The association between clinical features at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric and perinatal outcomes: a single-center retrospective cohort study

The association between clinical features at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric and perinatal outcomes: a single-center retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The association between clinical features at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric and perinatal outcomes: a single-center retrospective cohort study Young Ran Kim, Eun Duc Na, Jae Eun Jung, Ji Yeon Lee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1386906/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Dec, 2022 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 11 You are reading this latest preprint version Abstract Background To investigate the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy. Methods In this retrospective cohort study, we identified 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital between 2010 and 2020. The association between clinical characteristics at the time of myomectomy and subsequent obstetric outcomes were analyzed. Results There was one case of uterine rupture. The gestational age at delivery was 37.7±2.4 weeks. There were 2 (0.8%) cases of fetal loss before 23 weeks, but there were no cases of perinatal death. The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one was removed (aOR=2.41, 95% CI [1.20-4.86], p=0.014). The risk of neonatal composite morbidity was higher in the group in which myomas including the IM type were removed, than in the group in which only SS myomas were removed (aOR=14.29, 95% CI [1.82-99.57], p=0.012). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%, p=0.001) and lower birth weight (2901± 625 g vs. 3063± 576 g, p=0.001) compared to the group with diameters less than 15 cm. Placenta accreta/increta (7.9% vs. 3.8%, p=0.043) and lower placental weight (646± 170 g vs. 750± 232 g, p=0.034) were more common in patients with an interval between myomectomy and pregnancy of less than 12 months compared to more than 12 months. Conclusions To our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes. If the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase. Uterine myoma myomectomy pregnancy obstetric outcome perinatal outcome Background Uterine myomas (fibroids) are the most common benign pelvic tumors found in women of childbearing age. They are monoclonal tumors of the smooth muscle cells of the myometrium. Typical symptoms include excessive menstruation and pressure symptoms, as well as infertility in some patients. Treatment options in women of childbearing age include medications, uterine artery embolization, high-intensity focused ultrasound, and myomectomy. Myomectomy is recommended for patients with severe symptoms who wish to preserve their fertility. 1 However, there are some concerns that myomectomy may adversely affect subsequent pregnancy outcomes. Hysteroscopic resection of submucosal fibroids is known to have a strong association with complications in the subsequent pregnancy. 2 , 3 However, there is still insufficient evidence regarding the risk of non-hysteroscopic myomectomy on pregnancy outcomes; therefore, it is difficult to effectively counsel women who are planning to become pregnant after a non-hysteroscopic myomectomy or those who have already undergone myomectomy. In particular, the association between the location, type, and number of resected uterine myomas, and the time interval from myomectomy to the next pregnancy with uterine rupture, placental attachment abnormality, or fetal growth in the next pregnancy is unknown. Therefore, we investigated the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy. Methods This was a retrospective cohort study of 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital from 2010 to 2020. Cases with submucosal myomas, those that underwent hysteroscopic myomectomy, those with maternal medical or surgical comorbidities, and those with fetal abnormalities were excluded. We reviewed the clinical characteristics at the time of myomectomy and maternal demographics, clinical presentations, laboratory examinations, ultrasound assessments, and obstetrical outcomes of all included patients. Statistical analysis was performed using SPSS (version 23.0; SPSS Institute, Chicago, IL, USA) and R (R Foundation for Statistical Computing, Vienna, Austria). We analyzed discrete data using the Chi-square test, and comparisons of continuous variables were performed using the Student t-test or one-way ANOVA. We also performed a multivariable analysis including maternal age, body mass index (BMI), method of conception, and interval time between study and data collection as covariates when analyzing neonatal morbidity and mortality. Statistical significance was set at p < 0.05. Results A total of 248 women with a history of pre-pregnancy myomectomy were analyzed. The average maternal age was 35 years, and the natural pregnancy rate was 75.4%. One, two, three and four or more fibroids were removed in 41.1%, 16.9%, 10.9%, and 31% of cases, respectively. Only the SS type was removed in 31% of cases. The time interval until the next pregnancy was less than 6 months in 18.5%, between 6 months and less than 12 months in 17.3%, between 12 months and less than 24 months in 30.6%, and more than 24 months in 33.5% of cases (Table 1 ). The mean gestational age at delivery was 37.7 ± 2.4 weeks. The proportion of preterm births before 37 weeks was 12.1%. There were 2 (0.8%) cases of fetal loss before 23 weeks. There was one case of uterine rupture, but there were no cases of perinatal death. The rate of admission to the neonatal intensive care unit was 16.5% (Table 2 ). The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one myoma was removed (aOR = 2.41, 95% CI [1.20–4.86], p = 0.014) (Table 3 ). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%) and a lower birth weight (2901 ± 625 g vs. 3063 ± 576 g) compared to the group with a sum of less than 15 cm (Table 4 ). The risk of neonatal composite morbidity, including neonatal sepsis, retinopathy of prematurity, persistent ductus arteriosus, acute respiratory distress syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis, was higher in the group in which myomas including the IM type were removed than in the group in which only the SS type myomas were removed (aOR = 14.29, 95% CI [1.82–99.57], p = 0.012). Although not statistically significant, the group in which IM type myomas were removed showed a lower placental weight (683 ± 207 vs. 738 ± 213) compared to the group in which only SS type myomas were removed (Table 5 ). Compared to cases with a longer interval between myomectomy and pregnancy (more than 24 months), those with a shorter interval (less than 24 months) had a lower placental weight (655 ± 159 g vs. 726 ± 230 g, p = 0.011) (Table 6 ). In a subgroup analysis according to the time between myomectomy and pregnancy, the frequency of placenta accreta/increta was approximately four times higher in the group with an interval of less than 12 months compared to the group with an interval of 12 months or more (Supporting information, Table S1). There was no difference in obstetric or neonatal outcomes according to the surgical method (laparoscopy vs. laparotomy) for myomectomy (Supporting information, Table S2). Table 1 Clinical characteristics of the study population Delivery after pre-pregnancy myomectomy (N = 248) Maternal age (y)* 34.9 ± 3.8 Height (cm)* 161.5 ± 5.1 BMI* 23.0 ± 4.3 Nulliparity † 182 (73.4) Prior preterm birth before myomectomy † 4 (1.6) Spontaneous abortion after myomectomy † 32 (12.9) Method of conception Spontaneous † 187 (75.4) Ovarian stimulation † 6 (2.4) In vitro fertilization † 55 (22.2) Twin pregnancy † 18 (7.3) Number of uterine myomas removed One † 102 (41.1) Two † 42 (16.9) Three † 27 (10.9) Four or more † 77 (31.0) Sum of the diameters of which the three biggest uterine myomas* 11.0 ± 4.3 Type of uterine myomas - only subserosal myomas † 77 (31.0) Laparoscopic myomectomy † 70 (28.5) Interval time between myomectomy and pregnancy (month)* 23.8 ± 23.2 <6 months † 46 (18.5) ≤6 and < 12 months † 43 (17.3) ≤12 and < 24 months † 76 (30.6) ≥24 months † 83 (33.5) BMI, body mass index; *Data given as mean ± SD, † Data given as n (%) Table 2 Obstetric and neonatal outcomes Delivery after pre-pregnancy myomectomy (N = 248) Pregnancies with Preeclampsia* 6 (0.2) Loss of the fetus during GA 16–23 weeks* 2 (0.8) GA at delivery (week) † 37.7 ± 2.4 Preterm birth 23–27 + 6 weeks* 1 (0.4) 23–31 + 6 weeks* 4 (1.6) 23–33 + 6 weeks* 5 (2.0) 23–36 + 6 weeks* 30 (12.1) Cesarean delivery* 233 (94.0) Emergent delivery* 43 (17.3) Uterine rupture* 1 (0.4) Declined hemoglobin after delivery (g/dl) † 1.6 ± 1.3 Transfusion during peripartum period* 67 (27.0) Placental accreta/increta* 13 (5.2) Placental weight (g)† 700.2 ± 210.2 Neonates after 23 weeks (N = 246) Neonatal outcomes Birth weight (gram)† 3025.5 ± 590.0 SGA* 15 (6.0) Apgar score at 5min < 7* 6 (2.4) NICU admission* 41 (16.5) Neonatal death 0 (0.0) Morbidity during hospitalization Use of a ventilator* 33 (13.4) Respiratory distress syndrome* 14 (5.7) Bronchopulmonary