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Zhang L, Chen L, Hong X, Zheng D, Ying H, Hong L. Complete rupture of the pregnant uterus: A 12-year retrospective study. Int J Gynaecol Obstet 2024. [PMID: 38702923 DOI: 10.1002/ijgo.15576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/18/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To assess the frequency of uterine ruptures, clinical characteristics, and maternal and neonatal outcomes in a tertiary referral center. METHODS Information on complete uterine rupture between July 2010 and June 2022 was investigated retrospectively at a tertiary center. RESULTS There were 42 cases of complete uterine rupture in 144 474 deliveries, with an incidence rate of 0.029%. Twenty-seven cases had a scarred uterus and 15 had an unscarred uterus; Rupture of the lower uterine segment was predominant in the scarred uterus, whereas rupture of the body of the uterus was predominant in the non-scarred uterus (P ≤ 0.001). Newborns with Apgar score of 7 or less at 1 min in the non-scarred uterus group was more than that in the scarred uterus group (P = 0.001). There were no significant differences in the history of gynecologic surgery, induction of labor, mode of delivery, clinical features, maternal outcomes, neonatal weight, preterm birth rate, 5-min Apgar score, or neonatal mortality between the two groups (P > 0.05). CONCLUSION The clinical manifestations of uterine rupture are mainly abdominal pain, abnormal fetal heartbeat, or vaginal bleeding. Attention should also be paid to the history of previous uterine surgery. Strict prenatal management, early identification, and aggressive management can help improve maternal and child outcomes. Hysterectomy is not imperative.
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Affiliation(s)
- Li Zhang
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Liang Chen
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Xunyu Hong
- Intensive Care Department, Ningbo Women and Children's Hospital, Ningbo, China
| | - Dan Zheng
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Hongjun Ying
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Ling Hong
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, China
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Hu Y, Song X, Xu L, Zhou Z. High-intensity Focused Ultrasound is a Better Choice for Women with Fertility Desire: A Systematic Review and Meta-analysis of the Comparison between High-intensity Focused Ultrasound and Laparoscopic Treatment of Uterine Fibroids. Gynecol Minim Invasive Ther 2024; 13:79-89. [PMID: 38911304 PMCID: PMC11192288 DOI: 10.4103/gmit.gmit_23_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 06/25/2024] Open
Abstract
High-intensity focused ultrasound (HIFU) is commonly used to treat uterine fibroids and adenomyosis, but there is no evidence using metadata to compare fertility outcomes between conventional laparoscopic procedures and HIFU. The purpose of this study analysis is that evidence-based fertility outcomes may provide better treatment options for clinicians and patients considering fertility. The literature on fertility data for HIFU surgery versus laparoscopic myomectomy was searched in seven English language databases from January 1, 2010, to November 23, 2022. A total of 1375 articles were received in the literature, 14 of which were selected. We found that women who underwent HIFU surgery had higher rates of spontaneous pregnancy, higher rates of spontaneous delivery, and higher rates of full-term delivery but may have higher rates of miscarriage or postpartum complications than women who underwent laparoscopic myomectomy. Looking forward to future studies, it is hoped that the literature will examine endometrial differences in women who undergo HIFU and laparoscopic myomectomy to demonstrate the ability of endometrial repair. The location of fibroids in the sample should also be counted to allow for attribution statistics on the cause of miscarriage.
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Affiliation(s)
- Ying Hu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Surgery, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, China
| | - Xiaohong Song
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou, China
| | - Linjun Xu
- Department of Surgery, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, China
| | - Zhenfeng Zhou
- Department of Anesthesiology, Hangzhou Women’s Hospital, Hangzhou, China
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Balulescu L, Brasoveanu S, Pirtea M, Grigoras D, Secoșan C, Olaru F, Erdelean D, Margan MM, Alexandru A, Ivan CS, Pirtea L. The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review. J Pers Med 2024; 14:340. [PMID: 38672967 PMCID: PMC11051497 DOI: 10.3390/jpm14040340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
STUDY OBJECTIVE The objective of this systematic review is to investigate the impact of laparoscopic myomectomy techniques on pregnancy outcomes, with a specific focus on the correlation between the type of suture used during the procedure and the incidence of uterine rupture. Additionally, the study aims to examine how the localization and size of myomas, key factors in laparoscopic myomectomy, may influence fertility outcomes. DATA SOURCES extensive searches were conducted using MDPI, PubMed, Web of Science, and Cochrane Library databases from 2008 to November 2023. METHODS OF STUDY SELECTION The study involved women of reproductive age diagnosed with fibroids who underwent surgical removal of fibroids using either laparotomy or laparoscopy. The evaluation of pregnancy outcomes focused on indicators such as live birth rates, miscarriage rates, stillbirth rates, premature delivery rates, and cases of uterine rupture. Quality assessment was systematically performed by employing the National Institutes of Health Study Quality Assessment Tools, with the subsequent formulation of clinical recommendations that were meticulously graded in accordance with the robustness of the underlying evidence. RESULTS The pregnancy outcomes post-myoma treatment, as reflected in one of the presented tables, show a promising number of pregnancies and live births, but also indicate the potential risks of miscarriages and preterm births. The diversity in outcomes observed among various studies underscores the imperative for tailored patient care, as well as the necessity for additional research aimed at optimizing fertility and pregnancy outcomes following myoma treatment. CONCLUSION This study offers insights into the criteria for patient selection and intraoperative methodologies specifically related to laparoscopic myomectomy. To enhance our understanding of the associations between fibroid characteristics (location, size) and reproductive outcomes, additional research is warranted, particularly through well-designed clinical trials.
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Affiliation(s)
- Ligia Balulescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (D.G.); (C.S.); (F.O.); (D.E.); (L.P.)
| | - Simona Brasoveanu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (D.G.); (C.S.); (F.O.); (D.E.); (L.P.)
| | - Marilena Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (D.G.); (C.S.); (F.O.); (D.E.); (L.P.)
| | - Dorin Grigoras
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (D.G.); (C.S.); (F.O.); (D.E.); (L.P.)
| | - Cristina Secoșan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (D.G.); (C.S.); (F.O.); (D.E.); (L.P.)
| | - Flavius Olaru
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (D.G.); (C.S.); (F.O.); (D.E.); (L.P.)
| | - Dragos Erdelean
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (D.G.); (C.S.); (F.O.); (D.E.); (L.P.)
| | - Mădălin-Marius Margan
- Department of Functional Sciences, Discipline of Public Health, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Alexandru Alexandru
- Department of general medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.A.); (C.-S.I.)
| | - Cristiana-Smaranda Ivan
- Department of general medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.A.); (C.-S.I.)
| | - Laurențiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (D.G.); (C.S.); (F.O.); (D.E.); (L.P.)
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Bortoletto P, Romanski PA, Petrozza JC, Pfeifer SM. Reproductive surgery: revisiting its origins and role in the modern management of fertility. Fertil Steril 2023; 120:539-550. [PMID: 36870592 DOI: 10.1016/j.fertnstert.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
For years, reproductive surgery was the mainstay of reproductive care. With the evolution and ultimate success of in vitro fertilization (IVF), reproductive surgery became an adjuvant therapy, indicated mainly for severe symptoms or to enhance success rates with assisted reproductive technologies. As success rates for IVF have plateaued, and emerging data rekindles the enormous benefits of surgically correcting reproductive pathologies, there is renewed interest among reproductive surgeons in reviving research and surgical expertise in this area. In addition, new instrumentation and surgical techniques to preserve fertility have gained traction and will solidify the need to have skilled reproductive endocrinology and infertility surgeons in our practice.
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Affiliation(s)
- Pietro Bortoletto
- Boston IVF, Waltham, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | | | - John C Petrozza
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Decision of Reproductive Medicine & IVF, Massachusetts General Hospital, Boston, Massachusetts
| | - Samantha M Pfeifer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York
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Li F, Chen J, Yin L, Zeng D, Wang L, Tao H, Wu X, Wei F, Xu F, Shi Q, Lin Z, Wang Z. HIFU as an alternative modality for patients with uterine fibroids who require fertility-sparing treatment. Int J Hyperthermia 2023; 40:2155077. [PMID: 36603842 DOI: 10.1080/02656736.2022.2155077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To compare pregnancy outcomes after high-intensity focused ultrasound ablation (HIFU), myomectomy and uterine artery embolization (UAE) for fertility-sparing patients with uterine fibroids and to investigate the possible mechanism of improving pregnancy by HIFU. MATERIALS AND METHODS A meta-analysis of 54 studies containing 12,367 patients was conducted to compare the pregnancy outcomes of three fertility-sparing therapies. And a retrospective self-control study of 26 patients with uterine fibroids from May 2019 to December 2020 was performed to assess the blood flow impedance of bilateral uterine arteries before and after HIFU. RESULTS In the analysis by treatment option, the pregnancy rate after myomectomy was 0.43 (95% CI 0.36-0.49), which was higher than 0.18 (95% CI 0.10-0.26) after HIFU, the latter was significantly higher than that after UAE (ratio 0.08, 95% CI 0.06-0.10). The miscarriage rate after HIFU was 0.08 (95% CI 0.04-0.12), which was similar to 0.15 (95% CI 0.09-0.21) after myomectomy and also similar to 0.16 after UAE (95% CI 0.01-0.30). In the subgroup analysis, women who received ultrasound guided HIFU (USgHIFU) were more likely to have ideal pregnancy outcomes than that after magnetic resonance imaging-guided HIFU. The pulsatility index and resistance index on the right side were significantly higher 3 months after HIFU than before (1.637 ± 0.435 vs. 1.845 ± 0.469; p = 0.033; 0.729 ± 0.141 vs. 0.784 ± 0.081, p = 0.039). CONCLUSIONS HIFU, especially USgHIFU, may be an alternative fertility-sparing modality for patients with uterine fibroids over 40 years old. HIFU may contribute to improving pregnancy rates by elevating uterine blood flow impedance.
