Pregnancy outcome and deliveries following laparoscopic myomectomy

Uterine rupture after myomectomy by laparotomy is not a common occurrence. Some case reports of uterine rupture after laparoscopic myomectomy (LM) raise the question of the quality of the uterine scar produced when this technique is performed. In order to assess the outcome of pregnancies and deliveries after LM and to assess the risk of uterine rupture, we performed an observational study. Questionnaires were mailed to all women who had had LM for at least one intramural or subserosal myoma of more than 20 mm diameter and who were aged <45 years. Ninety-eight patients became pregnant at least once after LM, giving a total of 145 pregnancies. Among the 100 patients who had delivery, there were three cases of spontaneous uterine rupture. Because only one of these uterine ruptures occurred on the LM scar, the risk of uterine rupture was 1.0% (95% CI 0.0-5. 5%). Seventy-two patients (72.0%) had trials of labour. Of these, 58 (80.6%) were delivered vaginally. There was no uterine rupture during the trials of labour. Spontaneous uterine rupture seems to be rare after LM. This risk should not deter the use of LM if needed. When performing LM, particular care must be given to the uterine closure.     

Uterine leiomyoma and menstrual cycle characteristics in a population-based cohort study

BACKGROUND: We examined the association of uterine leiomyoma with menstrual cycle characteristics in a population of non-care-seeking women. METHODS: This cross-sectional study uses data from the Seveso Women's Health Study (SWHS), a population-based cohort in Italy. Participants included 341 premenopausal women, 30-60 years old, who had an intact uterus and were not pregnant, lactating, or using oral contraception or intra-uterine devices. We examined the presence of any ultrasound-detected uterine leiomyoma in relation to self-reported menstrual cycle length, flow length and heaviness of flow. The association of leiomyoma number, volume, tissue layer location and axial position with menstrual cycle characteristics was also examined. RESULTS: Uterine leiomyomata were detected in 73 women (21.4%). After adjustment for covariates, the presence of a leiomyoma was not significantly related to menstrual cycle length, flow length or heaviness of flow [odds ratio (OR) for scanty flow =1.9, 95% confidence interval (CI) 0.8-4.3; OR for heavy flow =1.3, 95% CI 0.7-2.5; relative to moderate flow]. Number, volume, tissue layer location (subserosal or intramural) and axial position (anterior or posterior) of the leiomyoma were also not related to menstrual cycle characteristics. CONCLUSION: In this Italian population of women not seeking gynaecological care, menstrual characteristics are not related to leiomyoma.     

腹腔镜下子宫肌瘤剔除术的临床应用

目的探讨腹腔镜下子宫肌瘤剔除术的手术技巧、复发及术后妊娠情况。方法子宫肌瘤患者217例，年龄25～43岁，平均年龄32岁（标准差7．3岁）．其中有蒂浆膜下肌瘤37例．阔韧带肌瘤4例．宫颈肌瘤7例，肌壁间肌瘤及无蒂浆膜下肌瘤169例．行腹腔镜下子宫肌瘤剔除术（laparoscopic myomectomv．LM）。结果217例手术均获成功．无严重并发症．217例中13例失访．204例随访11～47个月，平均（29．00±10．32）个月。术后9～47个月复发71例．占34．80％．有生育要求者49例，妊娠率46．67％．21例（21次）妊娠中．1例流产．1例异位妊娠．1例妊娠高血压疾病早产（剖宫产）．9例足月妊娠，其中7例行剖宫产，2例顺产；9例继续妊娠中[平均（22．00±6．82）周]，无一例子宫切口瘢痕裂开。结论LM后可提高妊娠率，复发率同开腹手术。LM后妊娠是安全的．但剖宫产几率增加。LM具有创伤小、恢复快的优点．是一种安全、可靠的手术方法．     

剖宫产同时子宫肌瘤剔除35例临床研究

目的 探讨妊娠合并子宫肌瘤病人在剖宫产同时肌瘤剔除术的可行性，安全性。方法 妊娠合并子宫肌瘤35例，在剖宫产同时行肌瘤剔除术，与35例单纯剖宫产的产妇做对照。结果 手术时间，术后出血量，术后病率，术后住院天数，肌瘤剔除组与单纯剖宫产组比较，差异不显著（均P〉0．05）。结论 剖宫产同时行肌瘤剔除术是可行的，安全的。妊娠合并子宫肌瘤时，应放宽剖宫产指征，同时行子宫肌瘤剔除术。     

