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Background <p>We aimed to evaluate the risk of perinatal complications in subsequent pregnancies after different types of myomectomy, viz. open, laparoscopic, or hysteroscopic. Moreover, we investigated whether the time interval from myomectomy to subsequent pregnancy (TIMP) is a risk factor for perinatal complications.</p> Methods <p>This retrospective cohort study analyzed data from the vast Japanese health insurance JMDC database between January 2008 and July 2024. We identified primiparous women and excluded participants based on the following criteria: age &lt; 20&#xa0;years at delivery, diagnosis of adenomyosis, multiple pregnancy, or history of repeated myomectomy using different approaches. The occurrence of placenta accreta spectrum (PAS), placenta previa, uterine rupture, gestational hypertension/preeclampsia, and placental abruption was compared among women who underwent open, laparoscopic, or hysteroscopic myomectomy and those in the control group. Subsequently, for each myomectomy procedure, we compared the TIMP between women with and without each perinatal complication. Fisher’s exact test and multivariable logistic regression models were employed.</p> Results <p>Among the 27,129 eligible women, 140, 305, and 97 underwent open, laparoscopic, and hysteroscopic myomectomy, respectively. The proportion of PAS was the highest in the hysteroscopic group (5.2%), followed by the control (1.8%), open (1.4%), and laparoscopic (1.3%) groups. After adjustment, there was no association between PAS and hysteroscopic myomectomy (adjusted odds ratio, 1.86; 95% confidence interval, 0.75–4.63). Uterine rupture after myomectomy was observed only in the laparoscopic surgery group (1.0%); this difference among the four groups was statistically significant (Fisher’s exact test, <i>P</i> = 0.001), although a robust adjusted analysis was not feasible due to the low incidence rate. The proportion of gestational hypertension/preeclampsia was the highest in the hysteroscopic group (17.5%); however, a similar trend was observed as for PAS (adjusted odds ratio, 1.30; 95% confidence interval, 0.74–2.27). The incidences of placenta previa and placental abruption did not differ significantly among the groups. The TIMP was the shortest after hysteroscopic myomectomy, followed by laparoscopic and open myomectomy. Although the number of outcomes was small, which constrained clinical interpretation, there were no perinatal complications associated with TIMP.</p> Conclusion <p>Our study suggested the potential risk of uterine rupture after laparoscopic myomectomy. The optimal TIMP remains unclear. The risks of perinatal complications after myomectomy should be assessed and addressed at the individual level based on the specific myomectomy method, but further research on the optimal TIMP is warranted.</p>

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Perinatal complications and time to subsequent pregnancy after open, laparoscopic, and hysteroscopic myomectomy: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年1月2日

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  • Maho Furukawa,
  • Osamu Wada-Hiraike,
  • Maika Nariai,
  • Hiromi Ga,
  • Risa Takai,
  • Yuki Enomoto,
  • Yusuke Sasabuchi,
  • Hideo Yasunaga,
  • Miyuki Harada,
  • Yasushi Hirota

摘要

Background

We aimed to evaluate the risk of perinatal complications in subsequent pregnancies after different types of myomectomy, viz. open, laparoscopic, or hysteroscopic. Moreover, we investigated whether the time interval from myomectomy to subsequent pregnancy (TIMP) is a risk factor for perinatal complications.

Methods

This retrospective cohort study analyzed data from the vast Japanese health insurance JMDC database between January 2008 and July 2024. We identified primiparous women and excluded participants based on the following criteria: age < 20 years at delivery, diagnosis of adenomyosis, multiple pregnancy, or history of repeated myomectomy using different approaches. The occurrence of placenta accreta spectrum (PAS), placenta previa, uterine rupture, gestational hypertension/preeclampsia, and placental abruption was compared among women who underwent open, laparoscopic, or hysteroscopic myomectomy and those in the control group. Subsequently, for each myomectomy procedure, we compared the TIMP between women with and without each perinatal complication. Fisher’s exact test and multivariable logistic regression models were employed.

Results

Among the 27,129 eligible women, 140, 305, and 97 underwent open, laparoscopic, and hysteroscopic myomectomy, respectively. The proportion of PAS was the highest in the hysteroscopic group (5.2%), followed by the control (1.8%), open (1.4%), and laparoscopic (1.3%) groups. After adjustment, there was no association between PAS and hysteroscopic myomectomy (adjusted odds ratio, 1.86; 95% confidence interval, 0.75–4.63). Uterine rupture after myomectomy was observed only in the laparoscopic surgery group (1.0%); this difference among the four groups was statistically significant (Fisher’s exact test, P = 0.001), although a robust adjusted analysis was not feasible due to the low incidence rate. The proportion of gestational hypertension/preeclampsia was the highest in the hysteroscopic group (17.5%); however, a similar trend was observed as for PAS (adjusted odds ratio, 1.30; 95% confidence interval, 0.74–2.27). The incidences of placenta previa and placental abruption did not differ significantly among the groups. The TIMP was the shortest after hysteroscopic myomectomy, followed by laparoscopic and open myomectomy. Although the number of outcomes was small, which constrained clinical interpretation, there were no perinatal complications associated with TIMP.

Conclusion

Our study suggested the potential risk of uterine rupture after laparoscopic myomectomy. The optimal TIMP remains unclear. The risks of perinatal complications after myomectomy should be assessed and addressed at the individual level based on the specific myomectomy method, but further research on the optimal TIMP is warranted.