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Affiliation(s)
- Fang Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Jing Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Li Yin
- Xiamen Maluan Bay Hospital, Xiamen, China
| | - Dingyuan Zeng
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Li Wang
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Hua Tao
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Xiajuan Wu
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Feng Wei
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Fan Xu
- Nanchong Central Hospital, North Sichuan Medical University, Nanchong, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound Engineering in Medicine, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Zhong Lin
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Use of a microsurgical vascular clip system for temporary bilateral occlusion of the four main uterine vessels for laparoscopic enucleation of very large intramural uterine fibroids. Arch Gynecol Obstet 2022; 306:1597-1605. [PMID: 35882651 PMCID: PMC9519638 DOI: 10.1007/s00404-022-06675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Abstract
Objectives The goal of this study was to examine the safety, feasibility, and effectiveness of the use of a microsurgical temporary vascular clip system to facilitate the laparoscopic enucleation of very large intramural uterine fibroids. Methods In this retrospective study, the surgical outcomes of 26 patients who underwent laparoscopic myomectomy with temporary uterine vessel clipping for very large (the largest measured diameter ≥ 9 cm) symptomatic intramural uterine fibroids in two tertiary referral hospitals between September 2017 and March 2020 were examined. Titan-made vascular clips (YASARGIL® Aneurysm Clip System) were used to temporarily occlude the bilateral uterine arteries and utero-ovarian vessels. Main outcomes included operating time, blood loss, number of leiomyomas and weight, conversion rate, intra- and postoperative complication rates, and length of hospital stay. Results Twenty six patients were included. Dominant intramural uterine fibroid diameters were 9–22 cm. The general characteristics of the patients were similar. The mean surgery duration and intraoperative blood loss were 175.3 ± 32.7 (range 120–250) min and 241.1 ± 103 (range 100–450) ml, respectively. The median postoperative drop in hemoglobin was 0.89 ± 0.75 g/dL. No patient required blood transfusion. No procedure was converted to laparotomy. No major intra- or postoperative complication occurred. Conclusions Laparoscopic myomectomy for very large intramural uterine fibroids can be performed safely and effectively, with less intraoperative blood loss, using vascular clips for temporary clamping of the bilateral uterine vessels.
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Gu J, Lin B, Guo Z, Aili A. How to boost an obstetrician's confidence in vaginal delivery after high-intensity focused ultrasound: a comparison study on delivery outcomes. Int J Hyperthermia 2022; 39:900-906. [PMID: 35848403 DOI: 10.1080/02656736.2022.2083700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To assess the feasibility of vaginal delivery after HIFU. METHODS A total of 37 women who met the trial of labor after HIFU (TOLAH) inclusion criteria and 368 women who met the trial of labor after cesarean delivery (TOLAC) inclusion criteria gave birth at Shanghai First Maternity and Infant Hospital between 14th June 2018 and 24th September 2021. The delivery outcomes of the two groups were compared. Multivariable logistic regression analysis was used to estimate the adjusted risk of postpartum hemorrhage (PPH). RESULTS In the Qualified Candidates for TOLAH group, vaginal delivery is substantially less common (p = 0.000). The prevalence of PPH in the Qualified Candidates for TOLAH group is lower than in the Candidates for TOLAC group (8.82% vs 10.51%, p = 0.534; 0% vs 2.51%, p = 0.418). Hemoglobin drop in the Qualified Candidates for TOLAH group is also lower (7.03 ± 7.39vs 12.11 ± 12.62, p = 0.001). The rate of using more than two types of uterotonic medications to promote contraction is significantly lower in the Qualified Candidates for TOLAH group (54.05% vs 69.84%, p = 0.04), and the percentage of abnormal uterine contraction is lower in the Qualified Candidates for TOLAH group (35.14% vs 49.18%, p = 0.072). PPH is strongly predicted by abnormal uterine contraction (aOR: 17.177, 95% CI:5.046 ∼ 58.472, p = 0.000), but not by HIFU (aOR:1.105; 95% CI:0.240 ∼ 5.087, p = 0.898). No uterine rupture occurred in the cases after HIFU. CONCLUSIONS No uterine rupture occurred in our study group after HIFU. HIFU is not a risk for PPH. It is promising for those after HIFU to choose vaginal delivery.
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Affiliation(s)
- Jinping Gu
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Lin
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhengyu Guo
- School of Medicine, Tongji University, Shanghai, China
| | - Aixingzi Aili
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Wu G, Li R, He M, Pu Y, Wang J, Chen J, Qi H. A comparison of the pregnancy outcomes between ultrasound-guided high-intensity focused ultrasound ablation and laparoscopic myomectomy for uterine fibroids: a comparative study. Int J Hyperthermia 2021; 37:617-623. [PMID: 32525708 DOI: 10.1080/02656736.2020.1774081] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective: To compare the pregnancy outcomes between ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation and laparoscopic myomectomy (LM).Materials and methods: This study included 676 women with symptomatic uterine fibroids who wished to become pregnant underwent USgHIFU or LM at three hospitals in China from 1 May 2009 to 31 May 2018. The related information of pregnancy and delivery were followed up and analyzed using the chi-square test and two-sided Student t-test.Results: The median follow-up duration was 5 (1-8) years; 20 patients (2.9%) were lost to follow-up. 320 patients were treated with UsgHIFU, and 336 were treated with LM. Two hundred nineteen (68.4%) women became pregnant after USgHIFU ablation, and 224 (66.7%) became pregnant after LM. Four hundred forty-three patients had 501 pregnancies (natural pregnancies, 405; in vitro fertilisation-embryo transfer pregnancies, 38). Average times to pregnancy were 13.6 ± 9.5 months after USgHIFU and 18.9 ± 7.3 months after LM (p < 0.05). The rate of cesarean delivery was lower in the USgHIFU group (41.6%) than in the LM group (54.9%) (p < 0.05). Incidences of placenta increta, placenta previa, and postpartum hemorrhage were low after USgHIFU compared with after LM. Incidences of preterm birth, fetal distress, fetal growth restriction, and puerperal infection were higher after USgHIFU than after LM. There was a risk of uterine rupture after both procedures.Conclusions: Compared with LM, USgHIFU ablation can significantly shorten the time to pregnancy, although pregnancy rates of the two procedures are similar. Some risks in pregnancy and delivery after HIFU should be evaluated and monitored.
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Affiliation(s)
- Guangping Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.,Department of Obstetrics and Gynecology, Chongqing Yubei District Maternal and Child Health Care Hospital, Chongqing, PR China
| | - Rong Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Min He
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, PR China
| | - Yuanfang Pu
- Department of Obstetrics and Gynecology of Chongqing, Nanchuan People's Hospital, Chongqing, PR China
| | - Jishu Wang
- Department of Obstetrics and Gynecology, Chongqing Yubei District Maternal and Child Health Care Hospital, Chongqing, PR China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, PR China
| | - Hongbo Qi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Hong YH, Song E, Kim SK, Lee JR, Suh CS. Operative and Obstetric Outcomes after Single-port Laparoscopic Myomectomy: A Retrospective Single-center Analysis of 504 Cases. J Minim Invasive Gynecol 2021; 28:2080-2088. [PMID: 34161855 DOI: 10.1016/j.jmig.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To analyze the obstetric and operative outcomes of 504 cases of single-port laparoscopic myomectomy (SPLM). DESIGN Single-center retrospective study. SETTING A tertiary university hospital. PATIENTS A total of 502 patients (504 SPLM procedures) who underwent SPLM for symptom relief or growing myomas between October 2009 and April 2020. INTERVENTIONS Data on patient demographics, operative variables (estimated blood loss, hemoglobin decrease, operation time, perioperative complications, and postoperative hospital stay), and obstetric outcomes (the surgery-to-pregnancy interval and birth-related outcomes) were obtained from medical records and analyzed. MEASUREMENTS AND MAIN RESULTS The mean age of the patients was 40.6 ± 6.6 years. The patients had had an average of 2.3 ± 2.2 myomas removed; the largest myoma size was 6.8 ± 2.4 cm. The mean operation time, postoperative hemoglobin decrease, and postoperative hospital stay duration were 112.9 ± 45.3 minutes, 1.7 ± 1.1 g/dL, and 2.2 ± 1.4 days, respectively. The overall rate of postoperative complications was 7.7% (39/504), and the common complications were transfusions (16/504, 3.1%) or wound problems (15/504, 3.0%). Conversion to multiport or open myomectomy was required in 0.8% of the cases (4/504). A total of 376 women were of child-bearing age, and 56 attempted to become pregnant after surgery. The mean interval from surgery to pregnancy was 15.6 ± 12.2 months. The obstetric outcomes were pregnancy (42/56, 75.0%), live birth (39/56, 69.6%), and miscarriage (2/56, 3.6%). One pregnant woman was lost to follow-up. The 39 live births predominantly involved full-term delivery (36/39, 92.3%), mostly through cesarean section (36/39, 92.3%). No postpartum complications were reported. The 2 most common obstetric complications were preterm labor (7.6%) and gestational diabetes (5.1%). CONCLUSION SPLM seems to be an effective procedure with good operative and postoperative obstetric outcomes for women with myomas who require surgery and may wish to subsequently become pregnant.