Risk of benign gynaecological diseases and hormonal disorders according to responsiveness to ovarian stimulation in IVF: a follow-up study of 8714 women

BACKGROUND: Over the past decade, attention has been focused increasingly on the long-term health effects of IVF in women. Assuming that hormonal changes due to stimulation regimens for IVF are strongest among 'high' responders, we evaluated whether responsiveness to ovarian stimulation in IVF is predictive of the risk of benign gynaecological disorders >12 months after the last IVF cycle. METHODS: A nationwide historical cohort study of women who underwent IVF treatment was conducted. After a median time of 4.6 years following the last IVF treatment cycle, 8714 cohort members completed a health survey questionnaire that inquired about reproductive variables and the occurrence and age at onset of specific medical conditions including uterine leiomyoma, surgically removed ovarian cysts and thyroid disorders. Detailed data on cause of subfertility and IVF treatment were collected from the medical records. Women were included in the 'high responders' group when on average >/=14 oocytes were retrieved per IVF cycle (n = 1562), in the 'normal responders' group when they had a mean number of 4-13 retrieved oocytes (n = 6033), and in the 'low responders' group when they had a mean number of 0-3 retrieved oocytes per cycle (n = 1119). RESULTS: Among women with a high response to ovarian stimulation, we found a borderline significantly decreased risk of uterine leiomyoma [relative risk (RR) = 0.6; 95% confidence interval (CI) 0.4-1.0] and surgically removed ovarian cysts (RR = 0.6; 95% CI 0.3-1.0) in comparison with 'normal responders'. After OHSS, the age-adjusted RRs were 1.8 (95% CI 0.9-3.8) for having surgically removed ovarian cysts and 1.0 (95% CI 0.4-2.2) for uterine leiomyoma (both not significant). CONCLUSIONS: Despite the small number of events observed, highly elevated risks of gynaecological disorders and hormonal diseases in women undergoing IVF treatment can be excluded based on the present data and this follow-up period. Women with a low response to ovarian stimulation tended to have higher risks of benign gynaecological diseases than high responders.     

Fertility after laparoscopic myomectomy of large intramural myomas: preliminary results

Fertility outcome following laparoscopic myomectomy was evaluated.A prospective clinical study was carried out between October1990 and October 1993 in 21 infertile patients who underwentlaparoscopic myomectomy for a myoma measuring 3>;5 cm indiameter. The overall rate of intrauterine pregnancy was 333%(seven patients). Out of 12 patients with infertility factorsassociated with uterine myomas, three (25.0%) became pregnant,whereas four (44.4%) out of nine patients with no other associatedinfertility factor became pregnant. No uterine rupture was observed.Out of the seven pregnancies, four were spontaneous and beganwithin 1 year of the operation. The other three were achievedafter in-vitro fertilization in patients with associated infertilityfactors. In the four patients who gave birth by Caesarean section,no adhesions were found on the myomectomy scar. From these preliminaryresults, laparoscopic surgery for myomas seems to offer comparableresults with those obtained by laparotomy.     

妊娠合并子宫肌瘤行剖宫产术中肌瘤切除的临床疗效分析

目的 探讨剖宫产术联合子宫肌瘤切除术治疗妊娠合并子宫肌瘤的临床疗效。方法 选择2015年6月~2017年6月我院收治的妊娠合并子宫肌瘤患者46例为研究对象,随机分为两组,对照组行剖宫产术治疗,观察组行剖宫产术联合子宫肌瘤切除术治疗,对比两组的手术时间、宫缩素用量、术中出血量、恶露干净时间、住院时间情况。结果 观察组的手术时间、宫缩素用量高于对照组,术中出血量、恶露干净时间、住院时间高于对照组,观察组的并发症发生率高于对照组,对比差异均存在统计学意义（P＜0.05）。结论 剖宫产术联合子宫肌瘤切除术治疗妊娠合并子宫肌瘤的应用效果显著,可改善症状和生活质量,也可缩短治疗时间,避免二次手术,提高治疗效果,值得应用。     

