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Siblini H, Al-Hendy A, Segars J, González F, Taylor HS, Singh B, Flaminia A, Flores VA, Christman GM, Huang H, Johnson JJ, Zhang H. Assessing the Hepatic Safety of Epigallocatechin Gallate (EGCG) in Reproductive-Aged Women. Nutrients 2023; 15:320. [PMID: 36678191 PMCID: PMC9861948 DOI: 10.3390/nu15020320] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/01/2023] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
A similar abstract of the interim analysis was previously published in Fertility and Sterility. EPIGALLOCATECHIN GALLATE (EGCG) FOR TREATMENT OF UNEXPLAINED INFERTILITY ASSOCIATED WITH UTERINE FIBROIDS (PRE-FRIEND TRIAL): EARLY SAFETY ASSESSMENT. Uterine fibroids are the most common cause of unexplained infertility in reproductive-aged women. Epigallocatechin gallate (EGCG), a green tea catechin, has demonstrated its ability to shrink uterine fibroids in prior preclinical and clinical studies. Hence, we developed an NICHD Confirm-funded trial to evaluate the use of EGCG for treating women with fibroids and unexplained infertility (FRIEND trial). Prior to embarking on that trial, we here conducted the pre-FRIEND study (NCT04177693) to evaluate the safety of EGCG in premenopausal women. Specifically, our aim was to assess any adverse effects of EGCG alone or in combination with an ovarian stimulator on serum liver function tests (LFTs) and folate level. In this randomized, open-label prospective cohort, participants were recruited from the FRIEND-collaborative clinical sites: Johns Hopkins University, University of Chicago, University of Illinois at Chicago, and Yale University. Thirty-nine women, ages ≥18 to ≤40 years, with/without uterine fibroids, were enrolled and randomized to one of three treatment arms: 800 mg of EGCG daily alone, 800 mg of EGCG daily with clomiphene citrate 100 mg for 5 days, or 800 mg of EGCG daily with Letrozole 5 mg for 5 days. No subject demonstrated signs of drug induced liver injury and no subject showed serum folate level outside the normal range. Hence, our data suggests that a daily dose of 800 mg of EGCG alone or in combination with clomiphene citrate or letrozole (for 5 days) is well-tolerated and is not associated with liver toxicity or folate deficiency in reproductive-aged women.
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Affiliation(s)
- Hiba Siblini
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - James Segars
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Frank González
- Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Hugh S. Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT 06520, USA
| | - Bhuchitra Singh
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ainna Flaminia
- Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Valerie A. Flores
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT 06520, USA
| | - Gregory M. Christman
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT 06510, USA
| | - Jeremy J. Johnson
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT 06510, USA
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Mahalingam M, Hu M, Schointuch M, Szychowski JM, Harper L, Owen J, Sinkey R. Uterine myomas: effect of prior myomectomy on pregnancy outcomes. J Matern Fetal Neonatal Med 2022; 35:8492-8497. [PMID: 34615420 PMCID: PMC10961099 DOI: 10.1080/14767058.2021.1984424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Reproductive aged women with fibroids must weigh the risks and benefits of preconception myomectomy. Women with fibroids may have higher rates of fetal growth restriction (FGR) and stillbirth; however, there is a paucity of data on the impact of myomectomy on pregnancy outcomes. We compared perinatal outcomes in women with prior myomectomy versus those with no prior myomectomy and at least one fibroid ≥ 5 cm. METHODS Retrospective cohort study of women at a single center who delivered between 2008 and 2017 with a viable intrauterine pregnancy at initial ultrasound scan and either prior myomectomy, or, in the no-myomectomy cohort, at least one fibroid ≥ 5 cm on a prenatal scan performed at < 21 weeks' gestation (wga). Pregnancies complicated by major congenital anomalies were excluded. Primary outcome was preterm birth (PTB) < 37wga. Secondary outcomes included rates of spontaneous loss, cesarean delivery (CD), abnormal placentation, malpresentation, FGR, birthweight, birthweight percentile, estimated blood loss (EBL), blood transfusion, and neonatal survival to discharge. RESULTS A total of 290 women met inclusion criteria: 70 had a prior myomectomy, 220 women had ≥1 fibroid ≥5cm. Women with prior myomectomy were older, more likely to have private insurance, and more likely used artificial reproductive technology to conceive; 20% with prior myomectomy still had at least one ≥ 5 cm myoma on their obstetric scan. Rates of spontaneous loss were lower in the prior myomectomy group (1.4% vs 7.3%; p = .08). Of the 273 pregnancies continuing beyond 20 weeks, women with prior myomectomy had significantly more PTBs (35% vs. 21%, p = .02) and significantly different primary birth indications (p < .0001). However, after controlling for late preterm, prelabor cesareans recommended by providers in the myomectomy cohort, the difference in PTB rates was not significant (p = .13). The myomectomy group had more CDs (88% vs. 53%, p < .0001), higher EBL (1250 mL vs. 811 mL, p = .04), and a trend toward more blood transfusions (16% vs 8%, p = .05). Other selected outcomes were similar, including rates of FGR. CONCLUSIONS Women with prior myomectomy had significantly more PTBs, due in part to more preterm, prelabor cesareans in the late preterm period. Otherwise, prior myomectomy did not confer appreciable obstetric or perinatal benefits, as patients had more CDs, and higher EBL. Recommendations to perform preterm prelabor cesareans in this population may explain some of the PTB disparity. The effect of prior myomectomy on early pregnancy loss and infertility requires further study.
