Risk of placenta accreta spectrum following myomectomy: a nationwide cohort study

IF 8.7 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology Pub Date : 2024-08-01 DOI:10.1016/j.ajog.2023.11.1251

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引用次数: 0

Abstract

Background

Whether myomectomy increases the risk of placenta accreta spectrum in the following pregnancies remains controversial.

Objective

This study aimed to investigate the effect of myomectomy on the risk of placenta accreta spectrum in the following pregnancies. Moreover, different methods of myomectomy on the risk of placenta accreta spectrum were explored.

Study Design

A nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database, including all pregnant patients in Taiwan who gave birth between January 2008 and December 2017. A 1:1 propensity score estimation matching was performed for the analysis of myomectomy on the risk of placenta accreta spectrum. Among pregnant patients who received myomectomy, different methods of myomectomy on the risk of placenta accreta spectrum were compared with the control group.

Results

Among the 1,371,458 pregnant patients in this study, 11,255 pregnant patients had a history of myomectomy. The risk of placenta accreta spectrum was higher in pregnant patients with a history of myomectomy than in pregnant patients without a history of myomectomy (incidence: 0.96% vs 0.20%; adjusted odds ratio, 2.28; 95% confidence interval, 1.85–2.81; P<.01). Among pregnant patients with a history of myomectomy, 5045 (46.87%) received laparotomic myomectomy, 3973 (36.93%) received laparoscopic myomectomy, and 1742 (16.20%) received hysteroscopic myomectomy. The incidence of placenta accreta spectrum was higher in the hysteroscopic group than in the laparotomic group or the laparoscopic group (1.89% [hysteroscopic group] vs 0.71% [laparotomic group] and 0.81% [laparoscopic group]; P<.05). Compared with patients without a history of myomectomy, the adjusted odds ratio for placenta accreta spectrum was 3.88 (95% confidence interval, 2.68–5.63; P<.05) in the hysteroscopic group.

Conclusion

Myomectomy, especially hysteroscopic myomectomy, is associated with an increased risk of placenta accreta spectrum in the subsequent pregnancy.

查看原文本刊更多论文

子宫肌瘤切除术后胎盘增生谱的风险:一项全国性队列研究。

背景:子宫肌瘤切除术是否会增加后续妊娠发生胎盘增生谱(PAS)的风险仍存在争议。目的:本研究旨在探讨子宫肌瘤切除术对妊娠后患胎盘增生谱风险的影响。探讨不同子宫肌瘤切除方法对胎盘增生谱的影响。研究设计:使用台湾国民健康保险研究数据库的数据进行全国性队列研究，包括2008年1月至2017年12月在台湾分娩的所有孕妇。子宫肌瘤切除术对增生性胎盘风险谱的分析采用1:1倾向评分估计匹配。在接受子宫肌瘤切除术的妊娠患者中，与对照组比较不同子宫肌瘤切除术方式对胎盘增生风险谱的影响。结果:本研究1371458例妊娠患者中，有子宫肌瘤切除术史的妊娠患者11255例。有子宫肌瘤切除术史的妊娠患者发生PAS的风险高于无子宫肌瘤切除术史的妊娠患者(发生率0.96% vs. 0.20%，校正优势比2.28,95% CI 1.85 ~ 2.81, p)结论:子宫肌瘤切除术，特别是宫腔镜子宫肌瘤切除术与后续妊娠发生PAS的风险增加相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of obstetrics and gynecology 医学-妇产科学

CiteScore

15.90

自引率

7.10%

发文量

2237

审稿时长

47 days

期刊介绍： The American Journal of Obstetrics and Gynecology, known as "The Gray Journal," covers the entire spectrum of Obstetrics and Gynecology. It aims to publish original research (clinical and translational), reviews, opinions, video clips, podcasts, and interviews that contribute to understanding health and disease and have the potential to impact the practice of women's healthcare. Focus Areas: Diagnosis, Treatment, Prediction, and Prevention: The journal focuses on research related to the diagnosis, treatment, prediction, and prevention of obstetrical and gynecological disorders. Biology of Reproduction: AJOG publishes work on the biology of reproduction, including studies on reproductive physiology and mechanisms of obstetrical and gynecological diseases. Content Types: Original Research: Clinical and translational research articles. Reviews: Comprehensive reviews providing insights into various aspects of obstetrics and gynecology. Opinions: Perspectives and opinions on important topics in the field. Multimedia Content: Video clips, podcasts, and interviews. Peer Review Process: All submissions undergo a rigorous peer review process to ensure quality and relevance to the field of obstetrics and gynecology.

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