dysplasia* 1 (0.4) Composite morbidity a * 20 (8.1) GA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; a Composite morbidity during hospitalization includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; * Data given as n (%), † Data given as mean ± SD Table 3 Obstetric outcomes according to the number of uterine myomas removed Number of uterine myomas removed (single) (N = 102) Number of uterine myomas removed (≥ 2) (N = 146) p-value Unadjusted odds ratio (95% CI) (Reference: single) p-value Adjusted odds ratio (95% CI) a (Reference: single) p-value GA at delivery (weeks)* 37.5 ± 2.6 37.8 ± 2.2 0.351 Birthweight (g)* 3046 ± 570 3011 ± 605 0.651 Placental weight (g)* 718 ± 233 688 ± 192 0.257 Preterm birth † 14 (13.9) 16 (11.0) 0.317 0.77 (0.36–1.66) 0.506 0.66 (0.24–1.80) 0.413 Emergent delivery † 16 (15.8) 27 (18.5) 0.358 1.21 (0.61–2.38) 0.589 0.93 (0.42–2.07) 0.862 Placental accreta/increta † 4 (3.9) 9 (6.2) 0.317 1.61 (0.48–5.38) 0.439 2.15 (0.55–8.36) 0.270 Transfusion † 19 (18.6) 48 (32.9) 0.009 2.14 (1.17–3.92) 0.014 2.41 (1.20–4.86) 0.014 SGA † 4 (3.9) 11 (7.5) 0.184 2.00 (0.62–6.46) 0.248 2.73 (0.68–10.94) 0.155 NICU admission † 15 (14.9) 26 (17.9) 0.324 1.25 (0.63–2.51) 0.524 1.18 (0.51–2.73) 0.707 Composite morbidity b† 9 (8.8) 11 (7.5) 0.444 0.84 (0.34–2.11) 0.714 0.62 (0.20–1.91) 0.404 GA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; ; a All outcomes were adjusted for maternal age, body mass index, method of conception, twin pregnancy, Interval time between myomectomy and pregnancy, myomectomy method, sum of the diameters of which the three biggest uterine myomas, and type of uterine myomas; b Composite morbidity includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; *Data given as mean ± SD, † Data given as n (%) Table 4 Obstetric outcomes according to the sum of the diameters of which the three biggest uterine myomas Sum of the diameters of which the three biggest uterine myomas (< 15cm) (N = 191) Sum of the diameters of which the three biggest uterine myomas (≥ 15cm) (N = 57) p-value Unadjusted odds ratio (95% CI) (Reference: <15cm) p-value Adjusted odds ratio (95% CI) a (Reference: <15cm) p-value GA at delivery (weeks)* 37.7 ± 2.5 37.6 ± 1.9 0.805 Birthweight (g)* 3063 ± 576 2901 ± 625 0.070 Placental weight (g)* 697 ± 204 710 ± 232 0.699 Preterm birth* 19 (10.1) 11 (19.3) 0.055 2.14 (0.95–4.81) 0.066 2.41 (0.87–6.67) 0.091 Emergent delivery † 30 (15.8) 13 (22.8) 0.152 1.58 (0.76–3.27) 0.223 1.17 (0.74–3.75) 0.219 Placental accreta/increta † 11 (5.8) 2 (3.5) 0.391 0.60 (0.13–2.77) 0.508 0.45 (0.09–2.28) 0.332 Transfusion † 52 (27.2) 15 (26.3) 0.519 0.96 (0.49–1.87) 0.892 0.80 (0.39–1.64) 0.533 SGA † 11 (5.8) 4 (7.0) 0.466 1.24 (0.38–4.04) 0.727 1.23 (0.33–4.57) 0.754 NICU admission † 32 (16.9) 9 (15.8) 0.510 0.92 (0.41–2.06) 0.839 0.84 (0.33–2.12) 0.710 Composite morbidity b† 14 (7.3) 6 (10.5) 0.298 1.49 (0.54–4.06) 0.439 1.61 (0.51–5.09) 0.416 GA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; ; a All outcomes were adjusted for maternal age, body mass index, method of conception, twin pregnancy, Interval time between myomectomy and pregnancy, myomectomy method, number of uterine myomas removed, type of uterine myomas; b Composite morbidity includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; *Data given as mean ± SD, † Data given as n (%) Table 5 Obstetric outcomes according to the type of uterine myomas Including intramural type (N = 171) Only subserosal type (N = 77) p-value Unadjusted odds ratio (95% CI) (Reference: Including intramural type) p-value Adjusted odds ratio (95% CI) a (Reference: Including intramural type) p-value GA at delivery (weeks)* 37.7 ± 2.3 37.7 ± 2.7 0.829 Birthweight (g)* 3032 ± 563 3011 ± 648 0.794 Placental weight (g)* 683 ± 207 738 ± 213 0.055 Preterm birth † 19 (11.2) 11 (14.5) 0.297 1.35 (0.61–2.99) 0.466 0.82 (0.29–2.27) 0.695 Emergent delivery † 31 (18.2) 12 (15.6) 0.377 0.83 (0.40–1.72) 0.611 0.81 (0.38–1.74) 0.597 Placental accreta/increta † 11 (6.4) 2 (2.6) 0.173 0.39 (0.08–1.79) 0.225 0.41 (0.08–2.10) 0.283 Transfusion † 45 (26.3) 22 (28.6) 0.411 1.12 (0.62–2.04) 0.711 1.47 (0.76–2.84) 0.249 SGA † 10 (5.8) 5 (6.5) 0.523 1.12 (0.37–3.39) 0.844 0.83 (0.23–3.03) 0.778 NICU admission † 30 (17.6) 11 (14.5) 0.338 0.79 (0.37–1.67) 0.538 0.65 (0.28–1.54) 0.330 Composite morbidity b† 19 (11.1) 1 (1.3) 0.005 0.11 (0.01–0.80) 0.030 0.07 (0.01–0.55) 0.012 GA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; ; a All outcomes were adjusted for maternal age, body mass index, method of conception, twin pregnancy, Interval time between myomectomy and pregnancy, myomectomy method, sum of the diameters of which the three biggest uterine myomas, and number of uterine myomas removed; b Composite morbidity includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; *Data given as mean ± SD, † Data given as n (%) Table 6 Obstetric outcomes according to the interval time between the myomectomy and the pregnancy Interval time between myomectomy and pregnancy (< 24 months) (N = 89) Interval time between myomectomy and pregnancy (≥ 24 months) (N = 159) p-value Unadjusted odds ratio (95% CI) (Reference: <24 months) p-value Adjusted odds ratio (95% CI) a (Reference: <24 months) p-value GA at delivery (weeks)* 37.8 ± 2.4 37.7 ± 2.4 0.620 Birthweight (g) * 3027 ± 599 3025 ± 587 0.975 Placental weight (g) 655 ± 159 726 ± 230 0.011 Preterm birth † 7 (8.0) 23 (14.6) 0.092 2.14 (0.95–4.81) 0.066 0.99 (0.36–2.76) 0.993 Emergent delivery † 17 (19.1) 26 (16.5) 0.359 1.58 (0.76–3.27) 0.223 1.67 (0.66–4.18) 0.277 Placental accreta/increta † 7 (7.9) 6 (3.8) 0.138 0.60 (0.13–2.77) 0.508 0.27 (0.06–1.35) 0.111 Transfusion † 24 (27.0) 43 (27.0) 0.557 0.96 (0.49–1.87) 0.892 1.13 (0.53–2.42) 0.745 SGA † 6 (6.7) 9 (5.7) 0.465 1.24 (0.38–4.04) 0.727 1.02 (0.21–4.92) 0.983 NICU admission † 18 (20.5) 23 (14.6) 0.156 0.92 (0.41–2.06) 0.839 0.50 (0.18–1.35) 0.170 Composite morbidity b† 8 (9.0) 12 (7.5) 0.430 1.49 (0.54–4.07) 0.439 0.56 (0.14–2.20) 0.405 GA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; ; a All outcomes were adjusted for maternal age, body mass index, method of conception, twin pregnancy, myomectomy method, sum of the diameters of which the three biggest uterine myomas, number of uterine myomas removed, and type of uterine myomas; b Composite morbidity includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; *Data given as mean ± SD, † Data given as n (%) There were 43 cases of emergency delivery, and the gestational age at the emergency delivery was 36.2 (26.9–40.3) weeks. The indications for emergency delivery were uterine rupture (1 case, 2.3%), preterm premature rupture of membranes (11 cases, 25.6%), and preterm labor (9 cases, 20.9%) (Supporting information, Table S3). When comparing the clinical characteristics at the time of myomectomy between elective and emergent delivery cases (except for medically indicated delivery), the interval time between myomectomy and pregnancy was significantly shorter in the case of emergent delivery compared to elective delivery (18.8 ± 14.6 months vs. 25.0 ± 24.5 months, p = 0.035) (Supporting information, Table S4). Discussion Recently, as more women are delaying pregnancy and childbirth, the incidence of pregnancies complicated by uterine myomas or previous myomectomy has increased. The presence of a uterine myoma may have a detrimental effect on implantation by obstructing reproductive cell migration, altering uterine contractions, and adversely affecting the endometrium. 4 Increased use of ultrasound imaging has led to more diagnoses of asymptomatic uterine myomas, and some early studies of women with unknown causes of infertility reported improved pregnancy rates in women with uterine myomas after myomectomy; however, these studies had certain limitations including the lack of randomization methods, and not considering other factors which may influence pregnancy outcomes. 5 Although there are reports that myomectomy is a safe treatment option for women preparing for pregnancy, 6 it is unclear whether this procedure offers a therapeutic benefit for women of childbearing age. Several factors should be considered when deciding whether to perform myomectomy, including the size and number of myomas, and their location in the uterus. Although several studies have shown that patient age, myoma size, myoma location, and the interval between myomectomy and pregnancy may influence pregnancy and live birth rates after myomectomy, 7 – 9 to our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes. Normal uterine myometrium is damaged during myomectomy. Removal of IM type myomas results in scarring of the uterine muscle; when the muscular tissue regenerates, the healing process consists of the regeneration of muscle fibers and formation of a connective tissue scar. This scar may interfere with decidual reactions, spiral artery remodeling, and successful placentation. Uterine spiral arteries play a vital role in supplying nutrients to the placenta and fetus, and for this purpose, they are remodeled into highly dilated vessels by invasion. 