School of Medicine and Health Sciences Poster Presentations

Title

Perinatal Outcomes of Women Undergoing Cesarean Delivery After Prior Myomectomy

Poster Number

162

Document Type

Poster

Status

Graduate Student - Doctoral

Abstract Category

Clinical Specialties

Keywords

Cesarean, Delivery, Myomectomy, Obstetrics, Perinatal

Publication Date

Spring 2018

Abstract

Objectives The purpose of this study was to evaluate maternal and neonatal outcomes after prior myomectomy in women undergoing planned cesarean delivery. Study Design We conducted a retrospective cohort study using the Maternal Fetal Medicine Units Cesarean Registry database comparing women undergoing a cesarean delivery with a history of prior myomectomy to women undergoing a cesarean delivery without a history of a prior myomectomy. Inclusion criteria were singleton gestations at term undergoing planned cesarean delivery. Exclusion criteria were stillbirth, cesarean delivery indication for non-reassuring fetal heart rate, 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. Logistic regression was used to adjust for confounders. Results The entire study population included 73,257 deliveries; 34,002 women met inclusion criteria, of which 367 had a prior myomectomy and 33,635 were controls. The demographics, which varied by maternal age, race and number of prior cesareans were adjusted for when calculating maternal outcomes. The rate of intraoperative transfusion in the prior myomectomy group was 1.4% (5/367) compared to 0.4% (131/33,635) in the control group (aOR 2.8; 95% CI 1.15-6.79). The prior myomectomy group had a higher incidence of postpartum transfusion rate (2.5%, 9/367) compared to the control group (1.2%, 416/33,635) (aOR 2.03 (1.06-3.92), uterotonics usage (5.4%, 20/367) compared to the control group (3.5%, 1,165/33,635;aOR 1.57; 95% CI 1.01-2.45), bowel injury (0.5%, 2/367) compared to the control group (0.0%, 14/33,635;aOR 8.13; 95% CI 2.05- 8.91) and cesarean hysterectomy (1.4%, 5/367) compared to the control group (77/33,635;aOR 3.43; 95% CI 1.32-8.91). Neonatal outcomes were not different between groups. Conclusion Prior myomectomy in women with term, singleton gestations undergoing planned cesarean delivery was associated with a 180% increased risk of intraoperative transfusion compared to the control group. Neonatal morbidity was not statistically different between the groups.

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Perinatal Outcomes of Women Undergoing Cesarean Delivery After Prior Myomectomy

Objectives The purpose of this study was to evaluate maternal and neonatal outcomes after prior myomectomy in women undergoing planned cesarean delivery. Study Design We conducted a retrospective cohort study using the Maternal Fetal Medicine Units Cesarean Registry database comparing women undergoing a cesarean delivery with a history of prior myomectomy to women undergoing a cesarean delivery without a history of a prior myomectomy. Inclusion criteria were singleton gestations at term undergoing planned cesarean delivery. Exclusion criteria were stillbirth, cesarean delivery indication for non-reassuring fetal heart rate, 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. Logistic regression was used to adjust for confounders. Results The entire study population included 73,257 deliveries; 34,002 women met inclusion criteria, of which 367 had a prior myomectomy and 33,635 were controls. The demographics, which varied by maternal age, race and number of prior cesareans were adjusted for when calculating maternal outcomes. The rate of intraoperative transfusion in the prior myomectomy group was 1.4% (5/367) compared to 0.4% (131/33,635) in the control group (aOR 2.8; 95% CI 1.15-6.79). The prior myomectomy group had a higher incidence of postpartum transfusion rate (2.5%, 9/367) compared to the control group (1.2%, 416/33,635) (aOR 2.03 (1.06-3.92), uterotonics usage (5.4%, 20/367) compared to the control group (3.5%, 1,165/33,635;aOR 1.57; 95% CI 1.01-2.45), bowel injury (0.5%, 2/367) compared to the control group (0.0%, 14/33,635;aOR 8.13; 95% CI 2.05- 8.91) and cesarean hysterectomy (1.4%, 5/367) compared to the control group (77/33,635;aOR 3.43; 95% CI 1.32-8.91). Neonatal outcomes were not different between groups. Conclusion Prior myomectomy in women with term, singleton gestations undergoing planned cesarean delivery was associated with a 180% increased risk of intraoperative transfusion compared to the control group. Neonatal morbidity was not statistically different between the groups.