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Affiliation(s)
- Mythreyi Mahalingam
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Muhan Hu
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica Schointuch
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M. Szychowski
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lorie Harper
- Department of Women’s Health, University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - John Owen
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Sinkey
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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Takeda A, Shibata M, Koike W. Early identification of uterine scar defect by preconception magnetic resonance imaging to achieve successful pregnancy outcome after laparoscopic-assisted myomectomy: Two case reports. Clin Case Rep 2022; 10:e05441. [PMID: 35169475 PMCID: PMC8832169 DOI: 10.1002/ccr3.5441] [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: 12/13/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/07/2022] Open
Abstract
Myomectomy improves the reproductive ability of women. However, the risk for uterine rupture and abnormal placentation remains a concern. In two cases with scar defects after laparoscopic-assisted myomectomy, one case developed amniocele, while other case showed abnormally invasive placenta. Obstetrical management measures with cesarean sections yielded uneventful postoperative courses.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and GynecologyGifu Prefectural Tajimi HospitalTajimiJapan
| | - Mayu Shibata
- Department of Obstetrics and GynecologyGifu Prefectural Tajimi HospitalTajimiJapan
| | - Wataru Koike
- Department of Diagnostic RadiologyGifu Prefectural Tajimi HospitalTajimiJapan
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Uzunlar O, Ibanoglu MC, Kaplan A. Technique to reduce blood loss during open abdominal myomectomy: transverse or vertical incision? ACTA ACUST UNITED AC 2021; 67:426-430. [PMID: 34468609 DOI: 10.1590/1806-9282.20200880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if there is a difference between uterine incision techniques (vertical vs. transversal) in terms of clinical results. METHODS All women with leiomyomas who underwent open abdominal myomectomy (n=61) between March and August 2016 at the Gynecology and Obstetrics Clinic at the Women's Health Research and Training Hospital Zekai Tahir Burak were included, and the clinical results were included and prospectively reviewed. RESULTS The estimated blood loss during myomectomy increased in the transversal group compared with the vertical group (809.33±483.34 versus 405.32±180.95 mL, p<0.001). The average operation duration was 60 min, and the patients got discharged on the second day after surgery. No intergroup statistical differences were observed in the surgical procedure. CONCLUSIONS Surgeons should give preference to the most viable incision depending on the size and location of the leiomyoma.
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Affiliation(s)
- Ozlem Uzunlar
- University of Health Sciences, Ankara Dr. Zekai Tahir Burak Women's Health Practice and Research Center, Department of Obstetrics and Gynecology - Ankara, Turkey
| | - Mujde Can Ibanoglu
- Etlik Zubeyde Hanim Women's Health and Research Hospital, Department of Obstetrics and Gynecology - Ankara, Turkey
| | - Asli Kaplan
- Ankara City Hospital, Ankara Dr. Zekai Tahir Burak Women's Health Practice and Research Center, Department of Obstetrics and Gynecology - Ankara, Turkey
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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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Lee SJ, Ko HS, Na S, Bae JY, Seong WJ, Kim JW, Shin J, Cho HJ, Choi GY, Kim J, Cho GJ, Park IY. Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:716. [PMID: 33228582 PMCID: PMC7685654 DOI: 10.1186/s12884-020-03406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy. METHODS We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis. RESULTS During the study period, 38,402 women with diagnosed myoma(s), 9890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16 and aOR 7.46, 95% CI 6.97-7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54 and aOR 1.58, 95% CI 1.35-1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5-25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18-105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy. CONCLUSIONS Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.
