가임기 여성의 자궁근종의 보존적 치료와 임신 예후
The Effects of Myoma and Uterine Preserving Procedures for Myoma on Pregnancy Outcomes
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Uterine myomas are the most common benign tumors in reproductive aged women. There have been concerns about fertility and obstetric complications in pregnant women with myomas. Currently, maternal age for pregnancy is increasing, and uterine-preserving therapeutic procedures of uterine fibroids such as myomectomy, high-intensity focused ultrasound (HIFU), or uterine artery embolization (UAE) have increased. However, it is unclear whether those treatments can improve fertility and pregnancy outcomes. Recent data suggest that pregnancies after uterus-preserving procedures are associated with obstetric complications such as cesarean section, placenta previa, preterm labor, premature birth, and low birth weight. The biggest obstetric concern in pregnancies after uterine-preserving procedures is uterine rupture during pregnancy, which can threaten the survival of fetuses. Moreover, uterine rupture after myomectomy is more likely to occur before labor onset. Most international guidelines suggest that myomectomy be considered for a woman with uterine myomas who has undergone several unsuccessful in vitro fertilization cycles despite appropriate ovarian response and good-quality embryos or for a woman with symptomatic myomas. In addition, HIFU or UAE treatments are relative contraindications in women with a future pregnancy plan, because there are limited data about associated pregnancy outcomes, and UAE can affect fertility after the procedure. The risks of uterine rupture and of obstetric complications in pregnancies after myomectomy should be discussed in affected women with a future pregnancy plan.
Abstract
Uterine myomas are the most common benign tumors in reproductive aged women. There have been concerns about fertility and obstetric complications in pregnant women with myomas. Currently, maternal age for pregnancy is increasing, and uterine-preserving therapeutic procedures of uterine fibroids such as myomectomy, high-intensity focused ultrasound (HIFU), or uterine artery embolization (UAE) have increased. However, it is unclear whether those treatments can improve fertility and pregnancy outcomes. Recent data suggest that pregnancies after uterus-preserving procedures are associated with obstetric complications such as cesarean section, placenta previa, preterm labor, premature birth, and low birth weight. The biggest obstetric concern in pregnancies after uterine-preserving procedures is uterine rupture during pregnancy, which can threaten the survival of fetuses. Moreover, uterine rupture after myomectomy is more likely to occur before labor onset. Most international guidelines suggest that myomectomy be considered for a woman with uterine myomas who has undergone several unsuccessful in vitro fertilization cycles despite appropriate ovarian response and good-quality embryos or for a woman with symptomatic myomas. In addition, HIFU or UAE treatments are relative contraindications in women with a future pregnancy plan, because there are limited data about associated pregnancy outcomes, and UAE can affect fertility after the procedure. The risks of uterine rupture and of obstetric complications in pregnancies after myomectomy should be discussed in affected women with a future pregnancy plan.
참고문헌 (43)
- American College of Obstetricians and Gynecologists, "ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas", Obstet Gynecol, 112(2 Pt 1), pp.387~400 (2008)
- Anneveldt KJ, "Systematic review of reproductive outcomes after High Intensity Focused Ultrasound treatment of uterine fibroids", Eur J Radiol, 141, pp.109801~ (2021)
- Chen J, "Evaluation of high-intensity focused ultrasound ablation for uterine fibroids : an IDEAL prospective exploration study", BJOG, 125, pp.354~364 (2018)
- Committee on Gynecologic Practice, "ACOG Committee Opinion. Uterine artery embolization", Obstet Gynecol, 103, pp.403~404 (2004)
- Flyckt R, "Comparison of Long-Term Fertility and Bleeding Outcomes after Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy", Obstet Gynecol Int, 2016, pp.2789201~ (2016)
- Fukuda M, "Comparison of the perinatal outcomes after laparoscopic myomectomy versus abdominal myomectomy", Gynecol Obstet Invest, 76, pp.203~208 (2013)
- Gambacorti-Passerini Z, "Trial of labor after myomectomy and uterine rupture : a systematic review", Acta Obstet Gynecol Scand, 95, pp.724~734 (2016)
- Gimovsky AC, "Perinatal outcomes of women undergoing cesarean delivery after prior myomectomy", J Matern Fetal Neonatal Med, 33, pp.2153~2158 (2020)
- Goldberg J, "Pregnancy after uterine artery embolization", Obstet Gynecol, 100(5 Pt 1), pp.869~872 (2002)
- Homer H, "Uterine artery embolization for fibroids is associated with an increased risk of miscarriage", Fertil Steril, 94, pp.324~330 (2010)
