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Verta S, Brambs CE, Christmann C. Cystic Adenomyoma in Pregnancy: A Case Report. Int J Womens Health 2024; 16:421-432. [PMID: 38469356 PMCID: PMC10926917 DOI: 10.2147/ijwh.s450701] [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: 11/20/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
Cystic adenomyomas (CA) are rare. They primarily affect adolescents and young women in their fertile years. Therefore, fertility and pregnancy outcome are of pivotal relevance in this patient collective. Apart from the guidelines of the European Society of Human Reproduction and Embryology (ESHRE) on the management of endometriosis in general, there are no specific treatment recommendations for CA and, as far as our research shows, no data illustrating the behavior of a CA over the course of pregnancy. Thus, we report the case of a 32-year-old 1-gravida, 1-para, preconceptionally diagnosed with a CA by ultrasound. After thoroughly discussing further treatment options, the decision was made to opt for a more conservative approach and not perform surgery before attempting a next pregnancy. The patient conceived spontaneously and sonographic monitoring of the CA throughout pregnancy showed complete regression of the cystic component during the second trimester. A healthy baby was delivered at term by an uncomplicated elective cesarean section. Following a review of the literature and taking into account the course of our case, we propose the feasibility of a conservative, non-surgical approach in women with a CA and the desire to conceive.
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Affiliation(s)
- Stephanie Verta
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Christine E Brambs
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Corina Christmann
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Grainger TC, McDougall A, Magama Z, Ranawakagedon J, Mallick R, Odejinmi F. Women's experiences of birth and birth options counselling after laparoscopic or open myomectomy. J OBSTET GYNAECOL 2023; 43:2205516. [PMID: 37200382 DOI: 10.1080/01443615.2023.2205516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/16/2023] [Indexed: 05/20/2023]
Abstract
There is emerging evidence that vaginal birth after open and laparoscopic myomectomy may be safe in many pregnancies, however, there are no studies examining the perspectives of women who have given birth post myomectomy and their preferences regarding mode of birth. We performed a retrospective questionnaire survey of women who had an open or laparoscopic myomectomy followed by a pregnancy within 3 maternity units in a single NHS trust in the UK over a 5-year period. Our results revealed only 53% felt actively involved in the decision making for their birth plan and 90% had not been offered a specific birth options counselling clinic. Of those who had either a successful trial of labour after myomectomy (TOLAM) or elective caesarean section (ELCS) in the index pregnancy, 95% indicated satisfaction with their mode of birth however, 80% would prefer vaginal birth in a future pregnancy. Whilst long term prospective data is required to fully establish the safety of vaginal birth after laparoscopic and open myomectomy, this study is the first to explore the subjective experiences of women who had given birth post laparoscopic or open myomectomy and has highlighted the inadequate involvement of these women in the decision-making process.IMPACT STATEMENTWhat is already known on this subject? Fibroids are the commonest female solid tumours in women of childbearing age with surgical management including open and laparoscopic excision techniques. However, the management of a subsequent pregnancy and birth remains controversial with no robust guidance on which women may be suitable for vaginal birth.What do the results of this study add? We present the first study to our knowledge which explores women's experiences of birth and birth options counselling after open and laparoscopic myomectomy.What are the implications of these findings for clinical practice and/or further research? We provide a rationale for using birth options clinics to facilitate an informed decision-making process and highlight the current inadequate guidance for clinicians on how to advise women having a pregnancy following a myomectomy. Whilst long term prospective data is required to fully establish the safety of vaginal birth after laparoscopic and open myomectomy, this needs to be carried out in a way which promotes the preferences of the women affected by this research.
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Affiliation(s)
- Thomas C Grainger
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Anna McDougall
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Zwelihle Magama
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Jeewantha Ranawakagedon
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Rebecca Mallick
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
| | - Funlayo Odejinmi
- The Women's Centre, Division of Women's and Children's Health, Whipps Cross University Hospital, Barts Health NHS Trust London, London, UK
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Cañete ML, Hernandez A, Romero V, Lobo I, Alcazar JL. Nuevo paradigma en la cirugía del mioma: reparación uterina. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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McDougall AA, Strong SM, Wonnacott A, Morin A, Tang LYO, Mallick R, Odejinmi F. Towards a clinical consensus on the management of pregnancy and birth after laparoscopic and open myomectomy: A survey of obstetricians and gynaecologists. Eur J Obstet Gynecol Reprod Biol 2023; 284:82-93. [PMID: 36944305 DOI: 10.1016/j.ejogrb.2023.03.008] [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: 11/06/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES The primary aim was to assess if a clinical consensus regarding the management of pregnancy post myomectomy existed amongst consultant obstetricians and gynaecologists. Secondary objectives were to evaluate factors which influence the clinician's decision making in this group of women. STUDY DESIGN Electronic survey sent to all consultants working in the North Central and East London deanery, Kent Surrey and Sussex deanery and Imperial NHS Trust to assess opinions on mode of birth post myomectomy, intervals advised to pregnancy post myomectomy, factors influencing the management of delivery in the scarred uterus post myomectomy, opinions on induction of labour and questions relating to operative notes. RESULTS 209 consultant responses received between 07/03/2022-07/05/2022 (44% response rate); 77% (161/209) practicing obstetricians and gynaecologists, 10% (21/109) pure gynaecologists and 13% (27/209) pure obstetricians. The majority would support a vaginal birth after open myomectomy (75%) and laparoscopic myomectomy (79%). No consensus was found as to the optimal time interval between myomectomy and pregnancy. Higher frequency of performing myomectomy and a greater level of experience were significantly associated with a shorter interval to pregnancy advised. The most important operative factors influencing decision to support trial of labour post myomectomy were breach of uterine cavity; location of fibroids removed and number of incisions on the uterus. 77% believe women should be given a choice regarding mode of delivery post myomectomy in a similar way to previous LSCS. 82.8% would support enrolment of patients into a prospective trial to investigate delivery post myomectomy. CONCLUSIONS We present a comprehensive survey of clinician opinions on pregnancy post myomectomy demonstrating that the majority of consultant obstetricians and gynaecologists sampled would support vaginal birth post myomectomy; counselling patients in a similar way to VBAC; a standardised myomectomy operation note and enrolment of patients in a future prospective trial. Wide variation in opinion regarding interval to pregnancy post myomectomy has been highlighted. We believe this information will facilitate counselling discussions and empower women with subsequent pregnancies after myomectomy to make an informed decision on mode of birth post myomectomy.
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Affiliation(s)
- A A McDougall
- Homerton University Hospital, Homerton Row, London E9 6SR, United Kingdom.
| | - S M Strong
- Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, United Kingdom
| | - A Wonnacott
- Royal London Hospital, Whitechapel Road, London E1 1FR, United Kingdom
| | - A Morin
- Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, United Kingdom
| | - L Y O Tang
- Royal Free Hospital, Pond St, London NW3 2QG, United Kingdom
| | - R Mallick
- University Hospitals Sussex NHS Foundation Trust, Princess Royal Hospital, Haywards Heath, RH16 4EX, United Kingdom
| | - F Odejinmi
- Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, United Kingdom
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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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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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