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Affiliation(s)
- Se Jin Lee
- Department of Obstetrics and Gynecology, Kangwon National University, School of Medicine, Chuncheon, South Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sunghun Na
- Department of Obstetrics and Gynecology, Kangwon National University, School of Medicine, Chuncheon, South Korea
| | - Jin Young Bae
- Department of Obstetrics and Gynecology, School of Medicine, Catholic University of Daegu, Daegu, South Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Jong Woon Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jaeeun Shin
- Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea
| | - Hae Joong Cho
- Department of Obstetrics and Gynecology, College of Medicine, Wonkwang University, Iksan, South Korea
| | - Gyu Yeon Choi
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Jinsil Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Rault E, Delorme P, Goffinet F, Girault A. Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis. BMC Pregnancy Childbirth 2020; 20:720. [PMID: 33228570 PMCID: PMC7686718 DOI: 10.1186/s12884-020-03413-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy. METHODS Retrospective cohort study including all women with a history of myomectomy (operated group) or uterine myomas during pregnancy (unoperated group) who delivered in a tertiary center between January, 2011 and December, 2017. The operated group included women who had a myomectomy history with or without myomas during the ongoing pregnancy. The unoperated group included women with uterine myoma(s) seen on at least one ultrasound during pregnancy without history of myomectomy. The primary outcome was preterm birth < 37 weeks, and the secondary outcome spontaneous preterm birth < 37 weeks. To control for confounding factors, a propensity score approach was used. Two sensitivity analysis were performed, one repeating the analysis using the propensity score after excluding operated women with persistent myomas and one using a classical multivariable logistic regression model. RESULTS The cohort included 576 women: 283 operated women and 293 unoperated women. The rate of preterm birth was similar in the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). No difference in preterm birth risk was shown between unoperated and operated women in the cohort matched on the propensity score: OR 0.86; 95%CI [0.47-1.59]. These results were consistent for spontaneous preterm birth (OR 1.61; 95%CI [0.61-4.23]) and for the sensitivity analyses. CONCLUSION In women with a leiomyomatous uterus, a history of myomectomy is not associated with a reduced preterm birth risk.
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Affiliation(s)
- Emmanuel Rault
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France
| | - Pierre Delorme
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France.,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France
| | - François Goffinet
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France.,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France
| | - Aude Girault
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France. .,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France.
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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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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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The Impact of Hormonal Replacement Treatment in Postmenopausal Women with Uterine Fibroids: A State-of-the-Art Review of the Literature. ACTA ACUST UNITED AC 2019; 55:medicina55090549. [PMID: 31480288 PMCID: PMC6780684 DOI: 10.3390/medicina55090549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Hormonal replacement therapy (HRT) is effective in treating many debilitating symptoms of menopause. However, its use in women with uterine fibroids is widely debated, based on the susceptibility of these tumors to sexual steroids. This review aims to ascertain the effects of HRT on leiomyomas development and growth in postmenopausal women. Materials and Methods: Electronic databases (i.e., MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) were searched from January 1990 until May 2019. All English-written studies evaluating the impact of various HRT regimens on uterine leiomyomas were selected. Results: Seventeen papers, considering a total of 1122 participants, were included. Fifteen of these were prospective trials, of which nine were randomized controlled trials. The remaining two works were a retrospective observational trial and a retrospective case series respectively. Five studies evaluated the effects of tibolone, also comparing it with various estrogen/progestin combinations, while two were about raloxifene. Thirteen studies compared different combinations of estrogens/progestins, the most common being transdermal estrogens (used in nine studies) and medroxyprogesterone acetate at different doses (used in 10 studies). Conclusions: For women with uterine fibroids, the choice of the most appropriate HRT regimen is crucial to avoid leiomyomas growth and the symptoms possibly related to it. Available data are conflicting, but suggest that uterine fibroids might be influenced by HRT, without representing an absolute contraindication to hormonal replacement therapy. Women with uterine fibroids subjected to HRT should be periodically examined and hormonal treatment should be discontinued if leiomyomas appear to increase in size. Moreover, the minimal effective dose of progestin should be employed.
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Frascà C, Arena A, Degli Esposti E, Raimondo D, Del Forno S, Moro E, Zanello M, Mabrouk M, Seracchioli R. First Impressions Can Be Deceiving: Surgical Outcomes of Laparoscopic Myomectomy in Patients Pretreated with Ulipristal Acetate. J Minim Invasive Gynecol 2019; 27:633-638. [PMID: 31419494 DOI: 10.1016/j.jmig.2019.04.026] [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: 12/31/2018] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVE To compare enucleation time, total operative time, and perioperative complications during laparoscopic myomectomy in patients pretreated with ulipristal acetate (UPA) compared with untreated patients. DESIGN Prospective, observational pilot study. SETTING Tertiary referral center of minimally invasive gynecologic surgery, Sant'Orsola Academic Hospital, Bologna, Italy. PATIENTS Seventy-four of 108 patients scheduled for laparoscopic myomectomy from January to November 2017 were enrolled. INTERVENTIONS Laparoscopic myomectomy following pretreatment with UPA or no hormonal pretreatment therapy. MEASUREMENTS AND MAIN RESULTS Of the 74 patients who were enrolled, 29 were pretreated with UPA (UPA group), and 45 did not receive any hormonal therapy before surgery (control group). Surgeons, blinded to patient pre-operative treatment, completed a 3-item questionnaire after each procedure to evaluate surgical difficulty. Based on surgeon response, myomas in the UPA group appeared softer and more difficult to enucleate because of less clear cleavage planes than the control group. The overall difficulty of myoma detachment from the myometrium was judged considerably higher in the UPA group. Despite this, enucleation time, total operative time, and perioperative complications were not statistically different in the 2 groups. CONCLUSION Myomas in patients pretreated with UPA are subjectively less easy to enucleate; however, surgical times and perioperative outcomes are not affected by pretreatment with UPA.