10 If this process fails, vascular malperfusion and its relationship with oxygen, trophoblast invasion from the outside or inside of the vessels (intravasation versus extravasation), the impact of hemodynamics on endovascular migration, the replacement of arterial components by trophoblasts, maternal tissue repair mechanisms, and the role of uterine natural killer cells can arise, which can lead to various obstetrical and perinatal complications. 10 Eventually, placental malperfusion may occur, and this pathological condition may manifest as a small placenta. Placentation near the post-procedure myomectomy site impairs intervillous blood flow, 11 resulting in uteroplacental insufficiency and fetal growth restriction. Previous studies have shown that placental volume at delivery is associated with adverse pregnancy outcomes. 12 , 13 In our study, the risk of neonatal composite morbidity, including neonatal sepsis, retinopathy of prematurity, persistent ductus arteriosus, acute respiratory distress syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis, was higher in the group in which myomas including the IM type were removed than in the group in which only the SS type myomas were removed. Although not statistically significant, the group in which myomas, including the IM type, were removed, showed a lower placental weight compared to the group in which only SS type myomas were removed. This suggests that damage to the vascular tissue of the myometrium or replacement of fibrotic tissue in the normal myometrium can adversely affect placental and fetal growth. Although not statistically significant, the group in which the sum of the diameters of three largest myomas was greater than 15 cm showed a lower birth weight compared to the group with a total diameter less than 15 cm. The results of our study suggest that the severity of the myometrial scar after myomectomy may affect future pregnancy outcomes. Disorders in placental formation and growth are also associated with preterm births. Oxidative stress due to insufficient uteroplacental perfusion can lead to preterm labor and preterm birth. 14 , 15 Previous studies have shown an association between a history of myomectomy and preterm birth. 16 – 20 In this study, the preterm birth rate in women with a history of myomectomy was 12.1% (30 women), which appears to be slightly higher than the incidence in the normal standard population. Although not statistically significant, a higher frequency of preterm birth (19.3% vs. 10.1%) was observed in the group with a sum of diameters of the three largest myomas greater than 15 cm compared to less than 15 cm. Previous reports have shown that most surgeons recommend contraception for 6–24 months after myomectomy. 7 It takes time for the injured myometrium to recover after myomectomy; if pregnancy occurs before the damaged myometrium fully heals, the placenta may invade the myometrium at the site of the resection, which can cause abnormal placentation. Placenta accreta or increta are serious complications which can result in severe maternal hemorrhage. 21 , 22 In our study, a shorter interval between myomectomy and pregnancy (less than 12 months) was associated with a higher frequency of placenta accreta or increta compared to an interval of more than 12 months. Insufficient recovery of the myometrium can also affect placental growth. 23 Accordingly, in our study, the placental weight was lower when the interval between myomectomy and subsequent pregnancy was less than 2 years. This study also showed that the shorter the interval time between myomectomy and subsequent pregnancy, the higher the risk of emergency delivery. The reasons for emergency delivery were preterm labor or preterm premature rupture of membranes, and uterine rupture, which, as described above, are likely to be related to insufficient recovery of the myomectomy site. The strengths of this study are mostly related to the homogeneity of data, as they were collected in a single center, and two experienced expert operators performed the myomectomy procedure. However, this study was limited by its retrospective design, which precluded us from following up all women who underwent myomectomy. Although this study included a relatively large number of patients compared to previous studies, in the future, larger prospective controlled studies are needed to validate our results and obtain sufficient data to reliably inform patients about the risks of myomectomy before pregnancy and counsel pregnant women about the increased risk of perinatal complications caused by myomectomy. Conclusions In conclusion, if the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase. These findings are of clinical significance, and they may help obstetricians to effectively counsel pregnant women with a history of myomectomy regarding the risk of subsequent pregnancies. Abbreviations BMI, body mass index IM, intramural SS, subserosal Declarations Ethics approval The institutional review boards (IRB) of CHA Bundang Medical Center approved this study (IRB no.: 2021-08-059, dates of approval: Aug. 25, 2021). Informed consent is not required, because this study is a retrospective cohort study which conducted by analyzing medical records, The IRB of this research institute agreed that informed consent was not required. All study methods were performed in accordance with the relevant guidelines and regulations of the IRB of this institution. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to concerns about the risk of data being used outside for other purposes but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2020R1C1C1012873). Author’s contributions YRK participated in the design of the study, acquisition of data, statistical analysis, interpretation of data, and writing of the manuscript. EDN participated in the statistical analysis, interpretation of data, and writing of the manuscript. JEJ participated in the acquisition of data and statistical analysis. JYL participated in the design of the study, acquisition of data, statistical analysis, interpretation of data, and writing of the manuscript. References Guo XC, Segars JH. The impact and management of fibroids for fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012;39:521–33. Jayakrishnan K, Menon V, Nambiar D. Submucous fibroids and infertility: Effect of hysteroscopic myomectomy and factors influencing outcome. J Hum Reprod Sci. 2013;6:35–9. Capmas P, Levaillant JM, Fernandez H. Surgical techniques and outcome in the management of submucous fibroids. Curr Opin Obstet Gynecol. 2013;25:332–8. Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z. Effect of uterine leiomyomata on the results of in-vitro fertilization treatment. Hum Reprod. 1995;10:2576–8. Rosenfeld DL. Abdominal myomectomy for otherwise unexplained infertility. Fertil Steril. 1986;46:328–30. Fagherazzi S, Borgato S, Bertin M, Vitagliano A, Tommasi L, Conte L. Pregnancy outcome after laparoscopic myomectomy. Clin Exp Obstet Gynecol. 2014;41:375–9. Zhang Y, Hua KQ. Patients' age, myoma size, myoma location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy. J Laparoendosc Adv Surg Tech A. 2014;24:95–9. Metwally M, Cheong YC, Horne AW. 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First-trimester screening model for small-for-gestational-age using maternal clinical characteristics, serum screening markers, and placental volume: prospective cohort study. J Matern Fetal Neonatal Med. 2021:1–6. Eloundou SN, Lee J, Wu D, Lei J, Feller MC, Ozen M, et al. Placental malperfusion in response to intrauterine inflammation and its connection to fetal sequelae. PLoS One. 2019;14:e0214951. Lee JY, Li S, Shin NE, Na Q, Dong J, Jia B, Jones-Beatty K, McLane MW, Ozen M, Lei J, Burd I. Melatonin for prevention of placental malperfusion and fetal compromise associated with intrauterine inflammation-induced oxidative stress in a mouse model. J Pineal Res. 2019;67:e12591. Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res. 2017;43:1789–804. Tian YC, Long TF, Dai YM. Pregnancy outcomes following different surgical approaches of myomectomy. J Obstet Gynaecol Res. 2015;41:350–7. Fukuda M, Tanaka T, Kamada M, Hayashi A, Yamashita Y, Terai Y, et al. Comparison of the perinatal outcomes after laparoscopic myomectomy versus abdominal myomectomy. Gynecol Obstet Invest. 2013;76:203–8. Kelly BA, Bright P, Mackenzie IZ. Does the surgical approach used for myomectomy influence the morbidity in subsequent pregnancy? J Obstet Gynaecol. 2008;28:77–81. Kumakiri J, Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Itoh S, et al. Pregnancy and delivery after laparoscopic myomectomy. J Minim Invasive Gynecol. 2005;12:241–6. Murayama Y, Baba K, Seki H. Abnormality and imaging diagnosis during second trimester of pregnancy. Obstetrical and Gynecological Practice. 2008;57:421–7. Jauniaux E, Toplis PJ, Nicolaides KH. Sonographic diagnosis of a non-previa placenta accreta. Ultrasound Obstet Gynecol. 1996;7:58–60. O'Connor BB, Pope BD, Peters MM, Ris-Stalpers C, Parker KK. The role of extracellular matrix in normal and pathological pregnancy: Future applications of microphysiological systems in reproductive medicine. Exp Biol Med (Maywood). 