medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-161medsovet-8174Research ArticleРЕПРОДУКТИВНОЕ ЗДОРОВЬЕ И ВРТREPRODUCTIVE HEALTH AND ARTТечение беременности у женщин с рубцом на матке после миомэктомииCourses of pregnancy in women witha uterine scar after conservative myomectomyhttps://orcid.org/0000-0002-9698-8038ЧегусЛ. А.ChegusL. A.

Чегус Лариса Алексеевна, к.м.н., кафедра акушерства и гинекологии

628011, Ханты-Мансийск, ул. Мира, д. 40

Larisa A. Chegus, Cand. Sci. (Med.), Associate Professor at the Department of Obstetrics and Gynecology

40, Mira St., Khanty-Mansiysk, 628011

lchegus@mail.ruhttps://orcid.org/0000-0001-6711-1563СоловьеваА. В.SolovyevaA. V.

Соловьева Алина Викторовна, д.м.н., профессор кафедры акушерства и гинекологии с курсом перинатологии

117198, Москва, ул. Миклухо-Маклая, д. 6

Alina V. Solovyeva, Dr. Sci. (Med.), Professor at the Department of Obstetrics and Gynecology with the course of Perinatology

6, Miklukho-Maklai St., Moscow, 11719

av_soloveva@mail.ruhttps://orcid.org/0000-0002-1434-0386АлейниковаЕ. Ю.AleynikovaE. Yu.

Алейникова Екатерина Юрьевна, аспирант кафедры акушерства и гинекологии с курсом перинатологии

117198, Москва, ул. Миклухо-Маклая, д. 6

Ekaterina Yu. Aleynikova, Postgraduate Student of the Department of Obstetrics and Gynecology with the course of Perinatology

6, Miklukho-Maklai St., Moscow, 11719

ketall@mail.ruhttps://orcid.org/0009-0005-3745-0042СпицынаМ. А.SpitsynaM. A.

Спицына Мария Александровна, клинический ординатор кафедры акушерства и гинекологии с курсом перинатологии

117198, Москва, ул. Миклухо-Маклая, д. 6

Maria A. Spitsyna, Clinical Resident of the Department of Obstetrics and Gynecology with the course of Perinatology

6, Miklukho-Maklai St., Moscow, 11719

lotyreva31@gmail.comХанты-Мансийская государственная медицинская академияРоссияKhanty-Mansiysk State Medical AcademyRussian FederationРоссийский университет дружбы народов имени Патриса ЛумумбыРоссияPeoples’ Friendship University of Russia named after Patrice LumumbaRussian Federation202401052024044855Copyright © Чегус Л.А., Соловьева А.В., Алейникова Е.Ю., Спицына М.А., 20242024Чегус Л.А., Соловьева А.В., Алейникова Е.Ю., Спицына М.А.Chegus L.A., Solovyeva A.V., Aleynikova E.Y., Spitsyna M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8174Введение

Введение. Миома матки – самое распространенное заболевание женской репродуктивной системы. При наличии показаний основным органосохраняющим методом лечения является миомэктомия. Однако, по мнению многих исследователей, женщины, перенесшие консервативную миомэктомию, подвержены более высокому риску развития таких осложнений во время беременности, как предлежание плаценты, плацентарные нарушения и несостоятельность рубца на матке.

Цель

Цель. Выявить особенности течения беременности, родов и перинатального исхода у женщин с рубцом на матке после миомэктомии, которые получали прегравидарную подготовку.

Материалы и методы

Материалы и методы. Ретроспективное исследование включало анализ 159 историй амбулаторного наблюдения женщин после консервативной миомэктомии, планирующих беременность, в т. ч. истории родов 109 беременных женщин в возрасте 29–40 лет, родоразрешенных в Перинатальном центре БУ «Окружная клиническая больница» г. Ханты-Мансийска с 2011 по 2021 г. c целью исследования особенностей течения беременности у женщин с рубцом на матке после консервативной миомэктомии.

Результаты

Результаты. При анализе данных были выявлены следующие статистически значимые различия между группами: первый триместр беременности у женщин с рубцом на матке в сравнении с контрольной группой чаще осложнялся предлежанием хориона, угрожающим самопроизвольным выкидышем, инфекцией мочевыводящих путей и ранним токсикозом (p < 0,05); во втором триместре беременности в 1-й группе чаще были угрожающие преждевременные роды и плацентарные нарушения (p < 0,05), большинство женщин с рубцом на матке после миомэктомии (77,8%) были родоразрешены посредством кесарева сечения в отличие от контрольной группы (9,7%) (p < 0,05).

