Do myomectomies alter third-trimester complications compared with women without myomectomies and uterine fibroids in situ: A retrospective cohort study of an American population database.
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OBJECTIVE: To evaluate population characteristics and pregnancy, delivery, and neonatal complications in women with myomectomy prior to pregnancy versus intramural fibroids in situ. METHODS: Retrospective cohort study using hospital discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2004 to 2014 included. A population of 14 206 pregnancies post-myomectomy and 81 517 with fibroids in situ were analyzed, performing multivariate logistic regression with adjustment. RESULTS: Post-myomectomy patients were younger, with lower body mass index, higher in vitro fertilization use, more commonly Caucasians or Hispanics, and had higher rates of pregestational diabetes, smoking, illicit drug use, previous cesarean delivery, and multiple gestations, compared with the in-situ fibroid (ISF) group. Post-myomectomy patients had decreased rates of gestational hypertension (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.77-0.97), eclampsia (aOR 0.76, 95% CI 0.32-0.81), gestational diabetes (aOR 0.83, 95% CI 0.77-0.90), spontaneous vaginal deliveries (aOR 0.09, 95% CI 0.08-0.11), postpartum hemorrhage (aOR 0.77, 95% CI 0.68-0.88), and intrauterine fetal death (aOR 0.64, 95% CI 0.43-0.97). Conversely, they had increased risks of placenta previa (aOR 1.40, 95% CI 1.20-1.64), preterm delivery (aOR 1.16, 95% CI 1.07-1.24), cesarean section (aOR 8.64, 95% CI 7.71-9.69), uterine rupture (aOR 2.21, 95% CI 1.31-3.74), transfusions (aOR 1.79, 95% CI 1.59-2.02), and congenital anomalies (aOR 2.35, 95% CI 2.01-2.75). CONCLUSIONS: The ISF group experienced different complications than the post-myomectomy group. Pregnancies post-myomectomy could benefit from additional screening or interventions during pregnancy to reduce complications from malplacentation and ensure delivery in specialized centers to mitigate risks. Patients should be counseled regarding these potential risks. Increased understanding of the role of myomectomies on reproductive outcomes requires further prospective studies.