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Affiliation(s)
- Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, (Drs. Hong, Song, Kim, and Lee), Seongnam, South Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Hong, Kim, Lee, and Suh), Seoul, South Korea
| | - Eunjin Song
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, (Drs. Hong, Song, Kim, and Lee), Seongnam, South Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, (Drs. Hong, Song, Kim, and Lee), Seongnam, South Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Hong, Kim, Lee, and Suh), Seoul, South Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, (Drs. Hong, Song, Kim, and Lee), Seongnam, South Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Hong, Kim, Lee, and Suh), Seoul, South Korea.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Hong, Kim, Lee, and Suh), Seoul, South Korea; Department of Surgical Oncology, Sheikh Khalifa Specialty Hospital (Dr. Suh), Ras Al Khaimah, United Arab Emirates
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10
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Margueritte F, Adam C, Fauconnier A, Gauthier T. Time to conceive after myomectomy: should we advise a minimum time interval? A systematic review. Reprod Biomed Online 2021; 43:543-552. [PMID: 34353724 DOI: 10.1016/j.rbmo.2021.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
The optimal time interval between myomectomy and pregnancy is unclear and no specific guidelines exist. The aim of this review was to study the time interval from myomectomy to pregnancy and the occurrence of uterine rupture after myomectomy. Randomized controlled trials, cohort studies and retrospective studies were used to assess the primary objective, and case reports, cases series or letters to the editor for the secondary objective. Only articles reporting myomectomy performed via the vaginal route, laparotomy, laparoscopy or robot-assisted surgery were selected for inclusion. Among 3852 women who wanted to become pregnant after the surgery, 2889 became pregnant, accounting for 3000 pregnancies (77.9%) and 2097 live births (54.4%). Mean time between myomectomy and pregnancy was estimated at 17.6 months (SD 9.2) for 2451 pregnant women. Among 1016 women, a third were advised to delay attempting to conceive for between 3 and 6 months and another third for between 6 and 12 months. A total of 70 spontaneous uterine ruptures with a mean gestational age of 31 weeks at occurrence were identified. No linear relationship was found between gestational age at the event and time interval from myomectomy to conception (P = 0.706). There are insufficient data to advise a minimal time interval between myomectomy and conception.
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Affiliation(s)
- François Margueritte
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, Poissy 78300, France.
| | - Camille Adam
- Limoges University Hospital, Mother and Child Hospital, Department of Gynecology and Obstetrics and Reproductive Medicine, 8 Rue Dominique Larrey, Limoges 87000, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, Poissy 78300, France
| | - Tristan Gauthier
- Limoges University Hospital, Mother and Child Hospital, Department of Gynecology and Obstetrics and Reproductive Medicine, 8 Rue Dominique Larrey, Limoges 87000, France
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11
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Tan SQ, Chen LH, Muhd Abdul Qadir D, Chern BSM, Yeo GSH. Risk factors and outcomes of uterine rupture in Singapore: Emerging trends. ANNALS ACADEMY OF MEDICINE SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT
Introduction: Uterine rupture is uncommon but has catastrophic implications on the pregnancy. A scarred
uterus and abnormal placentation are known contributory factors. The aim of our study was to review
the contributing factors, clinical presentation, complications and management of uterine rupture in our
population in light of the changing nature of modern obstetric practices.
Methods: A retrospective observational study was conducted at KK Women’s and Children’s Hospital
by studying proven cases of uterine rupture in the period between January 2003 and December 2014. These
cases were analysed according to their past history, clinical presentation, complications, management
and outcome.
Results: A total of 48 cases of proven uterine rupture were identified. The incidence of uterine rupture
was 1 in 3,062 deliveries. The ratio of scarred uterus rupture to unscarred uterus rupture was approximately
3:1. The most common factor was previous lower segment caesarean section for the scarred group, followed
by a history of laparoscopic myomectomy. Abdominal pain was the common clinical presentation in the
antenatal period, while abnormal cardiotocography findings were the most common presentation in
intrapartum rupture.
Conclusion: There is a notable shift in the trend of uterine rupture cases given the increasing use of
laparoscopic myomectomy and elective caesarean sections. While ruptures from these cases were few, their
presentation in the antenatal period calls for diligent monitoring with informed patient involvement in their
pregnancy care.
Keywords: Antenatal, laparoscopic myomectomy, birth after caesarean, rupture, VBAC
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Affiliation(s)
- Shu Qi Tan
- KK Women’s and Children’s Hospital, Singapore
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12
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Younes S, Radosa JC, Mothes A, Aktaş B, Radosa MP. Use of a microsurgical vascular clip system (Yasargil clip) in laparoscopic fibroid enucleation. J Turk Ger Gynecol Assoc 2020; 21:305-307. [PMID: 32500681 PMCID: PMC7726460 DOI: 10.4274/jtgga.galenos.2020.2020.0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This video demonstrates the use of a microsurgical temporary vascular clip system to facilitate laparoscopic enucleation of uterine fibroids. Throughout the course of the last three decades, the laparoscopic route has been established as the approach of choice in the surgical treatment of uterine fibroids. Laparoscopic fibroid enucleation is characterized by a low morbidity rate and a high patient satisfaction level. Especially when treating a large fibroid or multiple fibroids, the well-vascularized myometrium can constitute a technical challenge in endoscopic fibroid enucleation. Diffuse bleeding may lead to significant intraoperative hemorrhage. The extensive use of bipolar or monopolar diathermy, in order to achieve hemostasis, might lead to post-operative uterine wall necrosis with a potential risk of uterine rupture during subsequent pregnancies. To address this clinical challenge, we developed a technique with temporary interruption of the uterine blood supply by applying a microsurgical vascular clip (Yasargil vascular clip system, Aesculap, Tuttlingen, Germany) to the uterine artery and the utero-ovarian vessel arcade to minimize bleeding during endoscopic fibroid enucleation.
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Affiliation(s)
- Shadi Younes
- Department of Obstetrics and Gynecology, Leipzig University Hospital, Leipzig, Germany
| | - Julia Caroline Radosa
- Department of Obstetrics and Gynecology, Saarland University Hospital, Homburg, Germany
| | - Anke Mothes
- Department of Obstetrics and Gynecology, St. George’s University Hospital, Eisenach, Germany
| | - Bahriye Aktaş
- Department of Obstetrics and Gynecology, Leipzig University Hospital, Leipzig, Germany
| | - Marc Philipp Radosa
- Department of Obstetrics and Gynecology, Leipzig University Hospital, Leipzig, Germany
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13
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Younes S, Radosa JC, Mothes A, Aktaş B, Radosa MP. Use of a microsurgical vascular clip system (Yasargil clip) in laparoscopic fibroid enucleation. J Turk Ger Gynecol Assoc 2020. [PMID: 32500681 DOI: 10.4274/jtgga.galenos.2020.2020-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This video demonstrates the use of a microsurgical temporary vascular clip system to facilitate laparoscopic enucleation of uterine fibroids. Throughout the course of the last three decades, the laparoscopic route has been established as the approach of choice in the surgical treatment of uterine fibroids. Laparoscopic fibroid enucleation is characterized by a low morbidity rate and a high patient satisfaction level. Especially when treating a large fibroid or multiple fibroids, the well-vascularized myometrium can constitute a technical challenge in endoscopic fibroid enucleation. Diffuse bleeding may lead to significant intraoperative hemorrhage. The extensive use of bipolar or monopolar diathermy, in order to achieve hemostasis, might lead to post-operative uterine wall necrosis with a potential risk of uterine rupture during subsequent pregnancies. To address this clinical challenge, we developed a technique with temporary interruption of the uterine blood supply by applying a microsurgical vascular clip (Yasargil vascular clip system, Aesculap, Tuttlingen, Germany) to the uterine artery and the utero-ovarian vessel arcade to minimize bleeding during endoscopic fibroid enucleation.