2020;245:1163–74. Additional Declarations No competing interests reported. Supplementary Files Supplementarytables.docx Cite Share Download PDF Status: Published Journal Publication published 02 Dec, 2022 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Major revision 06 Jun, 2022 Reviews received at journal 29 May, 2022 Reviews received at journal 08 May, 2022 Reviewers agreed at journal 27 Apr, 2022 Reviews received at journal 28 Mar, 2022 Reviewers agreed at journal 23 Mar, 2022 Reviewers invited by journal 21 Mar, 2022 Editor assigned by journal 21 Mar, 2022 Editor invited by journal 08 Mar, 2022 Submission checks completed at journal 08 Mar, 2022 First submitted to journal 22 Feb, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1386906","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":89050049,"identity":"5d901012-d316-4e72-bab6-224cfa13ac02","order_by":0,"name":"Young Ran Kim","email":"","orcid":"","institution":"CHA Bundang Medical Center, CHA University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Young","middleName":"Ran","lastName":"Kim","suffix":""},{"id":89050052,"identity":"2f188d67-ffd8-45e3-bc72-58531d4f527c","order_by":1,"name":"Eun Duc Na","email":"","orcid":"","institution":"CHA Bundang Medical Center, CHA University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eun","middleName":"Duc","lastName":"Na","suffix":""},{"id":89050054,"identity":"b577ad0a-cab6-41eb-bb99-4b7eaf5d9d05","order_by":2,"name":"Jae Eun Jung","email":"","orcid":"","institution":"CHA Bundang Medical Center, CHA University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jae","middleName":"Eun","lastName":"Jung","suffix":""},{"id":89050055,"identity":"3a7811ef-68a9-4820-8b96-2ab4921f8fc8","order_by":3,"name":"Ji Yeon Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYBACPjBZcQBMHXhAjBY2MHkGqiUBSPAQpYWxDaKFgTgt7L3HHvycd0feXOzwQ6Atd+TsCWrhOZdu2LvtmeHO2WkGQC3PjAnbIpFjJsG77TDjhtsJIC2HE3sIapF/Yyb5d85h+w230z+AtNQT1iLBYybN23A4ccPtHLAtCYQdxpNjJi1z7HAyUEvBgQSDw4Y9Bwho4Wc/Yyb5puawLdBhmz98qDgsz95AyBpUYECa8lEwCkbBKBgFOAAAm5RDL6QnutMAAAAASUVORK5CYII=","orcid":"","institution":"CHA Bundang Medical Center, CHA University School of Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ji","middleName":"Yeon","lastName":"Lee","suffix":""}],"badges":[],"createdAt":"2022-02-23 01:59:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1386906/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1386906/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-022-05240-7","type":"published","date":"2022-12-03T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":48657455,"identity":"dccbb850-8af1-4f03-b515-cb90c0d748e1","added_by":"auto","created_at":"2023-12-22 07:14:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":516884,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1386906/v1/38055ae4-93c3-42b2-a789-00b4d9474e55.pdf"},{"id":19092574,"identity":"f58cd0f1-3205-41ba-8712-2e95a48649c2","added_by":"auto","created_at":"2022-03-10 19:37:51","extension":"docx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":60290,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytables.docx","url":"https://assets-eu.researchsquare.com/files/rs-1386906/v1/6b57dc2bc5d5c9a0215a26a4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The association between clinical features at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric and perinatal outcomes: a single-center retrospective cohort study","fulltext":[{"header":"Background","content":"\u003cp\u003eUterine myomas (fibroids) are the most common benign pelvic tumors found in women of childbearing age. They are monoclonal tumors of the smooth muscle cells of the myometrium. Typical symptoms include excessive menstruation and pressure symptoms, as well as infertility in some patients. Treatment options in women of childbearing age include medications, uterine artery embolization, high-intensity focused ultrasound, and myomectomy. Myomectomy is recommended for patients with severe symptoms who wish to preserve their fertility. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e However, there are some concerns that myomectomy may adversely affect subsequent pregnancy outcomes.\u003c/p\u003e \u003cp\u003eHysteroscopic resection of submucosal fibroids is known to have a strong association with complications in the subsequent pregnancy.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e However, there is still insufficient evidence regarding the risk of non-hysteroscopic myomectomy on pregnancy outcomes; therefore, it is difficult to effectively counsel women who are planning to become pregnant after a non-hysteroscopic myomectomy or those who have already undergone myomectomy. In particular, the association between the location, type, and number of resected uterine myomas, and the time interval from myomectomy to the next pregnancy with uterine rupture, placental attachment abnormality, or fetal growth in the next pregnancy is unknown.\u003c/p\u003e \u003cp\u003eTherefore, we investigated the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a retrospective cohort study of 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital from 2010 to 2020. Cases with submucosal myomas, those that underwent hysteroscopic myomectomy, those with maternal medical or surgical comorbidities, and those with fetal abnormalities were excluded. We reviewed the clinical characteristics at the time of myomectomy and maternal demographics, clinical presentations, laboratory examinations, ultrasound assessments, and obstetrical outcomes of all included patients.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using SPSS (version 23.0; SPSS Institute, Chicago, IL, USA) and R (R Foundation for Statistical Computing, Vienna, Austria). We analyzed discrete data using the Chi-square test, and comparisons of continuous variables were performed using the Student t-test or one-way ANOVA. We also performed a multivariable analysis including maternal age, body mass index (BMI), method of conception, and interval time between study and data collection as covariates when analyzing neonatal morbidity and mortality. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 248 women with a history of pre-pregnancy myomectomy were analyzed. The average maternal age was 35 years, and the natural pregnancy rate was 75.4%. One, two, three and four or more fibroids were removed in 41.1%, 16.9%, 10.9%, and 31% of cases, respectively. Only the SS type was removed in 31% of cases. The time interval until the next pregnancy was less than 6 months in 18.5%, between 6 months and less than 12 months in 17.3%, between 12 months and less than 24 months in 30.6%, and more than 24 months in 33.5% of cases (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean gestational age at delivery was 37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 weeks. The proportion of preterm births before 37 weeks was 12.1%. There were 2 (0.8%) cases of fetal loss before 23 weeks. There was one case of uterine rupture, but there were no cases of perinatal death. The rate of admission to the neonatal intensive care unit was 16.5% (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one myoma was removed (aOR\u0026thinsp;=\u0026thinsp;2.41, 95% CI [1.20\u0026ndash;4.86], p\u0026thinsp;=\u0026thinsp;0.014) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%) and a lower birth weight (2901\u0026thinsp;\u0026plusmn;\u0026thinsp;625 g vs. 3063\u0026thinsp;\u0026plusmn;\u0026thinsp;576 g) compared to the group with a sum of less than 15 cm (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The risk of neonatal composite morbidity, including neonatal sepsis, retinopathy of prematurity, persistent ductus arteriosus, acute respiratory distress syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis, was higher in the group in which myomas including the IM type were removed than in the group in which only the SS type myomas were removed (aOR\u0026thinsp;=\u0026thinsp;14.29, 95% CI [1.82\u0026ndash;99.57], p\u0026thinsp;=\u0026thinsp;0.012). Although not statistically significant, the group in which IM type myomas were removed showed a lower placental weight (683\u0026thinsp;\u0026plusmn;\u0026thinsp;207 vs. 738\u0026thinsp;\u0026plusmn;\u0026thinsp;213) compared to the group in which only SS type myomas were removed (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Compared to cases with a longer interval between myomectomy and pregnancy (more than 24 months), those with a shorter interval (less than 24 months) had a lower placental weight (655\u0026thinsp;\u0026plusmn;\u0026thinsp;159 g vs. 726\u0026thinsp;\u0026plusmn;\u0026thinsp;230 g, p\u0026thinsp;=\u0026thinsp;0.011) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e6\u003c/span\u003e). In a subgroup analysis according to the time between myomectomy and pregnancy, the frequency of placenta accreta/increta was approximately four times higher in the group with an interval of less than 12 months compared to the group with an interval of 12 months or more (Supporting information, Table S1). There was no difference in obstetric or neonatal outcomes according to the surgical method (laparoscopy vs. laparotomy) for myomectomy (Supporting information, Table S2).