Effectiveness of Laparoscopic Adenomyomectomy on Perinatal Outcomes

Yosuke Ono; Hajime Ota; Yoshiyuki Fukushi; Hikaru Tagaya; Yasuhiko Okuda; Osamu Yoshino; Hideto Yamada; Shuji Hirata; Shinichiro Wada

doi:10.4103/gmit.gmit_45_22

Effectiveness of Laparoscopic Adenomyomectomy on Perinatal Outcomes

Gynecol Minim Invasive Ther. 2023 Jan 17;12(4):211-217. doi: 10.4103/gmit.gmit_45_22. eCollection 2023 Oct-Dec.

Authors

Yosuke Ono^{1

2}, Hajime Ota², Yoshiyuki Fukushi², Hikaru Tagaya¹, Yasuhiko Okuda¹, Osamu Yoshino¹, Hideto Yamada³, Shuji Hirata¹, Shinichiro Wada²

Affiliations

¹ Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan.
² Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan.
³ Center for Recurrent Pregnancy Loss, Teine Keijinkai Hospital, Sapporo, Japan.

Abstract

Objectives: The objective of this study was to observe the influence of laparoscopic adenomyomectomy on perinatal outcomes.

Materials and methods: The retrospective cohort study included 43 pregnant cases with adenomyosis who did not undergo laparoscopic surgery before pregnancy (nonsurgery group; 26 cases) and did (surgery group; 17 cases). To evaluate the impact of surgery on perinatal outcomes, nine obstetric complications including preterm delivery, hypertensive disorder of pregnancy, placental malposition, oligohydramnios, gestational diabetes mellitus, uterine rupture, abruptio placentae, and postpartum hemorrhage were selected. One obstetric complication was counted as one point (Maximum 9 points for one person). The obstetrical morbidity was compared by adding up the number of relevant events (0-9) between the two groups. Apgar score, umbilical artery pH (UApH), neonatal intensive care unit (NICU) admission, and neonatal death were also examined.

Results: The surgery group had a significantly lower prevalence of fetal growth restriction compared to the nonsurgery group (nonsurgery vs. surgery; 26.9%, 7/26 vs. 0%, 0/17: P = 0.031). No differences were found in the morbidity of the nine obstetric complications (19.2%, 45/234 vs. 13.7%, 21/153), gestational weeks (mean ± standard deviation, 37.2 ± 2.4 vs. 36.4 ± 3.2), birth weight (2573.6 ± 557.9 vs. 2555.4 ± 680.8 g), Apgar score (1, 5 min; 8.0 ± 0.7 vs. 7.7 ± 1.2, 8.9 ± 0.6 vs. 8.5 ± 1.8), UApH (7.28 ± 0.08 vs. 7.28 ± 0.06), NICU admission (26.9%, 7/26 vs. 41.2%, 7/17), and neonatal death (0%, 0%) between both groups.

Conclusion: Laparoscopic adenomyomectomy may not increase obstetric complications, although attention must be paid to uterine rupture during pregnancy.

Keywords: Adenomyosis; fetal growth restriction; laparoscopic adenomyomectomy; perinatal outcome; pregnancy.