Perrine Ginod

Do myomectomies alter third‐trimester complications compared with women without myomectomies and uterine fibroids in situ: A retrospective cohort study of an American population database

Abstract Objective To evaluate population characteristics and pregnancy, delivery, and neonatal complications in women with myomectomy prior to pregnancy versus intramural fibroids in situ. Methods Retrospective cohort study using hospital discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2004 to 2014 included. A population of 14 206 pregnancies post‐myomectomy and 81 517 with fibroids in situ were analyzed, performing multivariate logistic regression with adjustment. Results Post‐myomectomy patients were younger, with lower body mass index, higher in vitro fertilization use, more commonly Caucasians or Hispanics, and had higher rates of pregestational diabetes, smoking, illicit drug use, previous cesarean delivery, and multiple gestations, compared with the in‐situ fibroid (ISF) group. Post‐myomectomy patients had decreased rates of gestational hypertension (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.77–0.97), eclampsia (aOR 0.76, 95% CI 0.32–0.81), gestational diabetes (aOR 0.83, 95% CI 0.77–0.90), spontaneous vaginal deliveries (aOR 0.09, 95% CI 0.08–0.11), postpartum hemorrhage (aOR 0.77, 95% CI 0.68–0.88), and intrauterine fetal death (aOR 0.64, 95% CI 0.43–0.97). Conversely, they had increased risks of placenta previa (aOR 1.40, 95% CI 1.20–1.64), preterm delivery (aOR 1.16, 95% CI 1.07–1.24), cesarean section (aOR 8.64, 95% CI 7.71–9.69), uterine rupture (aOR 2.21, 95% CI 1.31–3.74), transfusions (aOR 1.79, 95% CI 1.59–2.02), and congenital anomalies (aOR 2.35, 95% CI 2.01–2.75). Conclusions The ISF group experienced different complications than the post‐myomectomy group. Pregnancies post‐myomectomy could benefit from additional screening or interventions during pregnancy to reduce complications from malplacentation and ensure delivery in specialized centers to mitigate risks. Patients should be counseled regarding these potential risks. Increased understanding of the role of myomectomies on reproductive outcomes requires further prospective studies.

Pregnancy and delivery outcomes after abdominal vs. laparoscopic myomectomy: an evaluation of an American population database

To evaluate population characteristics and obstetric complications after abdominal myomectomy vs. laparoscopic myomectomy. Retrospective cohort study. A total of 13,868 and 338 pregnancies after abdominal or laparoscopic myomectomy, respectively. Obstetrics outcomes following abdominal and laparoscopic myomectomy were collected. Obstetric outcomes after abdominal or laparoscopic myomectomies were collected using hospital discharges from 2004 to 2014 inclusively, and adjusted using multiple and binomial logistic regression in different models for age, obesity, chronic hypertension, and pregestational diabetes mellitus. Pregnancy, delivery, and neonatal outcomes were analyzed. Abdominal myomectomy were characterized by younger patients, lower rates of Caucasian, chronic hypertension, pregestational diabetes, active smoking, illicit drug use, and higher rates of previous cesarean delivery, and multiple gestations when compared with laparoscopic myomectomy. Pregnant women with laparoscopic myomectomy had decreased rates of pregnancy-induced hypertension (adjusted risk ratios [aRR], 0.12; 95% confidence intervals [CI], 0.006-0.24]), gestational hypertension (aRR, 0.24; 95% CI, 0.08-0.76), pre-eclampsia (aRR, 0.18; 95% CI, 0.07-0.48), and pre-eclampsia or eclampsia superimposed on chronic hypertension (aRR, 0.03; 95% CI, 0.005-0.3), gestational diabetes mellitus (aRR, 0.14; 95% CI, 0.06-0.34), preterm premature rupture of membranes (aRR, 0.14; 95% CI, 0.02-0.96), preterm delivery (aRR, 0.36; 95% CI, 0.23-0.55), and cesarean delivery (aRR, 0.01; 95% CI, 0.007-0.01) and small for gestational age (aRR, 0.15; 95% CI, 0.005-0.04), compared with abdominal myomectomy group. Laparoscopic myomectomy group had a higher rate of spontaneous (aRR, 35.57; 95% CI, 22.53-62.66), and operative vaginal delivery (aRR, 10.2; 95% CI, 8.3-12.56), uterine rupture (aRR, 6.1; 95% CI, 3.2-11.63), postpartum hemorrhage (aRR, 3.54; 95% CI, 2.62-4.8), hysterectomy (aRR, 7.74; 95% CI, 5.27-11.4), transfusion (aRR, 3.34; 95% CI, 2.54-4.4), pulmonary embolism (aRR, 7.44; 95% CI, 2.44-22.71), disseminated intravascular coagulation (aRR, 2.77; 95% CI, 1.47-5.21), maternal infection (aRR, 1.66; 95% CI, 1.1-2.5), death (aRR, 2.04; 95% CI, 1.31-3.2), and intrauterine fetal death (aRR, 2.99; 95% CI, 1.72-5.2) compared with the abdominal myomectomy group. Women who had a previous abdominal myomectomy have underlying risk factors for hypertension disorders of pregnancy and gestational diabetes. Women who underwent laparoscopic myomectomies have higher risks of bleeding, uterine rupture, resultant complications, and death, and should be monitored as high-risk patients, like abdominal myomectomies.