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of the study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelivery after pre-pregnancy myomectomy\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;248)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (y)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNulliparity\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182 (73.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior preterm birth before myomectomy\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpontaneous abortion after myomectomy\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (12.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethod of conception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpontaneous\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e187 (75.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOvarian stimulation\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn vitro fertilization\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwin pregnancy\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (7.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of uterine myomas removed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (41.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (16.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (10.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFour or more\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (31.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSum of the diameters of which the three biggest uterine myomas*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of uterine myomas - only subserosal myomas\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (31.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparoscopic myomectomy\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterval time between myomectomy and pregnancy (month)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;6 months\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (18.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;6 and \u0026lt;\u0026thinsp;12 months\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;12 and \u0026lt;\u0026thinsp;24 months\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (30.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;24 months\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (33.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBMI, body mass index; *Data given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, \u003csup\u003e\u0026dagger;\u003c/sup\u003eData given as n (%)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetric and neonatal outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelivery after pre-pregnancy myomectomy\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;248)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancies with Preeclampsia*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of the fetus during GA 16\u0026ndash;23 weeks*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA at delivery (week)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u0026ndash;27\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u0026ndash;31\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u0026ndash;33\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u0026ndash;36\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (12.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean delivery*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e233 (94.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergent delivery*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterine rupture*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeclined hemoglobin after delivery (g/dl)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfusion during peripartum period*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (27.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental accreta/increta*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (5.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental weight (g)\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e700.2\u0026thinsp;\u0026plusmn;\u0026thinsp;210.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeonates after 23 weeks\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;246)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal outcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight (gram)\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3025.5\u0026thinsp;\u0026plusmn;\u0026thinsp;590.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApgar score at 5min\u0026thinsp;\u0026lt;\u0026thinsp;7*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (16.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorbidity during hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of a ventilator*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (13.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory distress syndrome*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchopulmonary dysplasia*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite morbidity \u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eGA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; \u003csup\u003ea\u003c/sup\u003e Composite morbidity during hospitalization includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; * Data given as n (%), \u003csup\u003e\u0026dagger;\u003c/sup\u003eData given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetric outcomes according to the number of uterine myomas removed\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of uterine myomas removed\u003c/p\u003e \u003cp\u003e(single)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of uterine myomas removed\u003c/p\u003e \u003cp\u003e(\u0026ge;\u0026thinsp;2)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnadjusted odds ratio (95% CI)\u003c/p\u003e \u003cp\u003e(Reference: single)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted odds ratio (95% CI) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(Reference: single)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA at delivery (weeks)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthweight (g)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3046\u0026thinsp;\u0026plusmn;\u0026thinsp;570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3011\u0026thinsp;\u0026plusmn;\u0026thinsp;605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental weight (g)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e718\u0026thinsp;\u0026plusmn;\u0026thinsp;233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e688\u0026thinsp;\u0026plusmn;\u0026thinsp;192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.77 (0.36\u0026ndash;1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.66 (0.24\u0026ndash;1.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergent delivery\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.21 (0.61\u0026ndash;2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.93 (0.42\u0026ndash;2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental accreta/increta\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.61 (0.48\u0026ndash;5.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.15 (0.55\u0026ndash;8.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfusion\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.14 (1.17\u0026ndash;3.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.41 (1.20\u0026ndash;4.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.00 (0.62\u0026ndash;6.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.73 (0.68\u0026ndash;10.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.25 (0.63\u0026ndash;2.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.18 (0.51\u0026ndash;2.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite morbidity \u003csup\u003eb\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.84 (0.34\u0026ndash;2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.62 (0.20\u0026ndash;1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eGA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; ; \u003csup\u003ea\u003c/sup\u003e All outcomes were adjusted for maternal age, body mass index, method of conception, twin pregnancy, Interval time between myomectomy and pregnancy, myomectomy method, sum of the diameters of which the three biggest uterine myomas, and type of uterine myomas; \u003csup\u003eb\u003c/sup\u003e Composite morbidity includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; *Data given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, \u003csup\u003e\u0026dagger;\u003c/sup\u003e Data given as n (%)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetric outcomes according to the sum of the diameters of which the three biggest uterine myomas\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSum of the diameters of which the three biggest uterine myomas\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;15cm)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;191)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSum of the diameters of which the three biggest uterine myomas\u003c/p\u003e \u003cp\u003e(\u0026ge;\u0026thinsp;15cm)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnadjusted odds ratio (95% CI)\u003c/p\u003e \u003cp\u003e(Reference: \u0026lt;15cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted odds ratio (95% CI) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(Reference: \u0026lt;15cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA at delivery (weeks)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthweight (g)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3063\u0026thinsp;\u0026plusmn;\u0026thinsp;576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2901\u0026thinsp;\u0026plusmn;\u0026thinsp;625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental weight (g)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e697\u0026thinsp;\u0026plusmn;\u0026thinsp;204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e710\u0026thinsp;\u0026plusmn;\u0026thinsp;232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.14 (0.95\u0026ndash;4.