Cesarean section incidence and vaginal birth success rate at term pregnancy after myomectomy

Czech version

Authors: L. Mekiňová ; Petr Janků ; E. Filipinská; J. Kadlecová; P. Ventruba
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA
Published in: Ceska Gynekol 2016; 81(6): 404-410

Overview

Objective:
To compare the incidence of primary and acute cesarean section (CS) and to compare success rate of vaginal delivery. To determine the frequency of maternal complications and evaluation of post-partum condition of the newborn.

Study design:
Prospective, pilot, cohort study.

Setting:
Department of Gynecology and Obstetrics Masaryk University and University Hospital Brno.

Methods:
Analysis of patients with physiologically ongoing singleton pregnancy and term delivery, vertex presentation. Women from the study group (n = 67) underwent myomectomy because of symptomatic, solitary uterine fibroid. Women from the control group (n = 4079) had no history of myomectomy. Analysis was aimed at comparing the incidence of primary and acute CS and comparing success rate of vaginal delivery in both groups and determing the frequency of maternal complications and evaluation of post-partum condition of the newborn.

Results:
A significantly higher incidence of primary cesarean section was observed in the study group with a history of myomectomy compared to the control group (n = 20, 29.9%; versus n = 396, 9.7 %, p < 0.001). No statistically significant difference in the incidence of acute cesarean section in both groups was recorded (n = 7, 10.4%; versus n = 570, 14.0%, p = 0.079). No statistically significant difference in the success of vaginal delivery in both groups was recorded (n = 40, 85.1%; versus n = 3113, 84.5%, p = 0.079). The excessive blood loss was the most frequent complication in both group (n = 9, 13.4%; versus n = 214, 5.2%, p = 0.057). No statistically significant difference in the incidence of uterine rupture and postpartum hysterectomy was recorded. No maternal or fetal death related to childbirth was observed.

Conclusion:
The history of myomectomy does not increase the incidence of acute cesarean section in the group of strictly selected patients suitable for vaginal birth and has no impact on the success of vaginal delivery. Careful management of labor is a prerequisite for a low risk of maternal complications and good perinatal outcomes.

Keywords:
myomectomy, cesarean section, vaginal delivery

Sources

1. Bernardi, TS., Radosa, MP., Weisheit, A., et al. Laparoscopic myomectomy: a 6-year follow-up single-center cohort analysis of fertility and obstetric outcome measures. Arch Gynecol Obstet, 2014, 290, p. 87–91.

2. Donnez, J., Donnez, O., Matule, D., et al. Longterm medical management of uterine fibroids with ulipristal acetate. Fertil Steril, 2016, 105, p. 165–173.

3. Donnez, J., Hudecek, R., Donnez, O., et al. Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids. Fertil Steril, 2015, 103, p. 519–527.

4. Donnez, J., Tatarchuk, T., Bouchard, P., et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med, 2012, 366, p. 409–420.

5. Donnez, J., Tomaszewski, J., Vázquez, F., et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med, 2012, 366, p. 421–432.

6. Dubuisson, JB., Fauconnier, A., Babaki-Fard, K., et al. Laparoscopic myomectomy: a current view. Hum Reprod, 2000, 6, p. 588–594.

7. Dubuisson, JB., Fauconnier, A., Deffarges, JV., et al. Pregnancy outcome and delivery following laparoscopic myomectomy. Hum Reprod, 2000, 15, p. 869–873.

8. Fait, T., Hudeček, R., Kopecký, P., a kol. Diagnostika a léčba děložních myomů v ambulantní gynekologické péči. Čes Gynek, 2015, 80, s. 309–312.

9. Gyamfi, C., Gilbert, S., Landon, MB., et al. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstet Gynecol, 2012, 120, p. 1332–1337.

10. Hackethal, A., Westermann, A., Tchartchian, G., et al. Laparoscopic myomectomy in patients with uterine myoma associated with infertility. Minim Invasiv Ther, 2011, 20, p. 338–345.

