| Objective: To investigate the outcomes and factors of pregnancy of patients who had stop birth-control after myomectomy by using retrospective investigation. In order to discuss the feasibility of myoma-complicated pregnancies, delivery outcomes had been compared between myoma-complicated pregnancies and pregnancies following myomectomy and the influence of myomectomy had been analyzed.Methods: The data,such as demographics,operation situation, fibroid types, recurrence of fibroid and pregnant outcomes, were collected by consulting medical record and being supplemented with telephone consultation from 353 patients whose age≤40 and had myomectomy in our hospital from December 1th 2009 to June 1th 2014.The 112 patients who had stop birth-control were choosed from 254 patients whose data were integrated.The pregnanted patients were defined as pregnancy group, otherwise were infertility group. The 41 patients who had conceived after myomectomy were defined as myomectomy group were compared with the 87 patients who had gave birth to baby with myoma in the same time were defined as myoma-complicated pregnancies group.All the data of two groups,such us the complication of pregnancy,delivery information,types of fibroid,the demographics,operation situation and pregnant rate were collected by consulting department records and telephone surveys. The chi-square test were used to analyze the demographics, operation informations,pregnancy rate, symptom, the types, number and size of fibroids between two groups and logistic regression were used to analysis the influence factors of pregnancy after myomectomy.Results: The 112 patients who had stop birth-control more than one year after myomectomy were choosed from 254 patients whose data were whole and there were85 patients had gestation,41 patients had delivery and 9 patients were still being in gestation. The pregnant rate were 75.9%, while no significant differences were found on the domicile and family history of fibroid between two groups(χ2=0.214,P=0.419;χ2=0.146,P=0.458).The pregnancy rate of patients whose age≥35 was 56.1% which lower than that of patient whose age<35(χ2=13.852,P=0.000)and the patients who had visited assisted reproductive technology had a lower pregnancy rate than that of patient who hadn’t(χ2=4.925,P=0.037). Thirty-nine out of 44 patients(88.6%)had conceived after myomectomy in the group of patients who had received higher education,while the rate was lower in the patients who had just received basic education(χ2=6.433,P=0.009).The patients who had never conceived get a highest pregnant rate(95.5%)after myomectomy and the rate became lower in the patient who had conceived 1 to 3times(74.1%),while in the patients who had more than 4 times pregnancy get the lowest pregnannt rate of 44.4%(χ2=9.613,P=0.008). No significant differences were found on the pregnant rate of surgical method, symptom, the number, size, relapse of fibroid in this two groups(P>0.05).By unconditional multivariate logistic regression model, it demonstrated that advanced age and if there were any infecund factors were risky factors of infertility after myomectomy(OR=0.236,95 % CI=0.079 ~ 0.706;OR=0.121,95%CI=0.027~0.540).The 41 patients who had delivery after myomectomy were defined as myomectomy group to compared with the 87 myoma-complicated pregnancies who defined as defined as myoma-complicated group.No significant differences on demographics, such as age,domicile, degree of education, and pregnancy history were found between two groups(P>0.05). The diameter of fibroids in myoma-complicated pregnancies group is significantly biger than that of myomectomy group(t=-4.608, P<0.001) and there were differences on the type of fibroids between this two groups(χ2=6.040,P=0.049). There were no significant differences were found on the rate of pregnance and cesarean section between myomectomy group and myoma-complicated pregnancy group(χ2=3.469, P=0.083. χ2=0.301, P=0.425). The myomectomy group had 1hypothyroidism, 5 intrahepatic cholestasis of pregnancy, 3 hypertensive disorder complicating pregnancy, 5 gestational diabetes mellitus, while the another grop had no hypothyroidism and 3 intrahepatic cholestasis of pregnancy,3hypertensive disorder complicating pregnancy, 5 gestational diabetes mellitus and there were no differences on these items of the two groups(P>0.05).There were no cardiac function insufficiency,severe anemia,hyperthyroidism took place in this two groups.There were no significant differences on postpartum hemorrhage, the amount of blood loss at delivery, placenta prevail,fetal distress and birth weight between myomectomy group and myoma-complicated pregnancy group(P > 0.05),however, the rate of preterm delivery and premature rupture of membranes in myomectomy group is higher than that of myoma-complicated pregnancy group(χ2=8.762, P=0.009;χ2=5.334,P=0.030).Both of the group had 1 mild neonatal asphyxia and 2 abnormal fetal position,while only the myomectomy group had 2 placenta previa and there were no severe neonatal asphyxia,placental abruption,uterine rupture and fetal malformation took place in this two groups.The pelvic adhesions had been found in 13 patients from32 patients who had cesarean section(40.6%).The rate of pelvic adhesions in TAM is high than that of LM(χ2=4.394,P=0.041).Conclusions: Age and if there were any infecund factors are the risky factors of gestation in the patients after myomectomy.Complications is more frequently in the group of pregnancies following myomectomy and myoma-complicated pregnancies may be feasible in the aged patient. |
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