- Jenabi E, "The association between uterine leiomyoma and placenta abruption : a meta-analysis", J Matern Fetal Neonatal Med, 30, pp.2742~2746 (2017)
- Jenabi E, "The uterine leiomyoma and placenta previa : a meta-analysis", J Matern Fetal Neonatal Med, 32, pp.1200~1204 (2019)
- "Treatment of uterine fibroids with magnetic resonance guided high intensity focused ultrasound"[URL]
- 강윤단, "고강도 집속 초음파 (HIFU) 후 임신 제 2 삼분기에 발생한 자연 자궁파열 1예", Perinatology, 26(4), pp.373~376 (2015), 대한주산의학회
- 김희선, "Uterine rupture in pregnancies following myomectomy: A multicenter case series", Obstetrics & Gynecology Science, 59(6), pp.454~462 (2016), 대한산부인과학회[DOI]
- 김묘선, "Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach", Obstetrics & Gynecology Science, 56(06), pp.375~381 (2013), 대한산부인과학회[DOI]
- Kinugasa-Taniguchi Y, "Impaired delivery outcomes in pregnancies following myomectomy compared to myomacomplicated pregnancies", J Reprod Med, 56, pp.142~148 (2011)
- Kirschen GW, "Vascular biology of uterine fibroids : connecting fibroids and vascular disorders", Reproduction, 162, pp.R1~R18 (2021)
- Klatsky PC, "Fibroids and reproductive outcomes : a systematic literature review from conception to delivery", Am J Obstet Gynecol, 198, pp.357~366 (2008)
- Koo YJ, "Pregnancy outcomes and risk factors for uterine rupture after laparoscopic myomectomy : a single-center experience and literature review", J Minim Invasive Gynecol, 22, pp.1022~1028 (2015)
- Korean Society of Obstetrics and Gynecology, "HIFU clinical guideline", Korean Society of Obstetrics and Gynecology, ~ (2016)
- "Korean vital statistics birth certificate data" (2020)[URL]
- Lee M, "Estimated prevalence and incidence of uterine leiomyoma, and its treatment trend in South Korean women for 12 years: a national population-based study", J Womens Health (Larchmt), 30, pp.1038~1046 (2021)
- Lee SJ, "Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy : retrospective cohort study", BMC Pregnancy Childbirth, 20, pp.716~ (2020)
- Ludwig PE, "Pregnancy success and outcomes after uterine fibroid embolization : updated review of published literature", Br J Radiol, 93, pp.20190551~ (2020)
- Makino S, "National survey of uterine rupture in Japan : Annual report of Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2018", J Obstet Gynaecol Res, 45, pp.763~765 (2019)
- Marret H, "Therapeutic management of uterine fibroid tumors : updated French guidelines", Eur J Obstet Gynecol Reprod Biol, 165, pp.156~164 (2012)
- Milazzo GN, "Myoma and myomectomy : poor evidence concern in pregnancy", J Obstet Gynaecol Res, 43, pp.1789~1804 (2017)
- Muram D, "Myomas of the uterus in pregnancy : ultrasonographic follow-up", Am J Obstet Gynecol, 138, pp.16~19 (1980)
- Pan L, "Pre-existing medical disorders as risk factors for preeclampsia : an exploratory case-control study", Hypertens Pregnancy, 38, pp.245~251 (2019)
- Pisco JM, "Pregnancy after uterine fibroid embolization", Fertil Steril, 95, pp.1121.e5~1121.e8 (2011)
- Pop L, "Patency of uterine wall in pregnancies following assisted and spontaneous conception with antecedent laparoscopic and abdominal myomectomies-a difficult case and systematic review", J Matern Fetal Neonatal Med, 32, pp.2241~2248 (2019)
- Practice Committee of the American Society for Reproductive Medicine, "Electronic address: ASRM@asrm.org; Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and", or reduce miscarriage rate: a guideline, 2017, pp.108, 416~425
- Practice Committee of the American Society for Reproductive Medicine, "Myomas and reproductive function", Fertil Steril, 82(Suppl 1), pp.S111~S116 (2004)
- Practice Committee of the American Society for Reproductive Medicine, "Myomas and reproductive function", Fertil Steril, 86(5 Suppl 1), pp.S194~S199 (2006)
- Rabinovici J, "Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery(MRgFUS)for conservative treatment of uterine fibroids", Fertil Steril, 93, pp.199~209 (2010)
- Seracchioli R, "Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy", Fertil Steril, 86, pp.159~165 (2006)
- Sridhar D, "Updates on MR-Guided Focused Ultrasound for Symptomatic Uterine Fibroids", Semin Intervent Radiol, 35, pp.17~22 (2018)
- Trampe BS, "Color Doppler ultrasonography for distinguishing myomas from uterine contractions in pregnancy", J Reprod Med, 46, pp.791~794 (2001)
- Vilos GA, "The management of uterine leiomyomas", J Obstet Gynaecol Can, 37, pp.157~178 (2015)
- Walker WJ, "Uterine artery embolisation for symptomatic fibroids : clinical results in 400 women with imaging follow up", BJOG, 109, pp.1262~1272 (2002)
- Wu G, "A comparison of the pregnancy outcomes between ultrasound-guided high-intensity focused ultrasound ablation and laparoscopic myomectomy for uterine fibroids : a comparative study", Int J Hyperthermia, 37, pp.617~623 (2020)
- 유은희, "복강경하 자궁근종절제술 후 산과적 결과", Obstetrics & Gynecology Science, 51(12), pp.1481~1486 (2008), 대한산부인과학회