Our Summary

The research paper focuses on a study that compared the occurrence of placental abnormalities in pregnancies after different types of surgical procedures to remove fibroids (benign tumors in the uterus), namely laparotomy, laparoscopy, and hysteroscopy.

The study included all women who had undergone these procedures and later gave birth at a specific healthcare center from February 2011 to January 2019. Information was collected from the patients’ medical records and through phone surveys. The patients were divided into three groups based on the type of surgery they had. Each group was then compared for factors such as age, body mass index (BMI), number of pregnancies (gravidity), fibroid characteristics, surgical procedure, post-surgery placental evaluation, and delivery characteristics.

The primary outcome the researchers were looking for was the need for any intervention during the third phase of delivery because the placenta didn’t separate naturally.

The study found that having a surgical procedure to remove fibroids did not increase the likelihood of placental abnormalities in subsequent pregnancies. Also, the type of surgery did not require any additional interventions for complications related to abnormal placenta requiring intervention, except for manual removal of the placenta (manual lysis). However, vaginal delivery rates were significantly higher, and the need for manual removal of the placenta was significantly lower in the group of women who had undergone a hysteroscopy.

FAQs

  1. What were the key findings of the research paper on surgical procedures to remove fibroids and their impact on subsequent pregnancies?
  2. Does having a surgical procedure to remove fibroids increase the likelihood of placental abnormalities in later pregnancies?
  3. Did the type of surgery to remove fibroids affect the need for additional interventions related to abnormal placenta in subsequent pregnancies?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to discuss with their healthcare provider the potential impact of the surgery on future pregnancies, including the risk of placental abnormalities. It’s important to have open communication with your doctor to understand any potential risks and to ensure the best possible outcome for both the surgery and future pregnancies.

Suitable For

Overall, patients who are typically recommended myomectomy are those who have symptomatic fibroids that are causing significant issues such as heavy menstrual bleeding, pelvic pain, or infertility. Myomectomy is often recommended for women who wish to preserve their fertility and have not had success with other treatment options. Additionally, patients who have fibroids that are causing complications during pregnancy, such as recurrent miscarriages or preterm labor, may also be recommended for myomectomy.

It is important for patients to discuss their individual circumstances with their healthcare provider to determine if myomectomy is the best treatment option for them. Factors such as the size and location of the fibroids, the patient’s age and desire for future fertility, and any other underlying health conditions will all be taken into consideration when making a recommendation for myomectomy.

Timeline

Before myomectomy:

  1. Patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, and pressure.
  2. Patient undergoes a consultation with a gynecologist who recommends a myomectomy as a treatment option for fibroids.
  3. Patient undergoes preoperative tests and evaluations to assess their overall health and suitability for surgery.
  4. Patient schedules the myomectomy procedure and prepares for the surgery by following preoperative instructions.

After myomectomy:

  1. Patient undergoes the myomectomy surgery to remove the fibroids from the uterus.
  2. Patient stays in the hospital for a few days for postoperative care and monitoring.
  3. Patient may experience pain, discomfort, and fatigue in the days following surgery.
  4. Patient follows postoperative instructions for recovery, including managing pain, avoiding heavy lifting, and monitoring for any signs of complications.
  5. Patient may have follow-up appointments with their gynecologist to monitor their recovery and discuss any concerns.
  6. Patient may experience improvements in their symptoms, such as reduced menstrual bleeding and pelvic pain, in the weeks and months following the myomectomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What are the potential risks and complications associated with myomectomy surgery?
  2. How will my fertility be affected by myomectomy surgery?
  3. What is the likelihood of fibroid recurrence after myomectomy?
  4. Will my fibroids affect my ability to conceive or carry a pregnancy to term?
  5. How long is the recovery period after myomectomy surgery?
  6. Will I be able to have a vaginal delivery after myomectomy?
  7. What type of anesthesia will be used during the surgery?
  8. How will my fibroids be removed during the surgery (laparotomy, laparoscopy, hysteroscopy)?
  9. Will I need to take any medications before or after the surgery?
  10. How often will I need to follow up with my doctor after the surgery?

Reference

Authors: Mohr-Sasson A, Timor I, Meyer R, Stockheim D, Orvieto R, Mashiach R. Journal: J Matern Fetal Neonatal Med. 2022 Nov;35(22):4332-4337. doi: 10.1080/14767058.2020.1849114. Epub 2020 Nov 25. PMID: 33236944