Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis

Emmanuel Rault,Pierre Delorme,Aude Girault,François Goffinet

doi:10.1186/s12884-020-03413-w

Abstract

BackgroundTo evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy.MethodsRetrospective cohort study including all women with a history of myomectomy (operated group) or uterine myomas during pregnancy (unoperated group) who delivered in a tertiary center between January, 2011 and December, 2017. The operated group included women who had a myomectomy history with or without myomas during the ongoing pregnancy. The unoperated group included women with uterine myoma(s) seen on at least one ultrasound during pregnancy without history of myomectomy. The primary outcome was preterm birth < 37 weeks, and the secondary outcome spontaneous preterm birth < 37 weeks. To control for confounding factors, a propensity score approach was used. Two sensitivity analysis were performed, one repeating the analysis using the propensity score after excluding operated women with persistent myomas and one using a classical multivariable logistic regression model.ResultsThe cohort included 576 women: 283 operated women and 293 unoperated women. The rate of preterm birth was similar in the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). No difference in preterm birth risk was shown between unoperated and operated women in the cohort matched on the propensity score: OR 0.86; 95%CI [0.47–1.59]. These results were consistent for spontaneous preterm birth (OR 1.61; 95%CI [0.61–4.23]) and for the sensitivity analyses.ConclusionIn women with a leiomyomatous uterus, a history of myomectomy is not associated with a reduced preterm birth risk.

Highlights

To evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy
Under French regulations, this study is exempt from Institutional Review Board (IRB) review because it was an observational study using anonymized data from medical records
The crude preterm birth rate was not significantly different between the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). These results were consistent for spontaneous preterm birth (4.8% in the unoperated group vs. 4.9% in the operated group; p = 0.92) and preterm birth < 34 weeks (8.5% in the unoperated group vs. 8.5% in the operated group; p = 0.98)

Summary

Introduction

To evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy. Myomas are benign uterine smooth muscle tumors affecting 1.5 to 11% of reproductive-aged women [1,2,3,4] Their prevalence during pregnancy is estimated between 1.2 and 12%, depending on the characteristics of the studied population [5, 6]. Publications concerning the impact of myomectomy on pregnancy outcomes, including preterm birth, do not report any control group. In these studies, the preterm birth rates vary widely from 3 to 38.2% [9,10,11,12,13,14]. Fukuda et al who compared the pregnancy outcomes between women operated by laparoscopy and laparotomy reported an overall 11.4% preterm birth rate in a study of 105 women and did not report any significant differences between the two groups [13]

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