Laparoscopic myomectomy and subsequent pregnancy: results in 54 patients

The laparoscopic approach to myomectomy has raised questions about the risk of uterine rupture in patients who become pregnant following surgery. It has been suggested that the rupture outside labour in pregnancies following laparoscopic myomectomy can be due to the difficulty of suturing or to the presence of a haematoma or to the wide use of radio frequencies. In this paper we describe the pregnancy outcome of 54 patients submitted to laparoscopic myomectomy at our Institution and prospectively followed during subsequent pregnancies. A total of 202 patients underwent laparoscopic myomectomy. A total of 65 pregnancies occurred in 54 patients who became pregnant following surgery. Data were collected about complications of pregnancy, mode of delivery, gestational age at delivery and birthweight of the neonates. No cases of uterine rupture occurred. Twenty-one pregnancies followed an IVF procedure. Nine patients conceived twice and one three times. Four multiple pregnancies occurred. Eight pregnancies resulted in a first trimester miscarriage and another in an interstitial pregnancy requiring laparotomic removal of the cornual gestational sac. Of the remaining 56 pregnancies, 51 (91%) were uneventful. In two cases a cerclage was performed at 16 weeks. In two cases pregnancy-induced hypertension developed. Two pregnancies ended with a preterm labour (26-36 weeks). A Caesarean section was performed in 45 cases (54/57, 80%). In terms of the safety of laparoscopic myomectomy in patients who become pregnant following surgery, our results were encouraging. However, further studies are needed to provide reliable data on the risk factors and the true incidence of uterine rupture.     

DNA repair gene XRCC1 Arg399Gln polymorphism is associated with increased risk of uterine leiomyoma

BACKGROUND: DNA repair gene XRCC1 Arg399Gln polymorphism has been associated with the risk of several human tumours. In the present study we investigated whether the XRCC1 polymorphism is related to the risk of uterine leiomyoma, the most common neoplasm of the female genital tract. METHODS: Three hundred and twenty-seven patients with uterine leiomyoma and 197 normal controls were enrolled, and XRCC1 genotyping was determined by PCR and restriction fragment length polymorphism. RESULTS: The proportions of individuals homozygous for 399Arg allele, heterozygous and homozygous for the 399Gln allele were 85.8%, 13.7% and 0.5% among the control group, and 46.2%, 53.2% and 0.6% in those with leiomyoma (P < 0.001), respectively. Logistic regression analysis (after adjusting for age, parity, menarche age and body mass index) showed a significant increased risk of uterine leiomyoma in women with the Arg/Gln genotype versus the Arg/Arg genotype (odds ratio 6.79; 95% confidence interval 4.20-10.99; P < 0.001). CONCLUSIONS: In Korean women, the 399Gln polymorphism of XRCC1 is associated with an increased risk of uterine leiomyoma.     

妊娠合并子宫肌瘤患者剖宫产时对肌瘤的合理处理方案研究

目的探讨妊娠合并子宫肌瘤患者进行剖宫产手术中对子宫肌瘤的合理处理方案研究。方法病例选自的妊娠期合并子宫肌瘤患者362例，其中单发子宫肌瘤207例，多发子宫肌瘤155例。孕妇年龄为21～34岁，孕周为31～41w，均为单胎妊娠。根据子宫肌瘤的大小、位置及数目，变性与否，医生提供可行、合理的参考意见，本着患者知情同意临床处理原则，可进行单纯剖宫产术、剖宫产同时子宫肌瘤核除术、剖宫产同时子宫次全切除术、剖宫产同时子宫全切除术。临床观察指标：孕妇年龄、孕周、手术中、术后出血量、术后复发情况及患者的满意度等。结果1．362例患者中，进行单纯剖宫产术患者（CS）39例（单发肌瘤37例、多发肌瘤2例），剖宫产同时子宫肌瘤核除术者256例（CS＋核瘤，单发肌瘤130例、多发肌瘤126例），剖宫产同时子宫次全切除术者62例（CS＋次切，单发肌瘤37例、多发肌瘤25例），剖宫产同时子宫全切除术者5例（CS＋全切，单发肌瘤3例、多发肌瘤2例）。2．不同处理方案的手术中出血总量没有明显差异（P＞0．05）；同时行子宫切除手术组的年龄较其他两组偏大（P＜0．05）；患者满意度以单纯CS组最差（15．4％）；患者因子宫肌瘤的再次开腹率在CS组为92．3％，CS＋核瘤组为1．17％，子宫切除组为0。结论妊娠合并子宫肌瘤患者在进行剖宫产时没有固定模式，需根据肌瘤的大小、位置、病人的年龄以及患者的生育需求等情况综合考虑。但在剖宫产同时行子宫肌瘤核除手术也是一种安全的手术方式。     

Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study

BACKGROUND: This prospective study was designed to evaluate the operative morbidity and reproductive outcome in patients who had secondary myomectomy for recurrent symptomatic uterine fibroids. METHODS: A total of 58 women were subjected to a secondary myomectomy via the abdominal route. The operative morbidity such as blood loss, presence of adhesions and febrile index were estimated and the pregnancy outcome over a 2-4 year period of follow-up. RESULTS: The mean age and standard deviation (+/- SD) of the women was 35 (+/- 2.4) years. Nineteen patients (33%) had a postoperative temperature vertical line 100 degrees F and the estimated blood loss ranged from 159-2500 ml (median 700 ml). Seven patients (12%) required blood transfusion and one had a hysterectomy due to haemorrhage. Nine women (15.5%) became pregnant but only five (56%) had live births. Those with successful pregnancies tended to be younger with a mean age of 31.8 (+/- 2.6) years versus 35 (+/- 1.8) years, (P = 0.08, non-significant) and had fewer uterine leiomyomata; median with range values, 2 (1-6) versus 7 (6-15). The variables which best predicted the postoperative likelihood of pregnancy were; age, presence of tubal adhesions and the number of uterine fibroids. CONCLUSION: This prospective study showed a high operative morbidity and a poor fertility outcome after a repeat myomectomy. The factors affecting successful outcome in a logistic regression model were age, tubal adhesions and number of uterine fibroids.     

The association between heavy metals, endometriosis and uterine myomas among premenopausal women: National Health and Nutrition Examination Survey 1999-2002

BACKGROUND: It has been hypothesized that exposure to exogenous estrogens may be associated with endometriosis and uterine myomas. We sought to investigate the association between heavy metals which have been shown to be hormonally active and these disorders using data from the National Health and Nutrition Examination Survey, 1999-2002. METHODS: Women aged 20-49 years who had data on metals and the outcomes of interest, were premenopausal and neither pregnant nor breastfeeding were eligible (n = 1425). Lead, cadmium and mercury were measured in whole blood. Diagnosis of outcomes was based upon self-report. Logistic regression was used to examine the association between tertiles of heavy metals and disease adjusting for age, race/ethnicity, use of birth control pills prior to diagnosis and smoking status at diagnosis. RESULTS: A dose-response association between cadmium and endometriosis was observed [tertile 2 versus 1: adjusted odds ratio (OR) = 1.94, 95% confidence interval (CI): 0.73-5.18; tertile 3 versus 1: adjusted OR = 3.39, 95% CI 1.37-8.40]. This association persisted in subanalyses: (i) limiting analysis to women diagnosed in the past 10 years and (ii) limiting analysis to women diagnosed since last pregnancy, although limited by sample size. CONCLUSIONS: These results must be interpreted with caution given the cross-sectional study design. The observed association between cadmium and endometriosis deserves further investigation in properly designed studies.     

Pregnancy following treatment of symptomatic myomas with laparoscopic bipolar coagulation of uterine vessels

BACKGROUND: Laparoscopic bipolar coagulation of uterine vessels (LBCUV) has been employed for women with symptomatic uterine myomas, but its effect on subsequent pregnancy has not been characterized. METHODS: Four-hundred and twenty-three women entered the study between March 1999 and December 2001. Of these, 142 women (33.6%) were under the age of 40 years at the time of LBCUV, 36 of whom (36/142, 25.3%) were sexually active without contraception. In a prospective study of 142 patients (<40 years old) undergoing LBCUV for symptomatic myomas, 15 women became pregnant (17 total pregnancies) and were evaluated by physical and ultrasound examinations. RESULTS: The volume of the dominant myoma was 117.4 +/- 118.4 and 36.8 +/- 56.8 cm(3) before and after LBCUV respectively. Volume of the dominant myoma after pregnancy was 46.2 +/- 76.7 cm(3) (mean +/- SD). There was a significant difference in myoma volume before and after LBCUV (P = 0.002), but no significant difference in myoma volume when comparing post-partum size with post-LBCUV size (P = 0.269). Pregnancy outcomes included seven miscarriages in the first trimester and one premature rupture of membrane (PPROM). Although the other pregnancies were regarded as uncomplicated, only two women were delivered of normal neonates as the other seven pregnancies were terminated secondary to patient request. CONCLUSIONS: The pregnancy and term pregnancy rates in sexually active women without contraception were 41.6% (15/36) and 5.6% (2/36) respectively. Because a relatively high rate (7/17, 41.2%) of early miscarriages was observed, we recommend that this procedure be employed only for women who do not desire additional children.     

