Influencing Factors and Predictive Value of Postpartum Hemorrhage Following Cesarean Myomectomy: A Retrospective Cohort Study
Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality, and uterine fibroids are a common condition that may contribute to this risk. This study aimed to determine the risk factors for PPH following cesarean myomectomy and to evaluate their predictive value...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
IMR Press
2025-07-01
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| Series: | Clinical and Experimental Obstetrics & Gynecology |
| Subjects: | |
| Online Access: | https://www.imrpress.com/journal/CEOG/52/7/10.31083/CEOG37509 |
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| Summary: | Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality, and uterine fibroids are a common condition that may contribute to this risk. This study aimed to determine the risk factors for PPH following cesarean myomectomy and to evaluate their predictive value. Methods: We conducted a retrospective analysis of 1002 women with fibroids ≥4 cm in diameter who underwent cesarean myomectomy at the Shenyang Women’s and Children’s Hospital from January 2014 to November 2022. The PPH and non-PPH groups consisted of 109 and 893 patients, respectively. Patient, clinical, and surgical data were collected from medical records. Factors associated with PPH were identified through univariate and multivariable logistic regression analyses. A receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of independent risk factors for PPH. Propensity score matching analysis was used to determine whether bilateral uterine artery ligation before myomectomy and the use of potent uterotonic drugs during this procedure protected against PPH. Results: Independent risk factors for PPH included multiple fibroids, specific sites of fibroids (located in the lower segment of the uterus, cervix, uterine cornu, or adjacent to the uterine vessels or the interstitial part of the fallopian tube), a longer surgery duration, and a larger fibroid size (diameter >7.5 cm for single fibroids and total diameter >14.5 cm for multiple fibroids). The results of the propensity score matching analysis indicated that bilateral uterine artery ligation and the administration of potent uterotonic drugs before myomectomy were protective factors against PPH. ROC curve analysis showed that both the maximum diameter of a single uterine fibroid and the sum of the maximum diameters of multiple uterine fibroids are predictive of PPH risk. Conclusions: Cesarean myomectomy is relatively safe for fibroids located at non-specific sites with a diameter ≤7.5 cm (single) or a total diameter ≤14.5 cm (multiple). The duration of surgery should be minimized. In high-risk cases, bilateral uterine artery ligation and the administration of potent uterotonic drugs before myomectomy should be considered. |
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| ISSN: | 0390-6663 |