Выводы

Выводы. Полученные нами данные о течении беременности, родов и перинатальных исходов после миомэктомии отразили необходимость и эффективность прегравидарной подготовки у данного контингента женщин.

Introduction

Introduction. Uterine fibroids are the most common disease of the female reproductive system. If indicated, the main organpreserving method of treatment is myomectomy. However, according to many researchers, women who have undergone conservative myomectomy are at a higher risk of developing complications during pregnancy such as placenta previa, placental disorders, and uterine scar failure.

Aim

Aim. To identify the features of the course of pregnancy, childbirth and perinatal outcome in women with a uterine scar after conservative myomectomy who received pregravid preparation.

Materials and methods

Materials and methods. A retrospective study included an analysis of 159 outpatient histories of women planning pregnancy after conservative myomectomy, including the birth histories of 109 pregnant women aged 29–40 years who delivered at the Perinatal Center of the Regional Clinical Hospital in Khanty-Mansiysk from 2011 to 2021 in order to study the characteristics of the course of pregnancy in women with a scar on the uterus after conservative myomectomy.

Results

Results. When analyzing the data, the following statistically significant differences between the groups were revealed: the first trimester of pregnancy in women with a uterine scar compared with the control group was more often complicated by chorion presentation, threatened miscarriage, urinary tract infection and early toxicosis (p < 0.05); in the second trimester of pregnancy in group 1, there were more often threatening preterm labor and placental disorders (p < 0.05), the majority of women with a scar on the uterus after myomectomy (77.8%) were delivered by caesarean section, in contrast to the control group (9.7%) (p < 0.05).

Conclusion

Conclusion. The data we obtained on the course of pregnancy, childbirth and perinatal outcomes after myomectomy reflected the need and effectiveness of preconception preparation in this contingent of women.

