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Objective:To estimate the safety of myomectomy in twin pregnant women with intramural myomas during cesarean section.Methods:The clinical data of 145 cases of twin pregnancies with intramural myomas who were delivered by cesarean section in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from June 2013 to December 2021 were collected. Maternal demographics, fibroids′ characteristics, maternal and fetal outcomes were compared between groups of cesarean section with myomectomy (myomectomy group, 49 cases) and cesarean section only (non-myomectomy group, 96 cases).Results:Compared with non-myomectomy group, myomectomy group had significantly prolonged operative time [50.0 minutes (37.5-57.5 minutes) vs 40.0 minutes (35.0-50.0 minutes), respectively; P=0.007] and significantly longer postoperative hospital stay [4.0 days (3.0-4.0 days) vs 3.0 days (3.0-4.0 days), respectively; P=0.047). Other maternal and fetal outcomes such as estimated blood loss, hemoglobin difference, postpartum hemorrhage, blood transfusion, B-Lynch structure, uterine artery ligation, postoperative fever and neonatal Apgar score showed no significant differences (all P>0.05). For intramural myomas <5 cm, there were no significant differences in maternal and fetal outcomes between myomectomy group and non-myomectomy group (all P>0.05). For intramural myomas ≥5 cm, operative time [55.0 minutes (40.0-60.0 minutes) vs 42.5 minutes (40.0-50.0 minutes), respectively; P=0.019] was significantly prolonged, postoperative hospital stay [4.0 days (4.0-5.0 days) vs 4.0 days (3.0-4.0 days), respectively; P=0.048] was significantly longer in myomectomy group than non-myomectomy group, but there were no significant differences in other maternal and fetal outcomes (all P>0.05). Conclusion:For twin pregnancies with intramural myomas, it is safe and feasible to remove intramural myomas during cesarean section by experienced obstetricians.
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Objective To elaborate the risk factors for leiomyoma residue and relapse after different approaches of myomectomy.Methods From Jan.2005 to Dec.2010 and Jan.2011 to Jan.2013,769 patients underwent myomectomy were recruited in Beijing Obstetrics and Gynecology Hospital.The patients demographic,leiomyoma characteristics,preoperative gonadotropin-releasing hormone agonist (GnRH-a) therapy,surgical approach,pathological type,follow-up information were collected.Results Leiomyoma number was the risk factor of postoperative residue and relapse,with the leiomyoma number increased one,the risk of residue and relapse increase 1.085 times (OR=1.085,95％CI:1.019-1.154,P=-0.010),1.043 times (RR=1.043,95％CI:1.014-1.073,P=0.003) respectively.Leiomyoma type (intramural leiomyoma) was the risk factor of relapse (RR=1.665,95％CI:1.029-2.693,P=0.038).Age was not the risk factor for postoperative residue rate (P=0.828) and relapse rate (P=0.193).GnRH-a didn't increase the postoperative residue and relapse rate (P=0.542,0.133).The postoperative residue rate (P=0.764),relapse rate (P=0.279) between transabdominal and laparoscopic myomectomy groups had no significant difference.Bizarre leiomyoma (RR=5.678,95％CI:1.373-23.490,P=0.017) and celluar leiomyoma (RR=2.201,95％CI:1.466-3.303,P＜0.01) were the risk factors for postoperative relapse rate.Conclusions Leiomyoma number,leiomyoma type (intramural leiomyoma) are the main risk factors for postoperative relapse.Pretreatment of GnRH-a and laparoscopic approach wouldn't increase the rate of residue and relapse.Bizarre leiomyoma and cellular leiomyoma have a higher relapse rate than common leiomyoma.