11. Horak, P., Mara, M., Dundr, P., et al. Effect of a selective progesterone receptor modulator on induction of apoptosis in uterine fibroids in vivo. Int J Endocrinol, 2012, p. 1–6.

12. Hruban, L., Janků, P., Ventruba, P., a kol. Vedení porodu po předchozím císařském řezu – analýza výsledků 2007–2010, Čes Gynek, 2012, 77 (2), s. 127–132.

13. Hudeček, R., Ivanová, Z., Šmerdová, M., a kol. Vliv aplikace GnRH analog na peroperační a postoperační výsledky myomektomie u žen v reprodukčním věku. Čes Gynek, 2012, 77, s. 109–117.

14. Klatsky, PC., Tran, ND., Laughey, AB., et al. Fibroids and reproductive outcomes: A systematic literature review from conception to delivery. Am J Obstet Gynecol, 2008, p. 357–366.

15. Kubinova, K., Mara, M., Horak, P., et al. Reproduction after myomectomy: Comparison of patients with and without second-look laparoskopy. Minim Invasiv Ther, 2011, p. 1–7.

16. Kumakiri, J., Takeuchi, H., Itoh, S., et al. Prospective evaluation for the feasibility and safety of vaginal birth after laparoscopic myomectomy. J Minim Invasiv Gyn, 2008,15, p. 420–424.

17. Malvasi, A., Cavallotti, G., Nicolardi, G., et al. NT, NPY, and PGP 9.5 presence in myometrium and in fibroid pseudocapsule and their possible impact on muscular physiology. Gynecol Endokrinol, 2013, 29(2), p. 177–181.

18. Mettler, L., Tinelli, A., Hurst, BS., et al. Neurovascular bundle in fibroid pseudocapsule and its neuroendocrinologic implication. Expert Rev Endocrinol Metab, 2011, 6(5), p. 715–722.

19. Mozota, DB., Kadhel, P., Janky, E. Fertility, pregnancy outcomes and deliveries following myomectomy: experience of a French Caribbean University Hospital. Arch Gynecol Obstet, 2014, 289, p. 681–686.

20. Nezhat, CH., Nezhat, F., Roemisch, M., et al. Pregnancy following laparoscopic myomectomy: preliminary results. Hum Reprod, 1999, 14, p. 1219–1221.

21. Palomba, S., Zupi, E., Manguso, F., et al. A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes. Fertil Steril, 2007, 88, p. 933–941.

22. Seracchioli, R., Rossi, S., Govoni, F., et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod, 2000, 15, p. 266–268.

23. Thisted, DL., Mortensen, LH., Krebs, L. Uterine rupture without previous caesarean delivery: a population – based cohort study. Eur J Obstet Gyn R B, 2015, 195, p. 151–155.

24. Tinelli, A., Hurst, BS., Hudelist, G., et al. Laparoscopic myomectomy focusing in the myoma pseudocapsule: technical and outcome report. Hum Reprod, 2012, 27, p. 427–435.

25. Tinelli, A., Hurst, BS., Mettler, L., et al. Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study. Hum Reprod, 2012, 27, p. 2664–2670.

26. Tinelli, A., Malvasi, A., Hurst, BS., et al. Surgical management of neurovascular bundle in uterine fibroid pseudocapsule. J Soc Laparoend, 2012, 16, p. 119–129.

27. Tinelli, A., Mettler, L., Malvasi, A., et al. Impact of surgical approach on blood loss during intracapsular myomectomy. Minim Invasiv Ther, 2014, 23, p. 87–95.

28. ÚZIS ČR. Rodička a novorozenec 2013. Ústav zdravotnických informací a statistiky ČR, 2015, s. 15, ISBN 978-80-7472-138-0.

29. Vilos, AG., Allaire, C., Laberge, PY., et al. The management of uterine leiomyomas. J Obstet Gynaecol Can, 2015, 37(2), p. 157–178.