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Affiliation(s)
- Clarissa Frascà
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy
| | - Alessandro Arena
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy.
| | - Eugenia Degli Esposti
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy
| | - Diego Raimondo
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy
| | - Simona Del Forno
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy
| | - Elisa Moro
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy
| | - Margherita Zanello
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy
| | - Mohamed Mabrouk
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria (Dr. Mabrouk) Egypt
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy
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12
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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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13
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Gambacorti-Passerini ZM, Penati C, Carli A, Accordino F, Ferrari L, Berghella V, Locatelli A. Vaginal birth after prior myomectomy. Eur J Obstet Gynecol Reprod Biol 2018; 231:198-203. [PMID: 30396109 DOI: 10.1016/j.ejogrb.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this retrospective cohort study was to evaluate the obstetrical and perinatal outcomes of vaginal birth in case of pregnancies achieved after prior myomectomy. We also analyzed how operative characteristics at the time of surgery might influence the choice of obstetricians about mode of delivery. STUDY DESIGN We analyzed retrospectively all women who underwent laparoscopic (LPS) or laparotomic (LPT) myomectomy between January 2002 and December 2014, in a network of three Institutions belonging to the University of Milano Bicocca, Italy. Women were contacted by phone interview and only cases with available follow-up data and who had a subsequent pregnancy were included. Operative characteristics and subsequent obstetrical outcomes were recorded and analyzed. RESULTS 469 women who underwent myomectomy were contacted by phone interview, and 152 pregnancies were achieved after surgery, 96 after LPS and 56 after LPT. A total of 110 pregnancies ended in deliveries at ≥24 weeks. Seventy-three (66.4%) women had trial of labor after myomectomy (TOLAM), while 24 (21.8%) had a planned cesarean delivery (CD). Sixty-six (90.4%) of the TOLAM cases successfully accomplished vaginal delivery. No cases of uterine rupture (UR) were reported, and all deliveries ended in live births. The incidence of Neonatal Intensive Care Unit admission was 14.5% (16/110), with no cases of perinatal death. Comparing the surgical details at the time of myomectomy, the incidence of uterine cavity entered was significantly higher in planned CD group compared to TOLAM cases (p < 0.001). No other significant difference between the two groups was reported. CONCLUSIONS A successful vaginal delivery was accomplished by 90.4% of women who had TOLAM, without any case of UR or severe maternal and perinatal complications. TOLAM may be considered and offered as feasible and relatively safe option. Obstetricians' attitude toward mode of delivery after prior myomectomy seems to be influenced by the reported entry into the uterine cavity at the time of surgery.
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Affiliation(s)
| | - C Penati
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Vimercate, Italy
| | - A Carli
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, San Gerardo Hospital - FMBBM, Monza, Italy
| | - F Accordino
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, San Gerardo Hospital - FMBBM, Monza, Italy
| | - L Ferrari
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, Italy
| | - V Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - A Locatelli
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Vimercate, Italy
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14
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Davis MR, Soliman AM, Castelli-Haley J, Snabes MC, Surrey ES. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. J Womens Health (Larchmt) 2018; 27:1204-1214. [PMID: 30085898 PMCID: PMC6205049 DOI: 10.1089/jwh.2017.6752] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Women with uterine fibroids (UF) may undergo less invasive procedures than hysterectomy, including myomectomy, endometrial ablation (EA), and uterine artery embolization (UAE); however, long-term need for reintervention is not well characterized. We estimated reintervention rates for 5 years and identified predictors of reintervention. Materials and Methods: A longitudinal retrospective cohort study was conducted in women in MarketScan® Commercial Claims and Encounters (Truven Health Analytics) aged 18–49 years with UF diagnosis before myomectomy, EA, or UAE from 2008 to 2014. Patients were categorized by initial procedure (index date) and required to have ≥12 months of continuous coverage before and after. Kaplan–Meier analyses and Cox proportional hazard models were used to estimate survival without reintervention and hazard of reintervention for 5 years. Results: The study included 35,631 women with myomectomy (n = 13,804: 8,018 abdominal, 941 hysteroscopic, and 4,845 laparoscopic), EA (n = 17,198), and UAE (n = 4,629). Myomectomy had the lowest 12-month reintervention rate (4.2%), followed by UAE (7.0%), then EA (12.4%; both p < 0.001 relative of myomectomy). Estimates of 5-year reintervention rates were 19% for myomectomy (17%, 28%, and 20% for abdominal, hysteroscopic, and laparoscopic, respectively), 33% for EA, and 24% for UAE. EA and UAE had adjusted hazard ratios of 2.63 (95% confidence interval [CI], 2.44–2.83) and 1.56 (95% CI, 1.42–1.72). Prior anemia, bleeding, pelvic inflammatory disease, and abdominal and pelvic pain increased the hazard of reintervention. Conclusion: Reintervention rate estimates ranged from 17% to 33% for 5 years after myomectomy, EA, and UAE for patients with UF. Risk of requiring reintervention should be considered during treatment selection.