Association between HSD17B1 rs605059 polymorphisms and the risk of uterine diseases: a systemic review and meta-analysis

The aim of this study was to evaluate the HSD17B1 gene polymorphisms in the risks of endometrial cancer, endometriosis and uterine leiomyoma by meta-analysis. A comprehensive electronic search was conducted in PubMed, Medline (Ovid), Embase, Weipu, Wanfang and CNKI. The pooled ORs were performed using the Revman 5.2 softerware. 8 case-control studies were included: 3 were about endometrial cancer, 4 were about endometriosis and 1 was about uterine leiomyoma. The result showed no significant association between HSD17B1 rs605059 gene polymorphisms and risks of endometrial cancer (AA vs. AG+GG: OR = 1.11, 95% CI = 0.94-1.32; AA+AG vs. GG: OR = 1.79, 95% CI = 0.42-7.52; AG vs. AA+ GG: OR = 0.87, 95% CI = 0.76-1.00; AA vs. GG: OR = 1.43, 95% CI = 0.62-3.30; A vs. G: OR = 1.00, 95% CI = 0.91-1.11) or endometriosis (AA vs. AG+GG: OR = 0.99, 95% CI = 0.75-1.32; AA+AG vs. GG: OR = 1.73, 95% CI = 0.92-3.25; AG vs. AA+ GG: OR = 1.24, 95% CI = 1.00-1.53; AA vs. GG: OR = 1.54, 95% CI = 0.79-2.97; A vs. G: OR = 1.23, 95% CI = 0.90-1.68). No association was found in a subgroup analysis based on Asian ethnicity for endometriosis. This meta-analysis suggested that HSD17B1 rs605059 polymorphisms were not associated with the risks of endometrial cancer and endometriosis. Further studies are needed to validate the conclusion and clarify the relationship between HSD17B1 rs605059 polymorphisms and the risk of uterine leiomyoma.     

Pregnancy following laparoscopic myomectomy: preliminary results.

The objective of this study was to assess the outcome of pregnancy in a series of women who underwent laparoscopic myomectomy. A total of 115 women underwent laparoscopic myomectomy for pressure and pain (76.5%), abnormal bleeding (52.2%) and/or infertility (29.6%). Follow up data were obtained either by reviewing the patient's chart or returned questionnaire. Of the 115 women, there were 42 pregnancies in 31 patients. Two women were lost to follow-up. Of the remaining 40 pregnancies, six ended with vaginal delivery at term. Caesareans were performed in 22 cases, including 21 at term and one at 26 weeks gestation. Two pregnancies were associated with a normal delivery, but the mode of delivery is unknown. Eight resulted in first trimester pregnancy loss, one was an ectopic pregnancy, and one patient underwent elective termination. Spontaneous uterine rupture was not noted during pregnancy or at term in any of the cases. Average length of follow-up from the date of surgery was 43 months, with a range of 9-99 months. Our series did not confirm the hypothesis that laparoscopic myomectomy is associated with an increased risk for uterine dehiscence during pregnancy. However, a larger series is needed to make a conclusive judgement.     

Fertility outcome after ectopic pregnancy and use of an intrauterine device at the time of the index ectopic pregnancy

Fertility after ectopic pregnancy (EP) was investigated in a non-selected population taking into account intrauterine device (IUD) use at the time of the EP. Between January 1992 and June 1996, 647 women listed in the EP register of Auvergne (France) were followed up. The analysis included only the 328 women who were seeking to become pregnant: 23 women using IUD at the time of the index EP (IUD users) and 305 IUD non-users. Among IUD users, there was no recurrence of EP, and the 1 year cumulative rate was 87% [95% confidence interval (CI): 73-100%] for intrauterine pregnancies and 86% (95% CI: 72-100%) for deliveries. Among IUD non-users, the 2 year cumulative rate for recurrence of EP was 28% (95% CI: 17-39%), and the 1 year cumulative rates were 60% (95% CI: 53-66%) for intrauterine pregnancies and 44% (95% CI: 38-56%) for deliveries. The adjusted intrauterine pregnancy rate of IUD users was not significantly different from that of IUD non-users. However, IUD non-users had more miscarriages, so their delivery rate was lower.     