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Affiliation(s)
- Shadi Younes
- Department of Obstetrics and Gynecology, Leipzig University Hospital, Leipzig, Germany
| | - Julia Caroline Radosa
- Department of Obstetrics and Gynecology, Saarland University Hospital, Homburg, Germany
| | - Anke Mothes
- Department of Obstetrics and Gynecology, St. George’s University Hospital, Eisenach, Germany
| | - Bahriye Aktaş
- Department of Obstetrics and Gynecology, Leipzig University Hospital, Leipzig, Germany
| | - Marc Philipp Radosa
- Department of Obstetrics and Gynecology, Leipzig University Hospital, Leipzig, Germany
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14
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Orlando M, Kollikonda S, Hackett L, Kho R. Non-hysteroscopic Myomectomy and Fertility Outcomes: A Systematic Review. J Minim Invasive Gynecol 2020; 28:598-618.e1. [PMID: 33065260 DOI: 10.1016/j.jmig.2020.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To perform a systematic review of the literature to identify best practices for nonhysteroscopic myomectomy for women with myomas who desire future fertility. The focus areas included factors associated with conception and pregnancy outcomes after myomectomy, impact of surgical route (laparotomic, laparoscopic, and the incorporation of robot assistance), and preoperative findings and surgical techniques that have an impact on reproduction. DATA SOURCES Librarian-led electronic searches of the Ovid MEDLINE, Ovid Embase, and Cochrane CENTRAL databases were performed from inception to February 2020. A targeted reference review was performed to update the original searches. METHODS OF STUDY SELECTION The participants were women of reproductive age with myomas who underwent myoma removal surgery through laparotomic or laparoscopic approaches. The fertility outcomes included markers for ovarian reserve, clinical pregnancy rates, and pregnancy outcomes. We performed quality assessment using National Institutes of Health Study Quality Assessment Tools and developed clinical recommendations graded according to the strength of the evidence. TABULATION, INTEGRATION, AND RESULTS The initial search identified 2163 studies, of which 51 met the inclusion criteria. These consisted of 11 studies that focused on the factors associated with conception or pregnancy outcomes after myomectomy, 10 studies that examined the route of nonhysteroscopic myomectomy, and 30 that were related to intraoperative techniques and findings. Overall, younger age, lower myoma number, and distortion of the endometrial cavity were associated with improved reproductive outcomes after myomectomy. The route of nonhysteroscopic myomectomy and intraoperative uterine artery occlusion did not significantly affect pregnancy rates or outcomes. Adhesion barriers present a possible target for further research. CONCLUSION This study provides insights into patient selection and intraoperative techniques for nonhysteroscopic myomectomy. Further research with well-designed clinical trials is needed to highlight the relationships between myoma characteristics (International Federation of Gynecology and Obstetrics type, location, and size) and reproductive outcomes.
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Affiliation(s)
- Megan Orlando
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Orlando, Kollikonda, and Kho); Floyd D. Loop Alumni Library (Ms. Hackett), Cleveland Clinic, Cleveland, Ohio.
| | - Swapna Kollikonda
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Orlando, Kollikonda, and Kho); Floyd D. Loop Alumni Library (Ms. Hackett), Cleveland Clinic, Cleveland, Ohio
| | - Loren Hackett
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Orlando, Kollikonda, and Kho); Floyd D. Loop Alumni Library (Ms. Hackett), Cleveland Clinic, Cleveland, Ohio
| | - Rosanne Kho
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Orlando, Kollikonda, and Kho); Floyd D. Loop Alumni Library (Ms. Hackett), Cleveland Clinic, Cleveland, Ohio
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15
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Clinical experience of robotic myomectomy for fertility preservation using preoperative magnetic resonance imaging predictor. Obstet Gynecol Sci 2020; 63:726-734. [PMID: 32932569 PMCID: PMC7677062 DOI: 10.5468/ogs.20145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Objective This study aimed to demonstrate the use of preoperative magnetic resonance imaging (MRI) findings to select the optimal surgical technique between single-site (SS) and multi-site (MS) robotic myomectomy based on clinical experience, for the preservation of fertility. Methods Ninety-eight patients who underwent SS or MS robotic myomectomy using the da Vinci® Si system after undergoing MRI were evaluated retrospectively. The correlation between preoperative MRI findings and the intraoperative or postoperative findings during robotic myomectomy for the preservation of fertility was analyzed. The reproductive outcome was investigated when the patient wished to conceive. Results The mean age of the patients was 35.68±5.04 years and 80 patients (81.6%) were nulliparous. The total diameter of myomas on MRI was 106.75±54.52 mm. The number of resected myomas was 4.31±4.39 (range, 1–27), and the total weight of resected myomas was 293.11±281.13 (range, 30–1,260) g. Myomas with high signal intensity on MRI required less time for resection. MS robotic myomectomy was performed for an increased number and total diameter of a myoma or a deep-seated myoma. Postoperatively, all patients resumed normal menstruation. Of the 15 patients who wished to conceive, 12 (80%) conceived successfully. Of these, uterine dehiscence occurred in 1 patient and 10 patients underwent an uneventful cesarean section. Conclusion SS or MS robotic myomectomy can be recommended for patients who wish to conserve fertility. However, the optimal surgical technique should be selected based on preoperative MRI findings to predict an effective surgical process and the successful preservation of fertility.
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16
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Arena A, Degli Esposti E, Cristani G, Orsini B, Moro E, Raimondo D, Del Forno S, Lenzi J, Casadio P, Seracchioli R. Comparison of fertility outcomes after laparoscopic myomectomy for barbed versus nonbarbed sutures. Fertil Steril 2020; 115:248-255. [PMID: 32933760 DOI: 10.1016/j.fertnstert.2020.07.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact on women's reproductive outcomes of barbed sutures to repair uterine breaches during laparoscopic myomectomy compared with traditional smooth sutures. DESIGN Retrospective, monocentric cohort study, with information on subsequent pregnancies prospectively acquired for some women. SETTING Tertiary-level academic referral center. PATIENT(S) Women older than 18 years who had undergone a laparoscopic myomectomy and had sought pregnancy afterward, divided into two groups based on type of suture used to repair the uterine wall: group A (nonbarbed) and group B (barbed). INTERVENTION(S) Laparoscopic removal of FIGO types 3, 4, 5, and 6 uterine leiomyomas by use of either only barbed sutures or only traditional smooth sutures to reconstruct the uterine defect. MAIN OUTCOME MEASURE(S) Pregnancy achievement rates, delivery modes, main pregnancy complications, perioperative complications for both kinds of suture, and the trend of the use of barbed sutures over time at our center. RESULT(S) Of 164 patients included, 83 were in group A and 81 in group B. Ninety-one patients (55.5%) experienced at least one postoperative pregnancy, with no differences between the groups (group A 60.5%; group B 50.6%). Of the 103 recorded postoperative pregnancies, 70 (68%) resulted in live births, 29 (28.1%) in first-trimester miscarriages, and 4 (3.9%) were ongoing. CONCLUSION(S) Barbed sutures have a similar impact on reproductive outcomes as smooth conventional threads, both in terms of pregnancy and obstetric complication rates, after laparoscopic myomectomy.
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Affiliation(s)
- Alessandro Arena
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Eugenia Degli Esposti
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy.
| | - Giulia Cristani
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Benedetta Orsini
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Elisa Moro
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simona Del Forno
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Dipartmento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
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17
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Berman JM, Shashoua A, Olson C, Brucker S, Thiel JA, Bhagavath B. Case Series of Reproductive Outcomes after Laparoscopic Radiofrequency Ablation of Symptomatic Myomas. J Minim Invasive Gynecol 2020; 27:639-645. [DOI: 10.1016/j.jmig.2019.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/24/2019] [Accepted: 06/14/2019] [Indexed: 11/24/2022]
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18
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Khaw SC, Anderson RA, Lui MW. Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids. Reprod Biomed Online 2020; 40:429-444. [DOI: 10.1016/j.rbmo.2020.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
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Karlsen K, Mogensen O, Humaidana P, Kesmodel US, Ravn P. Uterine fibroids increase time to pregnancy: a cohort study. EUR J CONTRACEP REPR 2019; 25:37-42. [PMID: 31821047 DOI: 10.1080/13625187.2019.1699047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The primary purpose of the study was to investigate a possible association between uterine fibroids and time to pregnancy (TTP), and, secondly, to explore the effect of myomectomy on TTP.Methods: This historical cohort study used data from the Danish National Birth Cohort and the Danish National Patient Registry. The study population consisted of 86,323 women with 92,696 pregnancies. The main outcome was TTP; groups were compared using a binary outcome: TTP >12 months or TTP ≤12 months.Results: Women who had a fibroid diagnosis code before attempting to conceive (n = 92) had an increased risk of TTP >12 months compared with women without a fibroid diagnosis code (n = 87,358) (adjusted odds ratio [OR] 1.67; 95% confidence interval [CI] 1.05, 6.68). Women who had a fibroid diagnosis code after pregnancy (n = 963) also had an increased risk of TTP >12 months compared with women without a fibroid diagnosis code (adjusted OR 1.24; 95% CI 1.04, 1.47).Conclusion: We found an association between having a uterine fibroid diagnosis code and TTP >12 months. We were not able to make a valid assessment of the effect of myomectomy on TTP.
