2561 Should Placental Abnormality be Expected in Subsequent Pregnancy after Myomectomy?

Abstract

Study Objective To compare the incidence of placental abnormalities in subsequent pregnancy after myomectomy performed by laparoscopy, laparotomy and hysteroscopy. Design A retrospective cohort study, conducted from February 2011 to November 2018. Setting A single tertiary care center. Patients or Participants All women after myomectomy that gave birth. Interventions Data was collected from patients' medical files. Groups were compared for women demographics, fibroids characteristics, operative management, post-operative placental evaluation and delivery characteristics. Primary outcome was defined as the need for any intervention for placental separation during the third phase of the delivery. Non-parametric statistics were used for analysis. Measurements and Main Results 241 women met inclusion criteria. Complete follow-up was achieved in 199 (82.57%) women, of them 82, 89 and 28 underwent laparoscopic, laparotomy and hysteroscopic myomectomy, respectively. There were no significant differences between the groups in women's age, BMI, gravidity and history of cesarean deliveries. Endometrial damage during laparoscopy and laparotomy was reported in 3 (3.6%) and 7 (7.8%) of the women, respectively (p=0.21), and in all women undergoing hysteroscopic myomectomy (p=0.001). During subsequent pregnancy, morbidly adherent placenta was suspected in only one woman in each of the groups (p=0.63), a rate that is considered lower than the reported rate after one cesarean delivery. Placenta previa was not seen in any of the women included in the study. Normal vaginal delivery was significantly higher in the hysteroscopy group compared to laparoscopy and laparotomy groups [11 (36.3%) vs. 5 (6.1%) vs. 4 (4.5%); p=0.001], with significantly lower need for manual lysis of the placenta [11(39.0%) vs. 51 (62.1%) vs. 62 (69.7%); p=0.01] and no need for any further interventions to control blood loss. Conclusion Subsequent pregnancy after myomectomy was not found to be associated with high placental abnormality rate. Furthermore, other than manual lysis, no difference in abnormal placentation requiring intervention was seen between the different techniques.