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Affiliation(s)
| | | | | | | | - Eric S Surrey
- 3 Colorado Center for Reproductive Medicine , Lone Tree, Colorado
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15
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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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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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17
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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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18
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Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res 2017; 43:1789-1804. [PMID: 28892210 DOI: 10.1111/jog.13437] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/21/2017] [Accepted: 05/28/2017] [Indexed: 02/02/2023]
Abstract
AIM Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. METHODS Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. RESULTS Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. CONCLUSIONS Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.
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Affiliation(s)
- Giusi Natalia Milazzo
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Angelica Catalano
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Valentina Badia
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Maddalena Mallozzi
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Donatella Caserta
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
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20
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Uterine Fibroids in the Setting of Infertility: When to Treat, How to Treat? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Bean EMR, Cutner A, Holland T, Vashisht A, Jurkovic D, Saridogan E. Laparoscopic Myomectomy: A Single-center Retrospective Review of 514 Patients. J Minim Invasive Gynecol 2017; 24:485-493. [DOI: 10.1016/j.jmig.2017.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 11/26/2022]
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22
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Chen KH, Seow KM, Chen LR. Uterine Suspension With Adjustable Sutures for Difficult Laparoscopic Myomectomy. J Minim Invasive Gynecol 2017; 24:264-271. [DOI: 10.1016/j.jmig.2016.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 01/09/2023]
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23
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Prise en charge des léiomyomes utérins. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S550-S576. [PMID: 28063565 DOI: 10.1016/j.jogc.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Flyckt R, Soto E, Nutter B, Falcone T. Comparison of Long-Term Fertility and Bleeding Outcomes after Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy. Obstet Gynecol Int 2016; 2016:2789201. [PMID: 28163718 PMCID: PMC5259613 DOI: 10.1155/2016/2789201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/10/2016] [Accepted: 11/24/2016] [Indexed: 11/23/2022] Open
Abstract
Background/Aims. To compare long-term fertility and bleeding outcomes of women who underwent robotic-assisted, laparoscopic, and abdominal myomectomy at our institution over a 15-year period. Methods. This was a retrospective cohort study of myomectomy patients 18-39 years old that had surgery between January 1995 and December 2009 at our institution. Long-term follow-up on fertility and bleeding outcomes was collected from the patient directly. The uterine fibroid symptom and quality of life survey was also administered to assess current bleeding patterns. Baseline characteristics were compared across groups. Univariable comparisons of fertility and bleeding outcomes based on surgical approach were made using analysis of variance, Kruskal-Wallis analysis of ranks, and Chi-square tests as appropriate. Results. 134/374 (36%) subjects agreed to participate in the study. 81 subjects underwent an open procedure versus 28 and 25 subjects in the laparoscopic and robotic groups, respectively. Median follow-up after surgery was 8 years. 50% of patients desired pregnancy following surgery and, of those, 60% achieved spontaneous pregnancy; the spontaneous pregnancy rate did not differ between groups. Additionally, UFS-QOL scores and/or subscores did not differ between groups. Conclusion. There is no significant difference in long-term bleeding or fertility outcomes in robotic-assisted, laparoscopic, or abdominal myomectomy.
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Affiliation(s)
- Rebecca Flyckt
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Enrique Soto
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Nutter
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tommaso Falcone
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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25
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Pakniat H, Soofizadeh N, Beigom Khezri M. Spontaneous uterine rupture after abdominal myomectomy at the gestational age of 20 weeks in pregnancy: A case report. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.7.8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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26
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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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27
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Abdelaziz A, Joseph S, Abuzeid M. Broad ligament uterine fibroid: Management with Davinci robotic myomectomy. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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28
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Saridogan E. Surgical treatment of fibroids in heavy menstrual bleeding. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:53-62. [PMID: 26693796 PMCID: PMC5779570 DOI: 10.2217/whe.15.89] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Uterine fibroids can cause abnormal uterine bleeding and their removal is beneficial in the treatment of heavy menstrual bleeding associated with fibroids for women who would like to preserve their uterus and fertility. Endoscopic (hysteroscopic and laparoscopic) approaches are the preferred methods of fibroid removal when appropriate. In the presence of submucosal fibroids, hysteroscopic resection is a simple, safe and effective treatment for heavy menstrual bleeding and reduces the need for more major surgery, such as hysterectomy. When abdominal myomectomy is required, laparoscopic myomectomy is the preferred choice in selected cases due to its advantages over open myomectomy.
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Affiliation(s)
- Ertan Saridogan
- Women's Health Division, University College London Hospitals, 250 Euston Road, London, NW1 2PG, UK
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29
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Bailey AP, Jaslow CR, Kutteh WH. Minimally invasive surgical options for congenital and acquired uterine factors associated with recurrent pregnancy loss. ACTA ACUST UNITED AC 2015; 11:161-7. [PMID: 25776290 DOI: 10.2217/whe.14.81] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recurrent pregnancy loss (RPL) is defined as two or more failed clinical pregnancies before 20 weeks' gestation and may be caused by genetic, endocrinologic, anatomic and immunologic abnormalities. Anatomic uterine anomalies include congenital malformations (bicornuate, didelphic, septate and unicornuate uteri) and acquired defects (fibroids, adenomas, adhesions and polyps). Women with septate and bicornuate uteri, intrauterine adhesions, and some adenomas and fibroids are at increased risk of RPL. Data support surgical treatment of all of these lesions except bicornuate uteri. The role of polyps in RPL is unclear. Minimally invasive options for surgical correction of intrauterine lesions include hysteroscopy, laparoscopy with and without robotic assistance and minilaparotomy.
