Nationwide population-based cohort study of adverse obstetric outcomes
in pregnancies with myoma or following myomectomy: Retrospective cohort
study
Abstract
Objectives: To evaluate risks of adverse obstetric outcomes in
pregnancies with myoma(s) or in pregnancies following myomectomy.
Design: Retrospective cohort Setting: The national health insurance
database Population: Women who had delivered in Republic of Korea,
between 2004 and 2015 Methods: We analyzed 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. Multivariate logistic regression analysis was performed. Main
Outcome Measures: The adverse obstetric outcomes. Results: There are
740,675 women who had never been diagnosed with myoma (Group A), 38,402
women who had diagnosed myoma(s) but no history of myomectomy (Group B),
and 9,890 women who had a history of myomectomy (Group C). Group B and
Group C had significantly higher risks of cesarean section and placenta
previa, compared to Group A. The risks of uterine rupture, preterm
birth, and low birth weight were significantly higher in Group C (aOR
12.78, 95% CI 6.5-25.13, p < 0.001; aOR 1.64, 95% CI
1.47-1.84, p < 0.001; and aOR 1.53, 95% CI 1.39-1.68, p
< 0.001, respectively), but not in Group B, compared to Group
A. The incidence of uterine rupture was the highest at delivery within
one year after myomectomy and decreased over time after myomectomy.
Conclusions: When a woman who might become pregnant later on is
diagnosed with uterine myoma, she should be counseled about the risk of
myoma(s) and myomectomy on obstetric complications, especially including
the significant risk of uterine rupture in pregnancies following
myomectomy.