Abstract：
OBJECTIVE: The authors conducted a large-scale cohort study using the Japan Society of Obstetrics and Gynecology\'s perinatal registry database to determine the effect of myomectomy on perinatal outcomes.
METHODS: This retrospective cohort study enrolled 203 745 women who gave birth between January and December 2020 in Japan. The participants were classified into two groups based on their history of myomectomy (open/laparoscopic) to investigate fertility treatment, delivery information, obstetric complications, maternal treatment, infant information, fetal appendages, obstetric history, underlying disease, infectious disease, drugs used, and case information regarding maternal and infant death.
RESULTS: In total, 1161 pregnant women had a history of myomectomy and 202 584 did not. Compared with the nonmyomectomy group, the myomectomy group had a higher occurrence rate of uterine rupture (0.9% vs 0.06%, P < 0.01) and placenta accreta (1.5% vs 0.5%, P < 0.01). In addition, history of myomectomy (odds ratio [OR], 2.62 [95% confidence interval (CI), 1.500-4.226]; P < 0.001) was found to be an independent factor for placenta accrete and uterine rupture (OR, 14.4 [95% CI, 6.75-27.02]; P < 0.001). Furthermore, myomectomy increased the risk of uterine rupture by 14 times.
CONCLUSIONS: Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture.
METHODS: This retrospective cohort study enrolled 203 745 women who gave birth between January and December 2020 in Japan. The participants were classified into two groups based on their history of myomectomy (open/laparoscopic) to investigate fertility treatment, delivery information, obstetric complications, maternal treatment, infant information, fetal appendages, obstetric history, underlying disease, infectious disease, drugs used, and case information regarding maternal and infant death.
RESULTS: In total, 1161 pregnant women had a history of myomectomy and 202 584 did not. Compared with the nonmyomectomy group, the myomectomy group had a higher occurrence rate of uterine rupture (0.9% vs 0.06%, P < 0.01) and placenta accreta (1.5% vs 0.5%, P < 0.01). In addition, history of myomectomy (odds ratio [OR], 2.62 [95% confidence interval (CI), 1.500-4.226]; P < 0.001) was found to be an independent factor for placenta accrete and uterine rupture (OR, 14.4 [95% CI, 6.75-27.02]; P < 0.001). Furthermore, myomectomy increased the risk of uterine rupture by 14 times.
CONCLUSIONS: Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture.
摘要：
目的：作者使用日本妇产科学会的围产期登记数据库进行了大规模队列研究，以确定子宫肌瘤切除术对围产期结局的影响。
方法：这项回顾性队列研究纳入了2020年1月至12月在日本分娩的203745名妇女。根据子宫肌瘤切除术（开腹/腹腔镜）的病史，将参与者分为两组，以研究生育治疗。交货信息，产科并发症,产妇治疗,婴儿信息,胎儿附属物,产科史,潜在的疾病，传染病,使用的药物，以及有关孕产妇和婴儿死亡的病例信息。
结果：总计，1161名孕妇有子宫肌瘤切除术史，202584名孕妇没有。与非子宫肌瘤切除术组相比，子宫肌瘤剔除组有较高的子宫破裂发生率(0.9%vs0.06%,P<0.01）和胎盘植入（1.5%vs0.5%，P<0.01)。此外,子宫肌瘤切除术史（比值比[OR]，2.62[95%置信区间(CI)，1.500-4.226]；P<0.001）被发现是胎盘植入和子宫破裂的独立因素（OR，14.4[95%CI，6.75-27.02]；P<0.001）。此外，子宫肌瘤切除术使子宫破裂的风险增加了14倍。
结论：子宫肌瘤切除术后妊娠可能增加胎盘植入和子宫破裂的风险。
方法：这项回顾性队列研究纳入了2020年1月至12月在日本分娩的203745名妇女。根据子宫肌瘤切除术（开腹/腹腔镜）的病史，将参与者分为两组，以研究生育治疗。交货信息，产科并发症,产妇治疗,婴儿信息,胎儿附属物,产科史,潜在的疾病，传染病,使用的药物，以及有关孕产妇和婴儿死亡的病例信息。
结果：总计，1161名孕妇有子宫肌瘤切除术史，202584名孕妇没有。与非子宫肌瘤切除术组相比，子宫肌瘤剔除组有较高的子宫破裂发生率(0.9%vs0.06%,P<0.01）和胎盘植入（1.5%vs0.5%，P<0.01)。此外,子宫肌瘤切除术史（比值比[OR]，2.62[95%置信区间(CI)，1.500-4.226]；P<0.001）被发现是胎盘植入和子宫破裂的独立因素（OR，14.4[95%CI，6.75-27.02]；P<0.001）。此外，子宫肌瘤切除术使子宫破裂的风险增加了14倍。
结论：子宫肌瘤切除术后妊娠可能增加胎盘植入和子宫破裂的风险。
