539: Perinatal outcomes of women undergoing cesarean delivery after prior myomectomy

Abstract

The purpose of this study was to evaluate maternal and neonatal outcomes after prior myomectomy in women undergoing cesarean delivery. We conducted a retrospective cohort study using the MFMU Cesarean Registry database comparing women undergoing a cesarean delivery with a history of prior myomectomy to women undergoing a cesarean delivery without a prior myomectomy. Inclusion criteria: singleton gestations at term undergoing planned cesarean delivery (CD). Exclusion criteria: stillbirth, CD indication non-reassuring fetal heart rare, macrosomia, abruption or previa, or women undergoing planned trial of labor after cesarean. Primary outcome was incidence of blood transfusion. Maternal and neonatal outcomes were compared secondarily. Poisson regression was used to compute risk ratios adjusted for confounders. The entire study population included 73,257 deliveries; 34,002 women met inclusion criteria, of which 367 had a prior myomectomy and 33,635 had no history of myomectomy (control group). The demographics, which varied by maternal age, race and number of prior cesareans were adjusted for when calculating maternal outcomes. The risk of intraoperative transfusion in the prior myomectomy group was 1.4% (5/367) compared to 0.4% (131/33,635) in the control group (aRR 2.8; 95% CI 1.15-6.79). The prior myomectomy group had a higher risk of postpartum transfusion (2.5%, 9/367) compared to the control group (1.2%, 416/33635) (aRR 2.03 (1006-3.92), uterotonics usage (5.4%, 20/367) compared to the control group (3.5%, 1165/33,635) (aRR 1.57; 95% CI 1.01-2.45), bowel injury (0.5%, 2/3675/367) compared to the control group (0.0%, 0/33,635) (aRR 8.13; 95% CI 2.05-8.91) and cesarean hysterectomy (1.4%, 5/367) compared to the control group (77/33,635) (aRR 3.43; 95% CI 1.32-8.91). Neonatal outcomes were not different between the groups. Prior myomectomy in women with term, singleton gestations undergoing planned cesarean delivery was associated with an 180% increased risk of intraoperative transfusion compared to the control group. Neonatal morbidity was not statistically different between the groups.View Large Image Figure ViewerDownload Hi-res image Download (PPT)