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Affiliation(s)
- Kamilla Karlsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ole Mogensen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Research, Aarhus University, Aarhus, Denmark
| | - Peter Humaidana
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,The Fertility Clinic, Skive Regional Hospital, Skive, Denmark.,Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark.,Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Pernille Ravn
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
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20
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Huberlant S, Lenot J, Neron M, Ranisavljevic N, Letouzey V, De Tayrac R, Masia F, Warembourg S. Fertility and obstetrical outcomes after robot-assisted laparoscopic myomectomy. Int J Med Robot 2019; 16:e2059. [PMID: 31770474 DOI: 10.1002/rcs.2059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 09/30/2019] [Accepted: 10/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate fertility after robot-assisted laparoscopic myomectomy (RALM) in terms of pregnancy rates, and obstetrical outcomes. PATIENTS This is a retrospective cohort of RALM performed for symptomatic leiomyomas among women who want to conceive. Medical data were retrospectively reviewed. An office hysteroscopy was prescribed 3 months after the surgery. RESULTS Fifty-three patients were included. The mean number of myomas was 2 ± 1.5 with a mean size of 69 ± 17.7 mm. A breach of the cavity was noticed in 15.1% of the cases. Two cases of intrauterine adhesions were diagnosed and treated during the post-operative office hysteroscopy (5.7%). Clinical pregnancy rates were 52.8% with a live birth rate of 41.5% in patients desiring pregnancy. A caesarean section was performed in 17 cases (70.8%). No case of uterine rupture was reported. CONCLUSION More than half of the patients became pregnant after RALM. A low rate of obstetrical complications was reported, with no uterine ruptures, highlighting the promise of this technique for infertile patients.
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Affiliation(s)
- Stéphanie Huberlant
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Juliette Lenot
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France.,Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Mathias Neron
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Noémie Ranisavljevic
- Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Vincent Letouzey
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Renaud De Tayrac
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Florent Masia
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Sophie Warembourg
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France.,Department of Obstetrics and Gynecology, Croix Rousse University Hospital (Hospices civils de Lyon), Lyon, France
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21
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Unexpected coexistent endometriosis in women with symptomatic uterine leiomyomas is independently associated with infertility, nulliparity and minor myoma size. Arch Gynecol Obstet 2019; 300:103-108. [PMID: 31006843 DOI: 10.1007/s00404-019-05153-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine risk factors for unexpected coexistent endometriosis in laparoscopic myomectomy for symptomatic uterine leiomyomas. METHODS This was a single-centre, retrospective cohort study conducted at a University Women's Hospital with a certified endometriosis centre. Data were collected from patients with symptomatic uterine leiomyomas who underwent laparoscopic myomectomy. The main outcome measured in the study was the presence of histologically confirmed endometriosis. Binary regression analysis was used to investigate risk factors for the coexistence of endometriosis. Postoperative complications were classified according to the Clavien-Dindo classification. RESULTS From 2014 to 2018, 223 patients underwent laparoscopic myomectomy for symptomatic leiomyomas, and 57 (25.6%) had unexpected endometriosis. Women with endometriosis significantly more frequently were nulliparous (66.7% vs. 51.2%; p = 0.04), had reported infertility (31.6% vs. 15.7%; p = 0.01) and smaller leiomyomas (mean diameter 4.92 cm) than women without endometriosis (mean diameter 6.02 cm; p = 0.006). Coexistent endometriosis significantly increased mean operative time (168.4 vs. 142.8 min; p = 0.05) while intra- and postoperative complications showed a similar distribution (p = 0.87) and length of hospital stay (p = 0.26). Binary regression analysis identified 2.3- and 2.2-fold increases in the risk of endometriosis for infertility (p = 0.042) and nulliparity (p = 0.041), respectively. Myoma size influenced the risk of endometriosis by a factor of 0.8 per cm (p = 0.037). CONCLUSIONS Coexistent endometriosis should be expected in leiomyoma patients particularly with nulliparity, infertility or minor myoma size as independent risk factors. Preoperative counselling should incorporate surgical therapy of coexisting endometriosis.
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22
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Oxley SG, Mallick R, Odejinmi F. Laparoscopic Myomectomy: An Alternative Approach to Tackling Submucous Myomas? J Minim Invasive Gynecol 2019; 27:155-159. [PMID: 30926366 DOI: 10.1016/j.jmig.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE To evaluate the differences in perioperative outcomes and immediate complication rates between laparoscopic myomectomy for submucous myomas and laparoscopic myomectomy for myomas in other locations. DESIGN Retrospective cohort study. SETTING University-affiliated hospital in London. PATIENTS A total of 350 patients with symptomatic uterine myomas underwent laparoscopic myomectomy. Thirty-three of these were performed for submucous myomas (group 1), and 317 were for myomas in other uterine locations (group 2). INTERVENTIONS Analysis of prospectively collected data on patient demographics, myoma characteristics, perioperative outcomes, and immediate complications. MEASUREMENTS AND MAIN RESULTS Patient demographics, including age, body mass index, and parity, were similar in the 2 groups. No significant differences in myoma characteristics were seen between groups 1 and 2, including the mean dimension of largest myoma (7.1 vs 7.8 cm, respectively; p = .35), mean number of myomas removed (3.8 vs 4.1; p = .665), and mean mass of myomas removed (142.0 g vs 227.3 g; p = .186). There were also no significant between-group differences in any perioperative outcomes, including mean blood loss (226.8 mL vs 266.4 mL; p = .373), duration of surgery (103 minutes vs 113 minutes; p = .264), and duration of hospital stay (1.4 days vs 1.7 days; p = .057). No complications arose from laparoscopic resection of submucous myomas. CONCLUSION Laparoscopic myomectomy for submucous myomas has similar perioperative outcomes and immediate complications as laparoscopic myomectomy for other myomas and can be considered for large or type 2 submucous myomas.
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Affiliation(s)
- Samuel George Oxley
- Department of Women's Health, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (Drs. Oxley and Odejinmi).
| | - Rebecca Mallick
- Department of Women's Health, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Haywards Heath, United Kingdom (Dr. Mallick)
| | - Funlayo Odejinmi
- Department of Women's Health, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (Drs. Oxley and Odejinmi)
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24
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Liu X, Xue L, Wang Y, Wang W, Tang J. Vaginal delivery outcomes of pregnancies following ultrasound-guided high-intensity focused ultrasound ablation treatment for uterine fibroids. Int J Hyperthermia 2018; 35:510-517. [PMID: 30354861 DOI: 10.1080/02656736.2018.1510548] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Xin Liu
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Lijuan Xue
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yang Wang
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Wei Wang
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
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25
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Kameda S, Toyoshima M, Tanaka K, Fujii O, Iida SI, Yaegashi N, Murakami T, Hoshi K. Utility of Laparoscopic Uterine Myomectomy as a Treatment for Infertility with No Obvious Cause Except for Uterine Fibroids. Gynecol Minim Invasive Ther 2018; 7:152-155. [PMID: 30306033 PMCID: PMC6172875 DOI: 10.4103/gmit.gmit_2_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/24/2018] [Accepted: 08/20/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives: Uterine fibroids are capable of causing infertility, but there are no definite criteria for which laparoscopic uterine myomectomy (LM) is known to be beneficial. To investigate the usefulness of LM, we examined pregnancy rates in patients with infertility with no obvious cause except for the presence of uterine fibroids. Materials and Methods: We retrospectively reviewed the clinical records at Suzuki Memorial Hospital between June 2010 and August 2014. We found 60 eligible patients (LM group, 46; non-LM group, 14). The criteria for performing LM were a maximal fibroid diameter of 40 mm or more or the presence of >4 fibroids. Results: The duration of infertility before the first visit was significantly longer in the LM group; although there was no significant difference in the mean patient age and body mass index. Pregnancy was achieved in 45.7% of patients (21/46) in the LM group and 28.6% (4/14) in the non-LM group. There were no pregnancies in patients with >10 fibroids. The postoperative pregnancy rate in the LM group was comparable to previously reported pregnancy rates. Conclusions: Our criteria for performing LM in patients with no obvious cause for infertility except for uterine fibroids seem appropriate, especially when the fibroids are large and the number of fibroids is between 4 and 9. However, our results suggest that the effectiveness of LM is low in patients with 10 or more uterine fibroids.
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Affiliation(s)
- Satomi Kameda
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kohei Tanaka
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Osamu Fujii
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Shu-Ichi Iida
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Kazuhiko Hoshi
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
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Wu X, Jiang W, Xu H, Ye X, Xu C. Characteristics of uterine rupture after laparoscopic surgery of the uterus: clinical analysis of 10 cases and literature review. J Int Med Res 2018; 46:3630-3639. [PMID: 29916299 PMCID: PMC6136024 DOI: 10.1177/0300060518776769] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective An increasing trend of uterine rupture (UR) after laparoscopic surgery of the
uterus (LSU) has been observed. Although the overall incidence is extremely
low, UR may have catastrophic outcomes. Therefore, investigation of its
potential risk factors is important. Methods We retrospectively reviewed the medical data of 10 women who developed UR
after LSU performed at our hospital from October 2003 to October 2016 and
conducted a literature review. Results All cases of UR occurred during the third trimester of pregnancy. The
surgeries contributing to UR were laparoscopic myomectomy, adhesion
decomposition, and salpingectomy, resulting in unfavorable outcomes
especially for the fetus. Diathermy was routinely used for hemostasis, and
multilayer suturing was not adequately performed in many cases. The
posterior wall was the most common site of UR in most cases. Silent rupture
with unremarkable symptoms was not rare. Similar risk factors were
identified in the literature review. Conclusions Excessive use of energy equipment and the lack of multilayer suturing were
the most common characteristics of UR after LSU. A history of LSU should
always be considered a risk factor for UR.