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.41 (0.87\u0026ndash;6.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergent delivery\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.58 (0.76\u0026ndash;3.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.17 (0.74\u0026ndash;3.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental accreta/increta\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.60 (0.13\u0026ndash;2.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.45 (0.09\u0026ndash;2.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfusion\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96 (0.49\u0026ndash;1.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.80 (0.39\u0026ndash;1.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.24 (0.38\u0026ndash;4.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.23 (0.33\u0026ndash;4.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.92 (0.41\u0026ndash;2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.84 (0.33\u0026ndash;2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite morbidity \u003csup\u003eb\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.49 (0.54\u0026ndash;4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.61 (0.51\u0026ndash;5.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eGA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; ; \u003csup\u003ea\u003c/sup\u003e All outcomes were adjusted for maternal age, body mass index, method of conception, twin pregnancy, Interval time between myomectomy and pregnancy, myomectomy method, number of uterine myomas removed, type of uterine myomas; \u003csup\u003eb\u003c/sup\u003e Composite morbidity includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; *Data given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, \u003csup\u003e\u0026dagger;\u003c/sup\u003e Data given as n (%)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetric outcomes according to the type of uterine myomas\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncluding intramural type\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;171)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOnly subserosal type\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnadjusted odds ratio (95% CI)\u003c/p\u003e \u003cp\u003e(Reference: Including intramural type)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted odds ratio (95% CI) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(Reference: Including intramural type)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA at delivery (weeks)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthweight (g)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3032\u0026thinsp;\u0026plusmn;\u0026thinsp;563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3011\u0026thinsp;\u0026plusmn;\u0026thinsp;648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental weight (g)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e683\u0026thinsp;\u0026plusmn;\u0026thinsp;207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e738\u0026thinsp;\u0026plusmn;\u0026thinsp;213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.35 (0.61\u0026ndash;2.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.82 (0.29\u0026ndash;2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergent delivery\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.83 (0.40\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.81 (0.38\u0026ndash;1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental accreta/increta\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.39 (0.08\u0026ndash;1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.41 (0.08\u0026ndash;2.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfusion\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12 (0.62\u0026ndash;2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.47 (0.76\u0026ndash;2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12 (0.37\u0026ndash;3.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.83 (0.23\u0026ndash;3.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.79 (0.37\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.65 (0.28\u0026ndash;1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite morbidity \u003csup\u003eb\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11 (0.01\u0026ndash;0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07 (0.01\u0026ndash;0.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eGA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; ; \u003csup\u003ea\u003c/sup\u003e All outcomes were adjusted for maternal age, body mass index, method of conception, twin pregnancy, Interval time between myomectomy and pregnancy, myomectomy method, sum of the diameters of which the three biggest uterine myomas, and number of uterine myomas removed; \u003csup\u003eb\u003c/sup\u003e Composite morbidity includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; *Data given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, \u003csup\u003e\u0026dagger;\u003c/sup\u003e Data given as n (%)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetric outcomes according to the interval time between the myomectomy and the pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterval time between myomectomy and pregnancy\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;24 months)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterval time between myomectomy and pregnancy\u003c/p\u003e \u003cp\u003e(\u0026ge;\u0026thinsp;24 months)\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;159)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnadjusted odds ratio (95% CI)\u003c/p\u003e \u003cp\u003e(Reference: \u0026lt;24 months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted odds ratio (95% CI) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(Reference: \u0026lt;24 months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA at delivery (weeks)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthweight (g) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3027\u0026thinsp;\u0026plusmn;\u0026thinsp;599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3025\u0026thinsp;\u0026plusmn;\u0026thinsp;587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental weight (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e655\u0026thinsp;\u0026plusmn;\u0026thinsp;159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e726\u0026thinsp;\u0026plusmn;\u0026thinsp;230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.14 (0.95\u0026ndash;4.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.99 (0.36\u0026ndash;2.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergent delivery\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.58 (0.76\u0026ndash;3.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.67 (0.66\u0026ndash;4.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental accreta/increta\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.60 (0.13\u0026ndash;2.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.27 (0.06\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfusion\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96 (0.49\u0026ndash;1.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.13 (0.53\u0026ndash;2.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.24 (0.38\u0026ndash;4.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.02 (0.21\u0026ndash;4.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.92 (0.41\u0026ndash;2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50 (0.18\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite morbidity \u003csup\u003eb\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.49 (0.54\u0026ndash;4.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.56 (0.14\u0026ndash;2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eGA, gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit; ; \u003csup\u003ea\u003c/sup\u003e All outcomes were adjusted for maternal age, body mass index, method of conception, twin pregnancy, myomectomy method, sum of the diameters of which the three biggest uterine myomas, number of uterine myomas removed, and type of uterine myomas; \u003csup\u003eb\u003c/sup\u003e Composite morbidity includes neonatal sepsis, retinopathy of prematurity, patent ductus arteriosus, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis; *Data given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, \u003csup\u003e\u0026dagger;\u003c/sup\u003e Data given as n (%)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were 43 cases of emergency delivery, and the gestational age at the emergency delivery was 36.2 (26.9\u0026ndash;40.3) weeks. The indications for emergency delivery were uterine rupture (1 case, 2.3%), preterm premature rupture of membranes (11 cases, 25.6%), and preterm labor (9 cases, 20.9%) (Supporting information, Table S3). When comparing the clinical characteristics at the time of myomectomy between elective and emergent delivery cases (except for medically indicated delivery), the interval time between myomectomy and pregnancy was significantly shorter in the case of emergent delivery compared to elective delivery (18.