Association of cyclin D1 G870A polymorphism with uterine leiomyoma in women whose body mass index values are above 25 kg/m2

BACKGROUND: Many studies have shown that a polymorphism (G870A) in cyclinD1 (CCND1) is associated with carcinogenesis in a variety ofcancers. Our aim was to determine if an association exists betweenthe CCND1 G870A polymorphism and uterine leiomyoma in Koreanwomen. METHODS: Blood samples of 331 cases and 204 controls aged 47.4 ±7.6 and 46.8 ± 10.4 years (mean ± SD), respectively,were collected. CCND1 genotyping was determined by PCR and restrictionfragment length polymorphism. RESULTS: Allelic frequencies of cases (A, 0.53; G, 0.47) were not significantlydifferent from those of controls (A, 0.49; G, 0.51) (P = 0.22).After adjustment for menarche age and BMI, multivariate logisticregression analysis showed that the AA genotype was not associatedwith increased risk for uterine leiomyoma [odds ratio (OR) =1.38, 95% confidence interval (CI); 0.85–2.26, P = 0.19].However, in stratification analysis of cases and controls withBMI >25 kg/m², allelic frequencies of cases (A, 0.56; G,0.44) were significantly different from controls (A, 0.36; G,0.64) (P = 0.005), and the AA genotype was associated with increasedrisk for uterine leiomyoma (OR = 3.61, 95% CI; 1.02–12.73,P = 0.046). Furthermore, the OR for AA compared with combinedGG and AG genotypes was 3.16 (95% CI 1.01–9.92, P = 0.048). CONCLUSIONS: The A allele and AA genotype of CCND1 G870A polymorphism havea significant association with an increased risk of the uterineleiomyoma in obese Korean women.     

Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies

BACKGROUND: Caesarean scar ectopic pregnancy is associated with a number of significant complications. In this study, we report on subsequent reproductive outcomes in a group of women following successful treatment of their scar pregnancies. METHODS: The study included those women who received treatment for their Caesarean scar pregnancies between April 1999 and October 2005. Their ability to conceive, the time it took to become pregnant and outcomes of subsequent pregnancies were all recorded. RESULTS: 40 women with Caesarean scar pregnancies were managed in our unit. The uterus was conserved in 38/40 cases. Follow-up data were available in 29/38 (76%) of women. Twenty-four out of 29 (83%) attempted to become pregnant. Twenty-one out of 24 [88%, 95% confidence interval (CI): 75-100] women conceived spontaneously. Twenty out of 21 (95%, 95% CI: 86-100) pregnancies were intrauterine and one woman (5%, 95% CI: 0-14) had a recurrent scar ectopic. Thirteen out of 20 (65%, 95% CI: 44-86) intrauterine pregnancies appeared normal. Nine out of 13 (69%) were delivered by Caesarean section. Seven out of 20 (35%, 95% CI: 14-56) intrauterine pregnancies ended in spontaneous abortions. CONCLUSIONS: Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of complications including recurrent scar implantation appears to be low.     

Subfecundity in overweight and obese couples

BACKGROUND: Recent studies indicate that not only women's but also men's obesity has adverse effects on fecundity and since fecundity is a couple concept, we examined fecundity in relation to overweight and obesity of the couple. We also examined the association between weight changes and fecundity over time. METHODS: Between 1996 and 2002, 64 167 pregnant women enrolled in the Danish National Birth Cohort were interviewed during and 18 months after pregnancy. Information on body mass index (BMI) and waiting time to pregnancy (TTP) was available for 47 835 couples. RESULTS: Among men and women with a BMI of 18.5 kg/m(2) or more, we found a dose-response relationship between increasing BMI group and subfecundity (a TTP of more than 12 months): Odds ratio (OR) = 1.32 (95% CI: 1.26-1.37) for women and OR = 1.19 (95% CI: 1.14-1.24) for men. Among 2374 women with an initial BMI of 18.5 kg/m(2) or more, who participated more than once in the Danish National Birth Cohort, each kilogram increment in weight between the two pregnancies was associated with a 2.84 (95% CI: 1.33-4.35) days longer TTP. CONCLUSIONS: Couples have a high risk of being subfecund if they are both obese.     

妊娠期子宫肌瘤5例的剔除治疗体会

目的探讨子宫肌瘤剔除术在妊娠期的应用价值及安全性。方法对2003年10月～1005年4月我院实施的妊娠期子宫肌瘤剔除术5例进行回顾分析。结果妊娠10～21周手术3例，其中1例宫颈巨大肌瘤同时行人工流产，2例术后均足月分娩，孕足月剖宫产同时剔除肌瘤2例，均无不良反应。结论妊娠期子宫肌瘤剔除术是解决妊娠合并较大子宫肌瘤尤其是红色变性时的有效方法，只要时机选择恰当，手术方法和技巧正确，可避免严重并发症发生。