镜）史，将参与者分为两组，以调查生育治疗、分娩信息、产科并发症、产妇治疗、婴儿信息、胎儿附属物、产科史、基础疾病、传染病、使用药物以及母婴死亡的病例信息。
共有 1161 名孕妇有子宫肌瘤切除术史，202584 名孕妇无子宫肌瘤切除术史。与非子宫肌瘤切除术组相比，子宫肌瘤切除术组子宫破裂的发生率更高（0.9%比 0.06%，P<0.01），胎盘植入的发生率也更高（1.5%比 0.5%，P<0.01）。此外，有子宫肌瘤切除术史（比值比[OR]，2.62[95%置信区间[CI]，1.500-4.226]；P<0.001）被发现是胎盘植入和子宫破裂的独立因素（OR，14.4[95%CI，6.75-27.02]；P<0.001）。此外，子宫肌瘤切除术使子宫破裂的风险增加了 14 倍。
子宫肌瘤切除术后妊娠可能增加胎盘植入和子宫破裂的风险。