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Affiliation(s)
- Xiaoyi Wu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Wei Jiang
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Huan Xu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Xuping Ye
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Congjian Xu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China.,2 Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200032, People's Republic of China.,3 Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, People's Republic of China
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Tomczyk KM, Wilczak M, Rzymski P. Uterine rupture at 28 weeks of gestation after laparoscopic myomectomy - a case report. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2018; 17:101-104. [PMID: 30150920 PMCID: PMC6107097 DOI: 10.5114/pm.2018.77314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/06/2018] [Indexed: 02/05/2023]
Abstract
There are many reasons for sterility, and uterine malformations are of the greatest concern. Among uterine disorders, myomas play a significant role and are present in 27% of infertile women. The occurrence of myomas is frequent - 20-40% in women of reproductive age. Thus, for those infertile patients surgical treatment may be needed to preserve an opportunity to conceive. This case report refers to an uterine rupture at 28 weeks of gestation after laparoscopic myomectomy (3 months before conceiving). The myomectomy was conducted correctly and two layers of sutures on the myometrium were performed. The purpose of the myomectomy in a young woman should be well considered. In cases of infertility, removal of the lesions is usually necessary to give the patient a chance of pregnancy. At the same time, the risk of uterine rupture is increased. There are some suggestions referring to myomectomy to reduce the risk of uterine rupture in a subsequent pregnancy. It seems that the method of sewing the uterine closure is crucial. For example, multilayer uterine stitches, preservation of the endometrial cavity, and avoidance of using electrosurgery to prevent devascularization (to avoid haematoma formation) should be taken into consideration to prevent weakness of the wall of the uterus. Uterine scars differ histologically and biochemically.
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Affiliation(s)
- Katarzyna M Tomczyk
- Department of Mother and Child Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Wilczak
- Department of Mother and Child Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Rzymski
- Department of Mother and Child Health, Poznan University of Medical Sciences, Poznan, Poland
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Yazawa H, Takiguchi K, Ito F, Fujimori K. Uterine rupture at 33rd week of gestation after laparoscopic myomectomy with signs of fetal distress. A case report and review of literature. Taiwan J Obstet Gynecol 2018; 57:304-310. [DOI: 10.1016/j.tjog.2018.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/24/2022] Open
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Abbas AM, Michael A, Ali SS, Makhlouf AA, Ali MN, Khalifa MA. Spontaneous prelabour recurrent uterine rupture after laparoscopic myomectomy. J OBSTET GYNAECOL 2018; 38:1033-1034. [DOI: 10.1080/01443615.2018.1447913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ahmed M. Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Armia Michael
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shymaa S. Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Alaa A. Makhlouf
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mustafa N. Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mansour A. Khalifa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Sawada M, Kakigano A, Matsuzaki S, Takiuchi T, Mimura K, Kumasawa K, Endo M, Ueda Y, Yoshino K, Kimura T. Obstetric outcome in patients with a unicornuate uterus after laparoscopic resection of a rudimentary horn. J Obstet Gynaecol Res 2018. [PMID: 29516633 DOI: 10.1111/jog.13622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Previous studies have shown adverse obstetric outcomes of the laparoscopic resection of a rudimentary horn. Our study aimed to investigate the obstetric outcome in our institution and to review previous studies. METHODS Using a retrospective analysis, data were reviewed from singleton pregnancies with maternal uterine anomalies at a medical center in Osaka, Japan, between January 2011 and March 2016. The uterine anomaly cases were divided into a 'postlaparoscopic resection of the rudimentary horn' group (study group) and an 'other uterine anomalies' (bicornuate uterus, uterine didelphys and unicornuate uterus) group (control group). Primary outcomes of interest were differences in obstetric outcomes, such as spontaneous preterm birth rate, small for gestational age (SGA) infant rate and hypertensive disorders of pregnancy (HDP) rate between the study and the control group, and the secondary outcome of interest was mode of delivery in the study group. RESULTS Data from 40 deliveries were included in the study (7 deliveries: study group, 33 deliveries: control group). No significant difference was observed between the two groups in terms of either mean gestational weeks at delivery (36.4 weeks vs 37.1 weeks; P = .38), cesarean delivery rate (57.1% vs 57.5%; P = 1.0), SGA infant rate (<10th percentile) (0% vs 24.2%; P = .31) and HDP rate (0.0% vs 3.0%; P = 1.0). Three of seven cases with postlaparoscopic resection of the rudimentary horn were able to deliver vaginally without complications. CONCLUSION Our study shows that the obstetric outcome observed in the study group was similar to that observed in the control group.
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Affiliation(s)
- Masaaki Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Morbidity, fertility and pregnancy outcomes after myoma enucleation by laparoscopy versus laparotomy. Arch Gynecol Obstet 2018; 297:969-976. [PMID: 29417281 DOI: 10.1007/s00404-018-4697-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Myomas are defined as benign tumours that arise from smooth muscle cells of the uterus. Clinically, they are found in 5-77% of women of reproductive age. The prevalence rate varies considerably in the literature and a large number of fibroids do not cause symptoms. The lifetime risk of acquiring myomas is 70% for Caucasian women and ≥ 80% for African American women. MATERIALS/METHODS The data of 265 patients undergoing surgery for symptomatic myomas by laparoscopy or laparotomy, performed in the gynaecological department of Hannover Medical School, Hannover, Germany, between 2009 and 2013, were retrospectively analysed in this retrospective design study. RESULTS High pregnancy rates (up to 70%) and birth rates (up to 86%) after myomectomy, regardless of the surgical approach adopted, were found in the current study. The trend was that ≥ 3 myomas and those that were ≥ 6 cm in size were almost always removed by laparotomy in our clinic. It was possible to remove up to 42 myomas without having to perform a hysterectomy. A statistically significant negative correlation was observed in relation to the association between the size of the largest myoma extracted and the pregnancy rate (p = 0.02). A statistically significant correlation between the number of removed myomas and the pregnancy rate was observed for patients who wished to bear children (p = 0.010). Elevated complication rates (of up to 50%) were reported for more than three extracted myomas with a statistically significance (p = 0.0471). CONCLUSIONS It is necessary to ensure sound preoperative selection of the surgical approach in order to achieve the most optimal results, especially for those patients who wished to bear children.
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Shue S, Radeva M, Falcone T. Comparison of Long-Term Fertility Outcomes after Myomectomy: Relationship with Number of Myomas Removed. J Minim Invasive Gynecol 2018; 25:1002-1008. [PMID: 29371170 DOI: 10.1016/j.jmig.2018.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To determine if the number of myomas removed during myomectomy for symptomatic relief affects long-term fertility outcomes in reproductive-aged women. DESIGN Retrospective cohort survey study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS One hundred forty-four patients who underwent myomectomy for symptomatic myomas and attempted to conceive afterward. INTERVENTION Questionnaire mailed to reproductive-aged women who received robotic, laparoscopic, or abdominal myomectomy. MEASUREMENTS AND MAIN RESULTS Patients with >6 myomas removed were less likely to achieve pregnancy after myomectomy than patients with ≤6 myomas removed (22.9% vs 70.8%, respectively; p < .001). To achieve pregnancy, 45% of those with >6 myomas removed (vs 17.6% of those with ≤6 myomas removed) relied on fertility treatment (clomiphene citrate, letrozole, intrauterine insemination, or in vitro fertilization). Of those with >6 myomas removed who became pregnant, 45.5% had a term birth, 45.5% miscarried, and 9.1% had an ectopic pregnancy. Of those with ≤6 myomas removed who became pregnant, 61.8% had a term birth, 23.5% had a preterm birth, and 13.2% miscarried. CONCLUSION The number of myomas removed during myomectomy significantly affects fertility. Women with >6 myomas removed were less likely to become pregnant, more likely to require fertility treatment, and less likely to have a term birth when compared with women with ≤6 myomas removed.
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Affiliation(s)
- Shirley Shue
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Milena Radeva
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
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Pop L, Suciu ID, Oprescu D, Micu R, Stoicescu S, Foroughi E, Sipos P. Patency of uterine wall in pregnancies following assisted and spontaneous conception with antecedent laparoscopic and abdominal myomectomies - a difficult case and systematic review. J Matern Fetal Neonatal Med 2018; 32:2241-2248. [PMID: 29320920 DOI: 10.1080/14767058.2018.1427060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A case of uterine rupture at 24 weeks in a pregnancy succeeding myomectomy and triple embryo transfer is described and literature is reviewed systematically to evaluate the importance of uterine rupture in pregnancies after myomectomy in general and some important sub-populations. Systematic search identified 179 papers and following a strategical selection process 45 studies were analyzed in detail, including 6 cohort and 19 observational studies, 3 case series and 17 case reports. Comparison of risk of uterine rupture after abdominal and laparoscopic myomectomy is made. In pregnancies after IVF number of embryos transferred are determined. Optimal contraceptive intervals and surgical techniques are discussed. The consequences of these observations are analyzed and conclusions are made which can assist individualizing treatment options and improve patient selection.