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Affiliation(s)
- Amelia P Bailey
- Minimally Invasive Surgery, Fertility Associates of Memphis, Memphis, TN 38120, USA
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Buckley VA, Nesbitt-Hawes EM, Atkinson P, Won HR, Deans R, Burton A, Lyons SD, Abbott JA. Laparoscopic Myomectomy: Clinical Outcomes and Comparative Evidence. J Minim Invasive Gynecol 2015; 22:11-25. [DOI: 10.1016/j.jmig.2014.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 12/22/2022]
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Sangha R, Strickler R, Dahlman M, Havstad S, Wegienka G. Myomectomy to Conserve Fertility: Seven-Year Follow-Up. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:46-51. [DOI: 10.1016/s1701-2163(15)30362-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lu N, Wang Y, Su YC, Sun YP, Guo YH. Effects of the distance between small intramural uterine fibroids and the endometrium on the pregnancy outcomes of in vitro fertilization-embryo transfer. Gynecol Obstet Invest 2014; 79:62-8. [PMID: 25427667 DOI: 10.1159/000363236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
AIM To explore the effects of the distance between small intramural uterine fibroids (≤4 cm) and the endometrium on the outcomes of in vitro fertilization-embryo transfer (IVF-ET). METHODS We prospectively analyzed pregnancy outcomes in 117 infertile women with small intramural uterine fibroids and 117 infertile women without uterine fibroids who all underwent IVF-ET. The size and number of small intramural uterine fibroids and the shortest distance between the small intramural uterine fibroids and the endometrium were measured by transvaginal three-dimensional ultrasound. The endometrial and subendometrial blood flow parameters, implantation rate, clinical pregnancy rate, abortion rate and live birth rate were compared between the women with and without small uterine fibroids and among the different shortest distances (≤1, 1-3 and >3 mm). The effects of the size and number of small intramural uterine fibroids on IVF-ET outcomes were observed. RESULTS The endometrial volume on ET day, the implantation rate and the live birth rate were significantly lower, but the abortion rate was significantly higher, in the women with small intramural uterine fibroids than in those without uterine fibroids (p < 0.05). The endometrial flow index was higher in the shortest distance ≤1-mm group than in the groups with 1-3 and >3 mm, and the implantation rate was higher in ≤1-mm group than in the >3-mm group (p < 0.05). There were no significant differences in clinical outcomes between different sizes and numbers of small intramural uterine fibroids. CONCLUSION Small intramural uterine fibroids can affect IVF-ET outcomes. Compared with other shortest distances (1-3 and >3 mm), the shortest distance of ≤1 mm has a higher implantation rate.
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Affiliation(s)
- Na Lu
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kim JY, Kim KH, Choi JS, Lee JH. A Prospective Matched Case-Control Study of Laparoendoscopic Single-Site vs Conventional Laparoscopic Myomectomy. J Minim Invasive Gynecol 2014; 21:1036-40. [DOI: 10.1016/j.jmig.2014.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/27/2014] [Accepted: 04/29/2014] [Indexed: 11/16/2022]
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Radosa MP, Owsianowski Z, Mothes A, Weisheit A, Vorwergk J, Asskaryar FA, Camara O, Bernardi TS, Runnebaum IB. Long-term risk of fibroid recurrence after laparoscopic myomectomy. Eur J Obstet Gynecol Reprod Biol 2014; 180:35-9. [PMID: 25016181 DOI: 10.1016/j.ejogrb.2014.05.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/09/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The use of laparoscopic myomectomy as a surgical treatment for uterine leiomyoma is associated with low intraoperative morbidity and short hospitalization. Limited data about the long-term outcome of this surgical approach are available. The aims of this study were to estimate the risk of uterine fibroid recurrence after laparoscopic myomectomy and to identify factors contributing to the rate of fibroid relapse. STUDY DESIGN Between 1996 and 2003, 331 patients underwent laparoscopic myomectomy to treat uterine leiomyoma in our hospital; 224 of these patients consented to participate in our 2009 follow-up survey. Clinical symptomatic uterine leiomyoma recurrence was defined as relapse. Recurrence rates at 24 and 60 months post-operatively were calculated for the study population. Fisher's exact tests were used to examine the impacts of factors previously linked to an increased risk of fibroid recurrence, including (1) patient age at the time of initial surgery, (2) pre-operative body mass index, (3) number and localization of uterine leiomyoma removed, and (4) pregnancy and (5) delivery after laparoscopic myomectomy on fibroid recurrence in our study cohort. RESULTS We observed 75 recurrences in 224 patients. The cumulative risk of recurrence was 4.9% at 24 months and 21.4% at 60 months post-operatively. An age of 30-40 years and the presence of more than one fibroid at the time of initial laparoscopic myomectomy were identified as factors significantly increasing the risk of symptomatic recurrence after laparoscopic myomectomy (31.25% and 38.71%, respectively; both p<0.01). CONCLUSION Patients with multiple uterine leiomyoma and those in the third decade of life should be counselled thoroughly about the risk of recurrence prior to laparoscopic myomectomy. The low observed recurrence rate in peri- and postmenopausal patients in our study may support the use of laparoscopic myomectomy as a uterus-preserving surgical alternative beyond the reproductive period.