родыпрегравидарная подготовкапредлежание хорионаугрожающий самопроизвольный выкидышинфекция мочевыводящих путейранний токсикозкесарево сечениеchildbirthpre-pregnancy preparationchorion presentationthreatening spontaneous miscarriageurinary tract infectionearly toxicosiscesarean sectionReferencesKiesler ZG, Hunter MI, Balboula AZ, Patterson AL. Periostin’s role in uterine leiomyoma development: a mini-review on the potential periostin poses as a pharmacological intervention for uterine leiomyoma. Arch Gynecol Obstet. 2024. https://doi.org/10.1007/s00404-024-07435-z.Kiesler ZG, Hunter MI, Balboula AZ, Patterson AL. Periostin’s role in uterine leiomyoma development: a mini-review on the potential periostin poses as a pharmacological intervention for uterine leiomyoma. Arch Gynecol Obstet. 2024. https://doi.org/10.1007/s00404-024-07435-z.Koga K, Fukui M, Fujisawa M, Suzukamo Y. Impact of diagnosis and treatment of uterine fibroids on quality of life and labor productivity: The Japanese online survey for uterine fibroids and quality of life (JOYFUL survey). J Obstet Gynaecol Res. 2023;49(10):2528–2537. https://doi.org/10.1111/jog.15758.Koga K, Fukui M, Fujisawa M, Suzukamo Y. Impact of diagnosis and treatment of uterine fibroids on quality of life and labor productivity: The Japanese online survey for uterine fibroids and quality of life (JOYFUL survey). J Obstet Gynaecol Res. 2023;49(10):2528–2537. https://doi.org/10.1111/jog.15758.El Sabeh M, Borahay MA. The Future of Uterine Fibroid Management: a More Preventive and Personalized Paradigm. Reprod Sci. 2021;28(11):3285–3288. https://doi.org/10.1007/s43032-021-00618-y.El Sabeh M, Borahay MA. The Future of Uterine Fibroid Management: a More Preventive and Personalized Paradigm. Reprod Sci. 2021;28(11):3285–3288. https://doi.org/10.1007/s43032-021-00618-y.Nieh C, Mabila SL. Incidence and health care burden of uterine fibroids among female service members in the active component of the U.S. Armed Forces, 2011–2022. MSMR. 2024;31(2):9–15. Available at: https://europepmc.org/article/MED/38466970.Nieh C, Mabila SL. Incidence and health care burden of uterine fibroids among female service members in the active component of the U.S. Armed Forces, 2011–2022. MSMR. 2024;31(2):9–15. Available at: https://europepmc.org/article/MED/38466970.Камхен ВБ, Жаймырзаева ГА. Миома матки у женщин фертильного возраста: размеры узлов и клинические проявления. Вестник КазНМУ. 2020;(3):12–14. Режим доступа: https://cyberleninka.ru/article/n/miomamatki-u-zhenschin-fertilnogo-vozrasta-razmery-uzlov-i-klinicheskieproyavleniya.Kamkhen VB, Zhaymyrzaeva GА. Uterine fibroids in women of fertile age: dimensions of nodes and clinical manifestations. Vestnik KazNMU. 2020;(3):12–14. (In Russ.) Available at: https://cyberleninka.ru/article/n/mioma-matki-u-zhenschin-fertilnogo-vozrasta-razmery-uzlov-iklinicheskie-proyavleniya.Michos G, Dagklis T, Papanikolaou E, Tsakiridis I, Oikonomou K, Mamopoulos AM et al. Uterine Leiomyomas and Infertility: A Comparison of National and International Guidelines. Cureus. 2023;15(12):e50992. https://doi.org/10.7759/cureus.50992.Michos G, Dagklis T, Papanikolaou E, Tsakiridis I, Oikonomou K, Mamopoulos AM et al. Uterine Leiomyomas and Infertility: A Comparison of National and International Guidelines. Cureus. 2023;15(12):e50992. https://doi.org/10.7759/cureus.50992.Ahmad A, Kumar M, Bhoi NR, Badruddeen, Akhtar J, Khan MI et al. Diagnosis and management of uterine fibroids: current trends and future strategies. J Basic Clin Physiol Pharmacol. 2023;34(3):291–310. https://doi.org/10.1515/jbcpp-2022-0219.Ahmad A, Kumar M, Bhoi NR, Badruddeen, Akhtar J, Khan MI et al. Diagnosis and management of uterine fibroids: current trends and future strategies. J Basic Clin Physiol Pharmacol. 2023;34(3):291–310. https://doi.org/10.1515/jbcpp-2022-0219.Cianci S, Gulino FA, Palmara V, La Verde M, Ronsini C, Romeo P et al. Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches. Medicina (Kaunas). 2023;60(1):64. https://doi.org/10.3390/medicina60010064.Cianci S, Gulino FA, Palmara V, La Verde M, Ronsini C, Romeo P et al. Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches. Medicina (Kaunas). 2023;60(1):64. https://doi.org/10.3390/medicina60010064.Ordás P, Spagnolo E, Fernández LG, Diestro Tejeda MD, Lafuente P, Salas P et al. Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: A singlecenter cohort study. Front Surg. 2022;9:997078. https://doi.org/10.3389/fsurg.2022.997078.Ordás P, Spagnolo E, Fernández LG, Diestro Tejeda MD, Lafuente P, Salas P et al. Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: A singlecenter cohort study. Front Surg. 2022;9:997078. https://doi.org/10.3389/fsurg.2022.997078.Tossamartvorakul M, Mendoza MCVR, Huang KG, Chang SH. Metastatic Smooth Muscle Tumor of Uncertain Malignant Potential after Laparoscopic Presuming Myomectomy. Gynecol Minim Invasive Ther. 2021;10(3):187–190. https://doi.org/10.4103/GMIT.GMIT_44_20.Tossamartvorakul M, Mendoza MCVR, Huang KG, Chang SH. Metastatic Smooth Muscle Tumor of Uncertain Malignant Potential after Laparoscopic Presuming Myomectomy. Gynecol Minim Invasive Ther. 2021;10(3):187–190. https://doi.org/10.4103/GMIT.GMIT_44_20.Kociuba J, Łoziński T, Latra K, Korczyńska L, Skowyra A, Zarychta E, Ciebiera M. Occurrence and Risk Factors for Perioperative Treatment Discontinuation during Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MR-HIFU) Therapy in Symptomatic Uterine Fibroids-A Retrospective Case-Control Study. J Clin Med. 2023;12(18):5999. https://doi.org/10.3390/jcm12185999.Kociuba J, Łoziński T, Latra K, Korczyńska L, Skowyra A, Zarychta E, Ciebiera M. Occurrence and Risk Factors for Perioperative Treatment Discontinuation during Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MR-HIFU) Therapy in Symptomatic Uterine Fibroids-A Retrospective CaseControl Study. J Clin Med. 2023;12(18):5999. https://doi.org/10.3390/jcm12185999.Akhatova A, Aimagambetova G, Bapayeva G, Laganà AS, Chiantera V, Oppelt P et al. Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(5):4480. https://doi.org/10.3390/ijerph20054480.Akhatova A, Aimagambetova G, Bapayeva G, Laganà AS, Chiantera V, Oppelt P et al. Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(5):4480. https://doi.org/10.3390/ijerph20054480.D’Asta M, Gulino FA, Ettore C, Dilisi V, Pappalardo E, Ettore G. Uterine Rupture in Pregnancy following Two Abdominal Myomectomies and IVF. Case Rep Obstet Gynecol. 2022;2022:6788992. https://doi.org/10.1155/2022/6788992.D’Asta M, Gulino FA, Ettore C, Dilisi V, Pappalardo E, Ettore G. Uterine Rupture in Pregnancy following Two Abdominal Myomectomies and IVF. Case Rep Obstet Gynecol. 2022;2022:6788992. https://doi.org/10.1155/2022/6788992.Khaw SC, Anderson RA, Lui MW. Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids. Reprod Biomed Online. 2020;40(3):429–444. https://doi.org/10.1016/j.rbmo.2020.01.003.Khaw SC, Anderson RA, Lui MW. Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids. Reprod Biomed Online. 2020;40(3):429–444. https://doi.org/10.1016/j.rbmo.2020.01.003.Wise LA, Thomas L, Anderson S, Baird DD, Anchan RM, Terry KL et al. Route of myomectomy and fertility: a prospective cohort study. Fertil Steril. 2022;117(5):1083–1093. https://doi.org/10.1016/j.fertnstert.2022.01.013.Wise LA, Thomas L, Anderson S, Baird DD, Anchan RM, Terry KL et al. Route of myomectomy and fertility: a prospective cohort study. Fertil Steril. 2022;117(5):1083–1093. https://doi.org/10.1016/j.fertnstert.2022.01.013.Хорольский ВА, Новикова ВА. Органосохраняющее лечение миомы матки как этап персонализированной прегравидарной подготовки. Лечение и профилактика. 2022;12(1):26–39. Режим доступа: https://www.elibrary.ru/gfhljj.Melnikova IYu, Buryak VN. Organ-preserving treatment of uterine fibroids as a stage of personalized preconception care. Disease Treatment and Prevention. 2022;12(1):26–39. (In Russ.) Available at: https://www.elibrary.ru/gfhljj.Стуклов НИ, Леваков СА, Сушинская ТВ, Митченкова АА, Ковальчук МО. Профилактика и лечение анемии у женщин репродуктивного возраста при гинекологических заболеваниях. Акушерство и гинекология. 2020;(3):218–226. https://doi.org/10.18565/aig.2020.3.218-226.Stuklov NI, Levakov SA, Sushinskaya TV, Mitchenkova AA, Kovalchuk MS. Prevention and treatment of anemia in reproductive-aged women with gynecological diseases. Akusherstvo i Ginekologiya (Russian Federation). 2020;(3):218–226. (In Russ.) https://doi.org/10.18565/aig.2020.3.218-226.Синчихин СП, Магакян СГ, Синчихина ЕС, Магакян ГС. Алгоритм ведения пациенток с миомой матки в прегравидарном периоде. Вопросы гинекологии, акушерства и перинатологии. 2022;21(6):139–145. Режим доступа: https://www.elibrary.ru/vcuxzv.Sinchikhin SP, Magakyan SG, Sinchikhina ES, Magakyan GS. Algorithm for the management of patients with uterine fibroids in the preconception period. Gynecology, Obstetrics and Perinatology. 2022;21(6):139–145. (In Russ.) Available at: https://www.elibrary.ru/vcuxzv.Jeldu M, Asres T, Arusi T, Gutulo MG. Pregnancy Rate after Myomectomy and Associated Factors among Reproductive Age Women Who Had Myomectomy at Saint Paul’s Hospital Millennium Medical College, Addis Ababa: Retrospective Cross-Sectional Study. Int J Reprod Med. 2021:6680112. https://doi.org/10.1155/2021/6680112.Jeldu M, Asres T, Arusi T, Gutulo MG. Pregnancy Rate after Myomectomy and Associated Factors among Reproductive Age Women Who Had Myomectomy at Saint Paul’s Hospital Millennium Medical College, Addis Ababa: Retrospective Cross-Sectional Study. Int J Reprod Med. 2021:6680112. https://doi.org/10.1155/2021/6680112.

The authors declare that there are no conflicts of interest present.