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6 months vs. 25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;24.5 months, p\u0026thinsp;=\u0026thinsp;0.035) (Supporting information, Table S4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRecently, as more women are delaying pregnancy and childbirth, the incidence of pregnancies complicated by uterine myomas or previous myomectomy has increased. The presence of a uterine myoma may have a detrimental effect on implantation by obstructing reproductive cell migration, altering uterine contractions, and adversely affecting the endometrium.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Increased use of ultrasound imaging has led to more diagnoses of asymptomatic uterine myomas, and some early studies of women with unknown causes of infertility reported improved pregnancy rates in women with uterine myomas after myomectomy; however, these studies had certain limitations including the lack of randomization methods, and not considering other factors which may influence pregnancy outcomes.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough there are reports that myomectomy is a safe treatment option for women preparing for pregnancy,\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e it is unclear whether this procedure offers a therapeutic benefit for women of childbearing age. Several factors should be considered when deciding whether to perform myomectomy, including the size and number of myomas, and their location in the uterus. Although several studies have shown that patient age, myoma size, myoma location, and the interval between myomectomy and pregnancy may influence pregnancy and live birth rates after myomectomy,\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e to our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes.\u003c/p\u003e \u003cp\u003eNormal uterine myometrium is damaged during myomectomy. Removal of IM type myomas results in scarring of the uterine muscle; when the muscular tissue regenerates, the healing process consists of the regeneration of muscle fibers and formation of a connective tissue scar. This scar may interfere with decidual reactions, spiral artery remodeling, and successful placentation. Uterine spiral arteries play a vital role in supplying nutrients to the placenta and fetus, and for this purpose, they are remodeled into highly dilated vessels by invasion.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e If this process fails, vascular malperfusion and its relationship with oxygen, trophoblast invasion from the outside or inside of the vessels (intravasation versus extravasation), the impact of hemodynamics on endovascular migration, the replacement of arterial components by trophoblasts, maternal tissue repair mechanisms, and the role of uterine natural killer cells can arise, which can lead to various obstetrical and perinatal complications.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Eventually, placental malperfusion may occur, and this pathological condition may manifest as a small placenta. Placentation near the post-procedure myomectomy site impairs intervillous blood flow,\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e resulting in uteroplacental insufficiency and fetal growth restriction. Previous studies have shown that placental volume at delivery is associated with adverse pregnancy outcomes.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn our study, the risk of neonatal composite morbidity, including neonatal sepsis, retinopathy of prematurity, persistent ductus arteriosus, acute respiratory distress syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis, was higher in the group in which myomas including the IM type were removed than in the group in which only the SS type myomas were removed. Although not statistically significant, the group in which myomas, including the IM type, were removed, showed a lower placental weight compared to the group in which only SS type myomas were removed. This suggests that damage to the vascular tissue of the myometrium or replacement of fibrotic tissue in the normal myometrium can adversely affect placental and fetal growth. Although not statistically significant, the group in which the sum of the diameters of three largest myomas was greater than 15 cm showed a lower birth weight compared to the group with a total diameter less than 15 cm. The results of our study suggest that the severity of the myometrial scar after myomectomy may affect future pregnancy outcomes.\u003c/p\u003e \u003cp\u003eDisorders in placental formation and growth are also associated with preterm births. Oxidative stress due to insufficient uteroplacental perfusion can lead to preterm labor and preterm birth.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Previous studies have shown an association between a history of myomectomy and preterm birth.\u003csup\u003e\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e In this study, the preterm birth rate in women with a history of myomectomy was 12.1% (30 women), which appears to be slightly higher than the incidence in the normal standard population. Although not statistically significant, a higher frequency of preterm birth (19.3% vs. 10.1%) was observed in the group with a sum of diameters of the three largest myomas greater than 15 cm compared to less than 15 cm.\u003c/p\u003e \u003cp\u003ePrevious reports have shown that most surgeons recommend contraception for 6\u0026ndash;24 months after myomectomy.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e It takes time for the injured myometrium to recover after myomectomy; if pregnancy occurs before the damaged myometrium fully heals, the placenta may invade the myometrium at the site of the resection, which can cause abnormal placentation. Placenta accreta or increta are serious complications which can result in severe maternal hemorrhage.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e In our study, a shorter interval between myomectomy and pregnancy (less than 12 months) was associated with a higher frequency of placenta accreta or increta compared to an interval of more than 12 months. Insufficient recovery of the myometrium can also affect placental growth.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Accordingly, in our study, the placental weight was lower when the interval between myomectomy and subsequent pregnancy was less than 2 years. This study also showed that the shorter the interval time between myomectomy and subsequent pregnancy, the higher the risk of emergency delivery. The reasons for emergency delivery were preterm labor or preterm premature rupture of membranes, and uterine rupture, which, as described above, are likely to be related to insufficient recovery of the myomectomy site.\u003c/p\u003e \u003cp\u003eThe strengths of this study are mostly related to the homogeneity of data, as they were collected in a single center, and two experienced expert operators performed the myomectomy procedure. However, this study was limited by its retrospective design, which precluded us from following up all women who underwent myomectomy. Although this study included a relatively large number of patients compared to previous studies, in the future, larger prospective controlled studies are needed to validate our results and obtain sufficient data to reliably inform patients about the risks of myomectomy before pregnancy and counsel pregnant women about the increased risk of perinatal complications caused by myomectomy.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, if the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase. These findings are of clinical significance, and they may help obstetricians to effectively counsel pregnant women with a history of myomectomy regarding the risk of subsequent pregnancies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI, body mass index\u003c/p\u003e\n\u003cp\u003eIM, intramural\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSS, subserosal\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe institutional review boards (IRB) of CHA Bundang Medical Center approved this study (IRB no.:\u0026nbsp;2021-08-059, dates of approval: Aug. 25, 2021). Informed consent is not required, because this study is a retrospective cohort study which conducted by analyzing medical records, The IRB of this research institute agreed that informed consent was not required. All study methods were performed in accordance with the relevant guidelines and regulations of the IRB of this institution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to concerns about the risk of data being used outside for other purposes but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2020R1C1C1012873).