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Affiliation(s)
- Lucian Pop
- a Department of Obstetrics and Gynecology , Alessandrescu-Rusescu Institute of Mother and Child Care , Bucharest , Romania.,b Department of Obstetrics and Gynecology , University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Ioan Dumitru Suciu
- c Department of General Surgery , Floreasca Emergency Hospital , Bucharest , Romania
| | - Daniela Oprescu
- a Department of Obstetrics and Gynecology , Alessandrescu-Rusescu Institute of Mother and Child Care , Bucharest , Romania.,b Department of Obstetrics and Gynecology , University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Romeo Micu
- d Department of Mother and Child , Iuliu Hateganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Silvia Stoicescu
- a Department of Obstetrics and Gynecology , Alessandrescu-Rusescu Institute of Mother and Child Care , Bucharest , Romania.,b Department of Obstetrics and Gynecology , University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Ebrahim Foroughi
- e Department of Obstetrics and Gynaecology , Sheffield Teaching Hospitals , Sheffield , UK
| | - Peter Sipos
- e Department of Obstetrics and Gynaecology , Sheffield Teaching Hospitals , Sheffield , UK.,f Department of Oncology and Metabolism , University of Sheffield , Sheffield , UK
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Li JS, Wang Y, Chen JY, Chen WZ. Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study. Sci Rep 2017. [PMID: 28638108 PMCID: PMC5479832 DOI: 10.1038/s41598-017-04319-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To explore the impact of high-intensity focused ultrasound (HIFU) ablation of uterine fibroids in nulliparous women on subsequent pregnancy and delivery. A retrospective analysis was conducted of nulliparous women who received HIFU treatment at Chongqing Medical University, Chongqing,China, from January 1, 2010, to January 1, 2015. A total of 189 cases were enrolled, the median follow-up time was three years. Among them,there were 131 cases pregnancy with a total of 133 times,the pregnancy rate was 69.3% (131/189),and the spontaneous conception rate was 95.4% (125/131). Of 131 pregnant women, 19 were on-going pregnancy, terminated pregnancy 114 times,which include 93 times successfully delivery with a 76.3% (87/114) full-term birth rate,and the cesarean section rate was 72.0% (67/93). Of 94 newborns,the average birth weight was (3.3 ± 0.4)kg (range:1.5–4.8 kg), and a pair of them were identical twins. The incidence of complications during pregnancy and delivery were 10.8% (10/93) and 7.5% (7/93),respectively,except one woman failed on-going pregnancy and one woman suffered hysterectomy due to the complications,others all successful pregnant and delivered. Multiple-factor regression analysis found that age and infertility history were the important factors that may affect pregnancy after HIFU (P < 0.01). Nulliparous women who undergo HIFU treatment for uterine fibroids can subsequently have successful pregnancy and delivery safely.
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Affiliation(s)
- Jun Shu Li
- The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing, 400016, China
| | - Yong Wang
- The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing, 400016, China
| | - Jin Yun Chen
- The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing, 400016, China. .,HIFU Center for Tumor Therapy, 1st Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, China.
| | - Wen Zhi Chen
- The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing, 400016, China. .,Clinical Center for Tumor Therapy, the Second Affiliated Hospital of Chongqing Medical University, 74 Lin jiang Road, Chongqing, 400010, China.
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Comment on "Laparoscopic Myomectomy of a Symptomatic Uterine Leiomyoma in a 15-Year-Old Adolescent". J Pediatr Adolesc Gynecol 2017; 30:442-443. [PMID: 27965124 DOI: 10.1016/j.jpag.2016.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/29/2016] [Accepted: 11/23/2016] [Indexed: 11/21/2022]
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Radosa JC, Radosa CG, Mavrova R, Wagenpfeil S, Hamza A, Joukhadar R, Baum S, Karsten M, Juhasz-Boess I, Solomayer EF, Radosa MP. Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study. PLoS One 2016; 11:e0166659. [PMID: 27898669 PMCID: PMC5127523 DOI: 10.1371/journal.pone.0166659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Uterine leiomyomas are the most common benign gynecologic tumors. To date laparoscopy myomectomy is the gold standard for treatment of symptomatic fibroids in reproductive-aged women. Detailed counseling about the effects of this procedure on postoperative sexuality and quality of life is important in these patients. However, available data on these subjects are limited and contradictory. The aim of this study was to assess sexual function and quality of life in premenopausal women undergoing laparoscopic myomectomy for symptomatic uterine fibroids. Material and Methods All premenopausal women who underwent laparoscopic myomectomy for symptomatic fibroids between April 2012 and August 2014 at a tertiary university center were enrolled in this prospective observational cohort study. Sexual function and quality of life were assessed for the pre- and postoperative (six months post-operatively) state using two validated questionnaires, the Female Sexual Function Index (FSFI) and the European Quality of Life Five-Dimension Scale (EQ-5D). Results Ninety-five of the 115 (83%) eligible patients completed the study. Overall a significant improvement in quality of life and sexual function was observed in the study cohort: Median FSFI (28 (18.7–35.2)) and EQ-5D scores (1 (0.61–1) after laparoscopic myomectomy were significantly higher than preoperative scores (21.2 (5.2–33.5); 0.9 (0.2–1); p ≤ 0.01). The number, position and localization of the largest fibroids were not correlated with pre- or postoperative sexual function or quality of life. Conclusion Laparoscopic myomectomy might have positive short-term effects on postoperative quality of life and sexual function in premenopausal women suffering from symptomatic fibroids.
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Affiliation(s)
- Julia Caroline Radosa
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
- * E-mail:
| | | | - Russalina Mavrova
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology & Medical Informatics, Saarland University Hospital, Homburg/Saar, Germany
| | - Amr Hamza
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Ralf Joukhadar
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Sascha Baum
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Maria Karsten
- Department of Gynecology, Charite Berlin, Berlin/Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Marc Philipp Radosa
- Department of Gynecology and Obstetrics, Jena University Hospital, Jena, Germany
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Uterine rupture in pregnancies following myomectomy: A multicenter case series. Obstet Gynecol Sci 2016; 59:454-462. [PMID: 27896247 PMCID: PMC5120064 DOI: 10.5468/ogs.2016.59.6.454] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/01/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this case series was to retrospectively examine records of cases with uterine rupture in pregnancies following myomectomy and to describe the clinical features and pregnancy outcomes. Methods This study was conducted as a multicenter case series. The patient databases at 7 tertiary hospitals were queried. Records of patients with a diagnosis of uterine rupture in the pregnancy following myomectomy between January 2012 and December 2014 were retrospectively collected. The uterine rupture cases enrolled in this study were defined as follows: through-and-through uterine rupture or tear of the uterine muscle and serosa, occurrence from 24+0 to 41+6 weeks’ gestation, singleton pregnancy, and previous laparoscopic myomectomy (LSM) or laparotomic myomectomy (LTM) status. Results Fourteen pregnant women experienced uterine rupture during their pregnancy after LSM or LTM. Preterm delivery of less than 34 weeks’ gestation occurred in 5 cases, while intrauterine fetal death occurred in 3, and 3 cases had fetal distress. Of the 14 uterine rupture cases, none occurred during labor. All mothers survived and had no sequelae, unlike the perinatal outcomes, although they were receiving blood transfusion or treatment for uterine artery embolization because of uterine atony or massive hemorrhage. Conclusion In women of childbearing age who are scheduled to undergo LTM or LSM, the potential risk of uterine rupture on subsequent pregnancy should be explained before surgery. Pregnancy in women after myomectomy should be carefully observed, and they should be adequately counseled during this period.
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Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update 2016; 22:665-686. [PMID: 27466209 PMCID: PMC5853598 DOI: 10.1093/humupd/dmw023] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/12/2016] [Accepted: 05/27/2016] [Indexed: 12/24/2022] Open
Abstract
Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid 'radical' surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine fibroids.There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to surgical intervention.There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). The efficacy of long-term intermittent use of UPA was recently demonstrated by randomized controlled studies.The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. These options now exist, with SPRMs which are proven to treat fibroid symptoms effectively. Gynecologists now have new tools in their armamentarium, opening up novel strategies for the management of uterine fibroids.
