Analysis of pregnancy outcome after hysteroscopic submucosal myomectomy
10.3760/cma.j.cn101441-20220520-00224
- VernacularTitle:宫腔镜下子宫黏膜下肌瘤切除术后妊娠情况分析
- Author:
Hongxia ZHANG
1
;
Shuo YANG
1
;
Xueling SONG
1
;
Yan YANG
1
;
Jiajia ZHANG
1
;
Caihong MA
1
;
Rong LI
1
Author Information
1. 北京大学第三医院妇产科生殖医学中心 国家妇产疾病临床医学研究中心（北京大学第三医院）辅助生殖教育部重点实验室（北京大学）北京市生殖内分泌与辅助生殖技术重点实验室，北京 100191
- Publication Type:Journal Article
- Keywords:
Hysteroscopy;
Myomectomy;
Pregnancy;
Submucosal myoma;
Placenta accrete
- From:
Chinese Journal of Reproduction and Contraception
2023;43(8):830-833
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the pregnancy outcome, influencing factors and pregnancy complications after hysteroscopic submucosal myomectomy in patients with infertility or recurrent abortion.Methods:The clinical data of patients who underwent hysteroscopic submucosal myomectomy in Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital from January 2010 to December 2020 were reviewed. The relationship between age, myoma classification, size, number and location and postoperative pregnancy was retrospectively cohort analyzed, and the related complications during pregnancy were discussed.Results:A total of 212 patients underwent surgery during the study period. The proportions of type 0, type 1, type 2 and mixed submucosal myoma were 9.4% (20/212), 33.5% (71/212), 51.4% (109/212) and 5.7% (12/212), respectively. Totally 85.4% (181/212) of patients underwent hysteroscopic resection of a single submucosal myoma, and the size of submucosal myoma of 79.3% (168/212) patients were ≤2 cm in diameter. Submucosal myoma were mainly located in the anterior and posterior wall, accounted for 31.6% (67/212) and 30.2% (64/212), respectively. Scissors removal accounted for 25.9% (55/212), and bipolar electroresection accounted for 72.2% (153/212). Totally 88 patients (41.5%) got pregnancy after hysteroscopic submucosal myomectomy. The postoperative pregnancy rate showed a downward trend over time, and the pregnancy rate in the first year after operation was 77.2% (68/88). Logistic analysis showed that pregnancy was related to age ( P<0.001), but not to the type, size, number and location of submucosal myoma (all P>0.05). Among the patients with postoperative pregnancy, there was no uterine rupture during pregnancy and delivery. Five cases (5.7%) had abnormal placental attachment, including 3 cases of placental implantation, 1 case of placental adhesion and 1 case of central placenta previa. Among the 5 patients, there were 2 cases with previous intrauterine adhesion and 4 cases with ≥2 times of myomectomy. Conclusion:The pregnancy rate of patients with infertility or recurrent abortion after submucosal myomectomy is the highest within the first year. The location and size of submucosal myoma should be combined to determine whether contraception and contraception time after operation. Those with a history of multiple intrauterine surgery may have abnormal placental attachment during pregnancy.