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYRK participated in the design of the study, acquisition of data, statistical analysis, interpretation of data, and writing of the manuscript. EDN participated in the statistical analysis, interpretation of data, and writing of the manuscript. JEJ participated in the acquisition of data and statistical analysis. JYL participated in the design of the study, acquisition of data, statistical analysis, interpretation of data, and writing of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGuo XC, Segars JH. The impact and management of fibroids for fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012;39:521\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayakrishnan K, Menon V, Nambiar D. Submucous fibroids and infertility: Effect of hysteroscopic myomectomy and factors influencing outcome. J Hum Reprod Sci. 2013;6:35\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCapmas P, Levaillant JM, Fernandez H. Surgical techniques and outcome in the management of submucous fibroids. Curr Opin Obstet Gynecol. 2013;25:332\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z. Effect of uterine leiomyomata on the results of in-vitro fertilization treatment. Hum Reprod. 1995;10:2576\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenfeld DL. Abdominal myomectomy for otherwise unexplained infertility. Fertil Steril. 1986;46:328\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFagherazzi S, Borgato S, Bertin M, Vitagliano A, Tommasi L, Conte L. Pregnancy outcome after laparoscopic myomectomy. Clin Exp Obstet Gynecol. 2014;41:375\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Hua KQ. Patients' age, myoma size, myoma location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy. J Laparoendosc Adv Surg Tech A. 2014;24:95\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMetwally M, Cheong YC, Horne AW. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2012;11:Cd003857.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoğan S, \u0026Ouml;zy\u0026uuml;nc\u0026uuml; \u0026Ouml;, Atak Z. Fibroids During Pregnancy: Effects on Pregnancy and Neonatal Outcomes. J Reprod Med. 2016;61:52\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePijnenborg R, Vercruysse L, Hanssens M. The uterine spiral arteries in human pregnancy: facts and controversies. Placenta. 2006;27:939\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod. 2000;15:2663\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim YR, Jung I, Park G, Chang SW, Cho HY. First-trimester screening for early preeclampsia risk using maternal characteristics and estimated placental volume. J Matern Fetal Neonatal Med. 2019:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim YR, Park G, Joo EH, Jang JH, Ahn EH, Jung SH, et al. First-trimester screening model for small-for-gestational-age using maternal clinical characteristics, serum screening markers, and placental volume: prospective cohort study. J Matern Fetal Neonatal Med. 2021:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEloundou SN, Lee J, Wu D, Lei J, Feller MC, Ozen M, et al. Placental malperfusion in response to intrauterine inflammation and its connection to fetal sequelae. PLoS One. 2019;14:e0214951.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JY, Li S, Shin NE, Na Q, Dong J, Jia B, Jones-Beatty K, McLane MW, Ozen M, Lei J, Burd I. Melatonin for prevention of placental malperfusion and fetal compromise associated with intrauterine inflammation-induced oxidative stress in a mouse model. J Pineal Res. 2019;67:e12591.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMilazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res. 2017;43:1789\u0026ndash;804.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian YC, Long TF, Dai YM. Pregnancy outcomes following different surgical approaches of myomectomy. J Obstet Gynaecol Res. 2015;41:350\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFukuda M, Tanaka T, Kamada M, Hayashi A, Yamashita Y, Terai Y, et al. Comparison of the perinatal outcomes after laparoscopic myomectomy versus abdominal myomectomy. Gynecol Obstet Invest. 2013;76:203\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly BA, Bright P, Mackenzie IZ. Does the surgical approach used for myomectomy influence the morbidity in subsequent pregnancy? J Obstet Gynaecol. 2008;28:77\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumakiri J, Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Itoh S, et al. Pregnancy and delivery after laparoscopic myomectomy. J Minim Invasive Gynecol. 2005;12:241\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurayama Y, Baba K, Seki H. Abnormality and imaging diagnosis during second trimester of pregnancy. Obstetrical and Gynecological Practice. 2008;57:421\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJauniaux E, Toplis PJ, Nicolaides KH. Sonographic diagnosis of a non-previa placenta accreta. Ultrasound Obstet Gynecol. 1996;7:58\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Connor BB, Pope BD, Peters MM, Ris-Stalpers C, Parker KK. The role of extracellular matrix in normal and pathological pregnancy: Future applications of microphysiological systems in reproductive medicine. Exp Biol Med (Maywood). 2020;245:1163\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Uterine myoma, myomectomy, pregnancy, obstetric outcome, perinatal outcome","lastPublishedDoi":"10.21203/rs.3.rs-1386906/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1386906/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eTo investigate the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eIn this retrospective cohort study, we identified 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital between 2010 and 2020. The association between clinical characteristics at the time of myomectomy and subsequent obstetric outcomes were analyzed. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThere was one case of uterine rupture. The gestational age at delivery was 37.7±2.4 weeks. There were 2 (0.8%) cases of fetal loss before 23 weeks, but there were no cases of perinatal death. The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one was removed (aOR=2.41, 95% CI [1.20-4.86], p=0.014). The risk of neonatal composite morbidity was higher in the group in which myomas including the IM type were removed, than in the group in which only SS myomas were removed (aOR=14.29, 95% CI [1.82-99.57], p=0.012). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%, p=0.001) and lower birth weight (2901± 625 g vs. 3063± 576 g, p=0.001) compared to the group with diameters less than 15 cm. Placenta accreta/increta (7.9% vs. 3.8%, p=0.043) and lower placental weight (646± 170 g vs. 750± 232 g, p=0.034) were more common in patients with an interval between myomectomy and pregnancy of less than 12 months compared to more than 12 months.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eTo our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes. If the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase.\u003c/p\u003e","manuscriptTitle":"The association between clinical features at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric and perinatal outcomes: a single-center retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-03-10 19:37:49","doi":"10.21203/rs.3.rs-1386906/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-06-06T15:24:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-05-29T07:30:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-05-08T05:21:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5b758913-9b19-4775-a325-11c8d126541b","date":"2022-04-28T03:10:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-03-28T22:25:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d54d89b1-38e9-4d60-ae28-8da0a977f1b6","date":"2022-03-23T20:56:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-03-21T18:27:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-03-21T17:41:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-03-08T06:25:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-03-08T05:55:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2022-02-23T01:58:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a8eb9d3d-971e-48d5-9585-ab0b871bc51b","owner":[],"postedDate":"March 10th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-12-22T07:14:11+00:00","versionOfRecord":{"articleIdentity":"rs-1386906","link":"https://doi.org/10.1186/s12884-022-05240-7","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2022-12-03 00:00:00","publishedOnDateReadable":"December 3rd, 2022"},"versionCreatedAt":"2022-03-10 19:37:49","video":"","vorDoi":"10.1186/s12884-022-05240-7","vorDoiUrl":"https://doi.org/10.1186/s12884-022-05240-7","workflowStages":[]},"version":"v1","identity":"rs-1386906","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1386906","identity":"rs-1386906","version":["v1"]},"buildId":"369fNeqWncA4NS6XSWjrt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}