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Affiliation(s)
- Jacques Donnez
- Professor EM, Catholic University of Louvain, Director, Société de Recherche pour l'Infertilité (SRI), 143 Avenue Grandchamp, B-1150 Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Gynecology Department, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte B1.52.02, 1200 Brussels, Belgium
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Parazzini F, Tozzi L, Bianchi S. Pregnancy outcome and uterine fibroids. Best Pract Res Clin Obstet Gynaecol 2016; 34:74-84. [DOI: 10.1016/j.bpobgyn.2015.11.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/18/2015] [Indexed: 11/30/2022]
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Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, Berghella V. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstet Gynecol Scand 2016; 95:724-34. [DOI: 10.1111/aogs.12920] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Alexis C. Gimovsky
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; Sidney Kimmel College of Medicine; Thomas Jefferson University; Philadelphia PA USA
| | - Anna Locatelli
- Department of Obstetrics and Gynecology; University of Milan Bicocca; Milan Italy
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; Sidney Kimmel College of Medicine; Thomas Jefferson University; Philadelphia PA USA
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Removal of uterine fibroids by mini-laparotomy technique in women who wish to preserve their uterus and fertility. Wideochir Inne Tech Maloinwazyjne 2016; 10:561-6. [PMID: 26865893 PMCID: PMC4729736 DOI: 10.5114/wiitm.2015.56998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/14/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The minilaparotomy is considered to be a safe and effective alternative to laparoscopy and abdominal laparotomy in myomectomy cases. AIM To perform a retrospective analysis of pre-surgical assessment, surgical course and post-operational parameters in women wishing to preserve their uterus and fertility who underwent myomectomy by minilaparotomy in the Department of Gynecology and Gynecological Oncology at the Polish Mother's Memorial Hospital - Research Institute in Lodz in the years 2008-2014. MATERIAL AND METHODS A total of 76 patients were qualified for minilaparotomy due to a benign gynecological pathology. Only 21 patients with uterine fibroids who wanted to preserve their uterus and fertility were appropriate for this study. Patients' records were analyzed in terms of: epidemiological history, surgical course, postoperative stay and pathological data. All studied patients were asked in 2014 about conception and pregnancy after minilaparotomy. RESULTS The median age was 35.7 years. The median patient body mass index (BMI) was 24 kg/m(2). The average decrease of hemoglobin was 1.5 g/dl. The size of the myoma was between 1.5 and 15 cm. There were no serious post-surgical complications. The size of the myoma did not correlate significantly with operation time, BMI or blood loss. There was no statistically significant dependence between operation time and average hematocrit and hemoglobin decrease. In our group 7 patients who had undergone myomectomy tried to achieve conception. Four of them succeeded in pregnancy and gave birth to healthy infants. CONCLUSIONS Myomectomy performed via minilaparotomy is a safe procedure for patients willing to preserve their uterus and fertility, and it combines some advantages of both laparotomy and laparoscopy.
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Spontaneous Uterine Rupture in a Preterm Pregnancy following Myomectomy. Case Rep Obstet Gynecol 2016; 2016:6195621. [PMID: 26925275 PMCID: PMC4746347 DOI: 10.1155/2016/6195621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 11/17/2022] Open
Abstract
A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm. The neonate was transferred to the Special Care Nursery for neonatal care. The patient had an uncomplicated postoperative course and was discharged home three days following delivery. This is an unusual presentation of uterine rupture following myomectomy where the fetal arm had protruded through the uterine wall.
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The challenge of preoperative identification of uterine myomas: Is ultrasound trustworthy? A prospective cohort study. Arch Gynecol Obstet 2015; 293:1235-41. [DOI: 10.1007/s00404-015-3937-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022]
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Après myomectomie, les patientes ont-elles le droit d’accoucher par voie basse ? Résultats d’une étude monocentrique. ACTA ACUST UNITED AC 2015; 43:496-501. [DOI: 10.1016/j.gyobfe.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/13/2015] [Indexed: 11/20/2022]
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Pregnancy Outcomes and Risk Factors for Uterine Rupture After Laparoscopic Myomectomy: A Single-Center Experience and Literature Review. J Minim Invasive Gynecol 2015; 22:1022-8. [PMID: 26012718 DOI: 10.1016/j.jmig.2015.05.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To evaluate pregnancy outcomes after laparoscopic myomectomy (LSM), focusing on the risk of uterine rupture. DESIGN Retrospective cohort study (Canadian Task Force classification III). SETTING University hospital. PATIENTS Of 676 women who visited the obstetrics department for a pregnancy after undergoing LSM performed at the same center between 1994 and 2012, we included the 523 women who had follow-up through the end of pregnancy. INTERVENTIONS All patients underwent LSM, and their medical charts were retrospectively reviewed. MEASUREMENTS AND MAIN RESULTS Multiple myomas were removed in 35.2% of cases, intramural-type lesions occurred in 46.5% of cases, and the mean myoma diameter was 4.9 cm. Pregnancy outcomes after LSM included 400 (76.5%) full-term deliveries and 100 (19.1%) vaginal deliveries, with other adverse outcomes being no different than the general population. The mean interval between LSM and pregnancy was 14 months, and only 3 (0.6%) cases of uterine rupture occurred during pregnancy. In analysis, by reviewing the published cases of uterine rupture, we found that the mean diameter, myoma number and type, and the rate of uterine suture were similar between the ruptured cases and all of our cases of LSM. CONCLUSION LSM can be safely used in women of reproductive age who want to become pregnant. Uterine rupture occurs in rare cases, regardless of myoma features, but further large-scale studies are required to ascertain the detailed effects of various surgical techniques.
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Floss K, Garcia-Rocha GJ, Kundu S, von Kaisenberg CS, Hillemanns P, Schippert C. Fertility and Pregnancy Outcome after Myoma Enucleation by Minilaparotomy under Microsurgical Conditions in Pronounced Uterus Myomatosus. Geburtshilfe Frauenheilkd 2015; 75:56-63. [PMID: 25684787 PMCID: PMC4318730 DOI: 10.1055/s-0034-1396163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 02/05/2023] Open
Abstract
Introduction: Besides the typical complaints and symptoms, myomas can cause sterility, infertility and complications during pregnancy. Laparoscopic interventions reach their limits with regard to organ preservation and the simultaneous desire to have children in the removal of multiple and larger intramural myoma nodes. The aim of this study is to examine fertility status and pregnancy outcome after myoma removal by minilaparotomy (skin incision maximal 8 cm) in women with pronounced uterus myomatosus. Materials and Methods: This retrospective study makes use of the data from 160 patients with an average age of 34.6 years. Factors analysed include number, size and localisation of the myomas, complaints due to the myoma, pre- and postoperative gravidity, mode of delivery, and complications of birth. Results: Indications for organ-sparing myoma enucleation were the desire to have children (72.5 %), bleeding disorders (60 %) and pressure discomfort (36.5 %). On average 4.95 (SD ± 0.41), maximally 46 myomas were removed. The largest myoma had a diameter of 6.64 cm (SD ± 2.74). 82.5 % of the patients had transmural myomas, in 17.5 % the uterine cavity was inadvertently opened. On average the operating time was 163 minutes (SD ± 45.47), the blood loss 1.59 g/dL (SD ± 0.955). 60.3 % of the patients with the desire to have children became pregnant postoperatively. 75.3 % of the pregnancies were on average carried through to the 38th week (28.4 % vaginal deliveries, 71.6 % Caesarean sections). In the postoperative period there was one case of uterine rupture in the vicinity of a previous scar. Discussion: By means of the microsurgical "mini-laparotomy" even extensive myomatous uterine changes can, in the majority of cases, be operated in an organ-sparing manner with retention of the ability to conceive and to carry a pregnancy through to maturity of the infant. The risk for a postoperative uterine rupture in a subsequent pregnancy and during delivery is minimal.
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Affiliation(s)
- K. Floss
- Obstetrics and Gynecology, Medical School of Hannover (MHH), Hannover
| | | | - S. Kundu
- Obstetrics and Gynecology, Medical School of Hannover (MHH), Hannover
| | | | - P. Hillemanns
- Obstetrics and Gynecology, Medical School of Hannover (MHH), Hannover
| | - C. Schippert
- Obstetrics and Gynecology, Medical School of Hannover (MHH), Hannover
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Boosz AS, Reimer P, Matzko M, Römer T, Müller A. The conservative and interventional treatment of fibroids. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:877-83. [PMID: 25597366 DOI: 10.3238/arztebl.2014.0877] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/08/2014] [Accepted: 09/08/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum of available treatments has been widened by the introduction of new drugs and interventional procedures. METHODS Selective literature review on the treatment of uterine fibroids, including consideration of several Cochrane Reviews. RESULTS Fibroids can be treated with drugs, interventional procedures (uterine artery embolization [UAE] and focused ultrasound treatment [FUS]), and surgery. The evidence regarding the various available treatments is mixed. All methods improve symptoms, but only a few comparative studies have been performed. A meta-analysis revealed that recovery within 15 days is more common after laparoscopic enucleation than after open surgery (odds ratio [OR], 3.2). A minimally invasive hysterectomy, or one performed by the vaginal route, is associated with a shorter hospital stay and a more rapid recovery than open transabdominal hysterectomy. UAE is an alternative to hysterectomy for selected patients. The re-intervention rates after fibroid enucleation, hysterectomy, and UAE are 8.9-9%, 1.8-10.7%, and 7-34.6%, respectively. The main drugs used to treat fibroids are gonadotropin-releasing hormone analogs and selective progesterone receptor modulators. CONCLUSION Multiple treatment options are available and enable individualized therapy for symptomatic fibroids. The most important considerations in the choice of treatment are the question of family planning and, in some cases, the technical limitations of the treatments themselves.
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Affiliation(s)
- Alexander Stephan Boosz
- Städtisches Klinikum Karlsruhe, Department of Gynecology and Obstetrics, Frauenklinik des Evangelischen Krankenhauses Köln Weyertal, Städtisches Klinikum Karlsruhe, Institute of Diagnostic and Interventional Radiology, FUS Center, Dachau Medical Center
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