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Affiliation(s)
- M P Radosa
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany
| | - Z Owsianowski
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany
| | - A Mothes
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany
| | - A Weisheit
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany
| | - J Vorwergk
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany
| | - F A Asskaryar
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany
| | - O Camara
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany
| | - T S Bernardi
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany
| | - I B Runnebaum
- Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
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The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s10397-014-0842-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Weibel HS, Jarcevic R, Gagnon R, Tulandi T. Perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:128-32. [PMID: 24518911 DOI: 10.1016/s1701-2163(15)30658-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Because of concerns about uterine rupture, many obstetricians recommend elective Caesarean section for women with a prior myomectomy. This practice has led to an increased rate of elective CS and subsequently of repeat Caesarean sections. The purpose of this study was to evaluate the perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy. METHODS We conducted a survey of 49 practising obstetricians from July 2012 to January 2013, using a standard questionnaire. This included questions on labour and delivery after myomectomy by laparotomy or laparoscopy. RESULTS Overall, the inter-respondent agreement was fair (kappa 0.3; P < 0.001). There was no significant difference in the likelihood that respondents would allow vaginal delivery after myomectomy by laparotomy and by laparoscopy (27% and 14% if the uterine cavity was entered and 76% and 71% if the uterine cavity was not entered, respectively). However, the likelihood that respondents would allow vaginal delivery was significantly reduced if the uterine cavity was entered, regardless of the surgical approach (P < 0.001). Entry into the uterine cavity during myomectomy also significantly increased the likelihood that obstetricians would recommend elective CS rather than induction of labour. There was no significant difference in practice regarding the use of oxytocin with amniotomy, oxytocin infusion, or prostaglandins. CONCLUSION Despite a lack of evidence, obstetricians consider entry into the uterine cavity at myomectomy to be an important factor in determining the method of delivery, the use of oxytocin, and delivery by elective Caesarean section. This was independent of the myomectomy approach.
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Affiliation(s)
- Hélène S Weibel
- Department of Obstetrics and Gynecology, McGill University, Montreal QC
| | - Radomir Jarcevic
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal QC
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal QC
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal QC
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Bernardi TS, Radosa MP, Weisheit A, Diebolder H, Schneider U, Schleussner E, Runnebaum IB. Laparoscopic myomectomy: a 6-year follow-up single-center cohort analysis of fertility and obstetric outcome measures. Arch Gynecol Obstet 2014; 290:87-91. [DOI: 10.1007/s00404-014-3155-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
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Lipskind ST, Gargiulo AR. Computer-Assisted Laparoscopy in Fertility Preservation and Reproductive Surgery. J Minim Invasive Gynecol 2013; 20:435-45. [DOI: 10.1016/j.jmig.2013.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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Kayem G, Raiffort C, Legardeur H, Gavard L, Mandelbrot L, Girard G. Critères d’acceptation de la voie vaginale selon les caractéristiques de la cicatrice utérine. ACTA ACUST UNITED AC 2012; 41:753-71. [DOI: 10.1016/j.jgyn.2012.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Scholz C, Wöckel A, Ebner F, Reich A, Janni W. Uteruserhaltende Myomchirurgie. GYNAKOLOGE 2012. [DOI: 10.1007/s00129-012-2991-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pitter MC, Gargiulo AR, Bonaventura LM, Lehman JS, Srouji SS. Pregnancy outcomes following robot-assisted myomectomy. Hum Reprod 2012; 28:99-108. [PMID: 23081871 DOI: 10.1093/humrep/des365] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the characteristics of the pregnancy outcomes in women undergoing robot-assisted laparoscopic myomectomy (RALM) for symptomatic leiomyomata uteri? SUMMARY ANSWER Despite a high prevalence of women with advanced maternal age, obesity and multiple pregnancy in our cohort, the outcomes are comparable with those reported in the literature for laparoscopic myomectomy. WHAT IS KNOWN ALREADY Reproductive outcomes after traditional laparoscopic myomectomy are well documented. However, reproductive outcomes following robotic myomectomy are not well studied. This paper describes the pregnancy outcomes for a large cohort of women after robotic myomectomy. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort of women who became pregnant after robot-assisted myomectomy at three centers. Of the 872 women who underwent robotic myomectomy during the period October 2005-November 2010, 107 subsequently conceived resulting in 127 pregnancies and 92 deliveries through 2011. PARTICIPANTS/MATERIAL, SETTING, METHODS Women of reproductive age with fibroids who wanted a minimally invasive treatment option and desired uterine preservation were recruited. We conducted a multicentre study with three centers, two in a private practice and one in an academic setting. Pregnancy outcomes and their relationship to myoma characteristics were analyzed. MAIN RESULTS AND ROLE OF CHANCE Mean ± SD age at myomectomy was 34.8 ± 4.5 years and 57.4% [95% confidence interval (CI) 48.0, 66.3] of women were overweight or obese. The mean number of myomas removed was 3.9 ± 3.2 with a mean size of 7.5 ± 3.0 cm and mean weight of 191.7 ± 144.8 g. Entry of the myoma into the endometrial cavity occurred in 20.6% (95% CI 15.0, 27.7) of patients. The mean time to conception was 12.9 ± 11.5 months. Assisted reproduction techniques were employed in 39.4% (95% CI 32.6, 46.7) of these women. Seven twin pregnancies and two triplet pregnancies occurred, for a multiple pregnancy birth rate of 9.8% (95% CI 5.0, 17.8). Spontaneous abortions occurred in 18.9% (95% CI 13.0, 26.6). Preterm delivery prior to 35 weeks of gestational age occurred in 17.4% (95% CI 10.9, 26.5). One uterine rupture (1.1%; 95% CI 0.3, 4.7) was documented. Pelvic adhesions were discovered in 11.4% (95% CI 7.0, 18.0) of patients delivered by Cesarean section. Higher preterm delivery rates were significantly associated with a greater number of myomas removed and anterior location of the largest incision (compared with all other sites) in logistic regression analyses (P = 0.01). None of the myoma characteristics were related to spontaneous abortion. BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION Given the retrospective nature of the data collection, some pregnancies may not have been captured. In addition, owing to the high prevalence of infertility patients in this cohort, the data cannot be used to counsel women who are undergoing RALM about fertility rates after surgery. GENERALIZABILITY TO OTHER POPULATIONS Prospective studies are needed to determine if the results shown in our cohort are generalizable to all women seeking a minimally invasive option for the conservative treatment of symptomatic fibroids with pregnancy as a desired outcome. STUDY FUNDING/COMPETING INTEREST(S) There was no funding source for this study.
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Robot-Assisted Laparoscopic Myomectomy Compared With Standard Laparoscopic Myomectomy. Obstet Gynecol 2012; 120:284-91. [DOI: 10.1097/aog.0b013e3182602c7d] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Robot-assisted laparoscopic myomectomy and adenomyomectomy with a flexible CO2 laser device. J Robot Surg 2012; 7:157-62. [DOI: 10.1007/s11701-012-0360-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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Hayasaka S, Arai M, Ugajin T, Fujii O, Nabeshima H, Uthunomiya H, Yokomizo R, Yuki H, Terada Y, Murakami T, Yaegashi N. Factors Affecting Fertility Following Laparoscopic Myomectomy. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shinichi Hayasaka
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Maiko Arai
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Tomohisa Ugajin
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Osamu Fujii
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiroshi Nabeshima
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiroki Uthunomiya
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Rei Yokomizo
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiromithu Yuki
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Othu, Shiga, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
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Retrospective analysis of the efficacy of perioperative use of the cell salvage and autologous blood recovery system during laparoscopic myomectomy. Arch Gynecol Obstet 2011; 285:1073-7. [DOI: 10.1007/s00404-011-2118-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
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Landon MB, Lynch CD. Optimal timing and mode of delivery after cesarean with previous classical incision or myomectomy: a review of the data. Semin Perinatol 2011; 35:257-61. [PMID: 21962624 DOI: 10.1053/j.semperi.2011.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uterine rupture is an obstetrical emergency that can be catastrophic for the mother and fetus. Previous uterine surgery, including previous cesarean delivery or myomectomy, is an established risk factor, although the exact magnitude of the associated risk remains uncertain. We reviewed the literature related to uterine rupture after previous cesarean delivery with classical incision or myomectomy in an attempt to quantify outcomes associated with various management strategies. Although cesarean delivery with a classical incision is relatively uncommon (representing 0.3%-0.4% of deliveries), it presents a significant risk of rupture in subsequent pregnancies (1%-12% on the basis of published reports). Available data suggest that scheduled cesarean at 36-37 weeks optimizes both maternal and fetal outcomes in these cases. Patients with previous myomectomy are more frequently encountered in the obstetrical population. The risk of uterine rupture in subsequent pregnancies in these women is substantially lower than those with a history of previous classical incision (0.5%-0.7% on the basis of published reports). Although less common, given the potentially devastating consequences of uterine rupture, scheduled delivery at 38 weeks is suggested in those women requiring cesarean delivery. Despite the lack of well-controlled studies, preferred management strategies can be gleaned from previously published data to optimize maternal and fetal outcomes in women with these risk factors.
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Affiliation(s)
- Mark B Landon
- The Ohio State University College of Medicine, Columbus, OH 43210, USA.
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