4 курс / Акушерство и гинекология / Оптимизация_хирургического_метода_лечения_миомы

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CHAPTER 2 CLINICAL PRESENTATION OF WOMEN

ENROLLED IN THE TRIAL

To solve the tasks, obstetric and somatic history, as well as the course and complications of the present pregnancy were studies in pregnant women with myomectomy uterine scar and in pregnant women with untreated uterine fibroids. All patients underwent examination and treatment in the Obstetrics Department of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott from 2017 to 2018.

The study group consisted of 160 patients with a history of laparoscopic myomectomy for uterine fibroids and subsequent childbirth by C-section.

The control group consisted of 60 patients with untreated (neither surgery nor medication) uterine fibroids and subsequent natural childbirth.

2.1 Clinical presentation of patients in the study and control group

In order to determine the homogeneity of the examined groups of patients,

an assessment of the average age and body mass index (BMI) was initially carried out. The average age of the examined women in all groups ranged from 25 to 46 years and did not differ significantly (Table 2.1).

Table 2.1 – Patient distribution by age in the study and control group

The average BMI of the examined women in all groups ranged from 18.6 to 32 kg/m2 and also did not significantly differ between the groups (Table 2.2).

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Table 2.3 – Specific obstetric history characteristics in the study vs. control group, %

of the main group and the comparison group shown in Table 2.3 show that there was no significant difference between the groups in the frequency of miscarriage, the frequency of detection of endometrial polyps and endometrial hyperplasia. Significant differences were found in the frequency of artificial abortions, the indicator of which was higher

(46.7%) in the comparison group compared to the main group (31.7%). As for

the frequency of artificial abortions, it can be assumed that higher fertility in women who have not undergone surgical intervention probably matters here. As for ectopic pregnancy, which occurred in three out of 60 cases in women of the main group and absent in the comparison group, further research and a set of more material are needed

for final conclusions.

Analysis of the frequency of spontaneous miscarriages requires separate

consideration. He showed that spontaneous miscarriages were significantly more common in women in the main group compared to the comparison group, namely in 42% of cases versus 25% (p<0.05). As is known, spontaneous miscarriage can have a negative effect on the reparative processes of the myometrium in the future. These data are clearly presented in Figure 2.2.

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Table 2.4 – Extragenital disorders in study and control groups, %

Figure 2.3 – Myomatous node localization in the study vs. control group

Statistical analysis showed that there were no significant differences between the study vs. control group in the localization of myomatous nodes on the anterior and posterior walls of the uterus.

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Specific results reported in Chapter 2 are published in the following paper:

Shapovalova A.I. Myomectomy or conservative management of uterine myoma: impact on reproductive potential / A.I. Shapovalova, E.N. Popov, E.V. Mozgovaya // Journal of Obstetrics and Women Diseases. – 2021. – Vol.70, N 5. – P. 95-104 [70].

Myometrium assessment in the uterine scar area

using dynamic contrast enhancement MRI of pelvis

In 6 months after surgical treatment, all patients from the main group underwent

pelvic MRI with dynamic contrast. At the same time, to assess the condition

of the myometrium in the area of the scar on the uterus after performing myomectomy, the following parameters were evaluated: the thickness of the myometrium in the area

of the accumulation of contrast by the myometrium in the area of scar changes was evaluated. The results are presented in Table 2.5.

Table 2.5 – Pelvic DCE MRI following laparoscopic myomectomy

As follows from Table 2.5, 95% of myometrium thickness in the myomectomy scar area and intact myometrium thickness of the uterine wall, where the removed myomatous node was located, shows no anatomical dehiscence. When measuring the thickness of the uterine scar and the thickness of the myometrium of the intact uterine wall, where myomectomy was performed, there are also no signs of insolvency.

Figure 2.6 – Pelvic inflammatory diseases (PID) in the study vs. control group

As can be seen, the frequency of inflammatory diseases of the pelvic organs of women from the main group and the comparison group did not significantly differ.

Of interest is the fertility status of patients of reproductive age in the comparison group and in patients of the main group whose fibroids were removed by laparoscopic access. To this end, we studied the frequency of pregnancy naturally and with the help of ART. The results obtained are shown in Figure 2.7. In the main group, 37.2% of patients resorted to the use of the ART method for pregnancy, while in the patients of the comparison group this indicator was only 6.12% (p<0.001). From this we can conclude about the negative impact of the consequences of surgical intervention on the fertile status of a woman.