Fertiliteit- en zwangerschapsuitkomsten na hysteroscopische placentarestverwijdering

Nele Coryn
Aan de hand van een retrospectieve analyse wordt de follow up studie gedaan betreffende reproductieve en zwangerschapsuitkomsten na hysteroscopische
placentarestverwijdering (loop resectie versus morcellatie).

reproductieve en zwangerschapsuitkomsten na hysteroscopische placentarestverwijdering

Doelstelling
In deze masterproef wordt aan de hand van een retrospectieve analyse de follow up studie gedaan betreffende reproductieve en zwangerschapsuitkomsten na hysteroscopische placentarestverwijdering (loop resectie versus morcellatie).

Methodologie
Van alle patiënten die geïncludeerd zijn in voorgaande RCT, waarbij hysteroscopische placentarestverwijdering door middel van loop resectie (n=40) vergeleken werd met morcellatie (n=46), werden fertiliteit en zwangerschapsuitkomsten nagegaan. De primaire uitkomst waren levendgeboorte en zwangerschapscomplicaties, verdeeld in uterusruptuur,
abnormale placentatie (placenta accreta/increta/percreta, placenta previa, vasa previa, retentio placentae na de bevalling of expulsie met noodzaak tot manuele verwijdering of curettage en placentarest 6 weken na de bevalling of expulsie) en andere
zwangerschapscomplicaties (bloedverlies tijdens het eerste, tweede en/of derde trimester, premature contracties, preterme prematuur gebroken vliezen, hypertensieve aandoeningen
gerelateerd aan de zwangerschap of intrauteriene groei restrictie. De secondaire uitkomst was de tijd tot zwangerschap.

Resultaten
Het antwoord percentage bedroeg 75% (30/40) voor de loop resectie groep en 84.8% (39/46) voor de morcellatie groep. The mediane follow-up was 4 jaar (IQR 4 – 6) in de morcellatie
groep en 5 jaar (IQR 4 -5) in de loop resectie groep (p = 0.90). 71% (49/69) hadden een zwangerschapswens na de hysteroscopische placentarestverwijdering. In de intention-to-treat analyse, de levendgeboorte in de morcellatiegroep bedroeg 88.9% (24/27), 68.2% (15/22) in de loop resectie groep. Dit niet significant verschillend (p = 0.09). Een uterusruptuur werd
alleen in de morcellatie groep gezien in 4.2% (1/24) van de patiënten (p = 1.00). De casus betrof een patiënte met gekende hemi-uterus waarbij een perforatie was opgetreden tijdens de
dilatatie. Complicaties betreffende de placenta werden in 20.8% (5/24) en 22.2% (4/18) (p = 0.33) gezien en andere zwangerschapscomplicaties in 33.3% (8/24) en 16.6% (3/18) (p =
0.33) voor respectievelijk de morcellatie en loop resectiegroep. De mediane tijd tot zwangerschap was 14 weken (IQR 5 – 33) in de morcellatie groep en 15 weken (IQR 6 – 37) in de loop resectie groep (p = 0.96).

Conclusie
Hysteroscopische placentarestverwijdering door middel van zowel loop resectie als morcellatie lijken geen schadelijk effect te hebben op reproductieve en zwangerschapsuitkomsten in een volgende zwangerschap. De zwangerschapspercentages zijn
voor beide groepen vergelijkbaar, met een trend tot naar meer levendgeboorte in de morcellatie groep.

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Universiteit of Hogeschool
master in de specialistische geneeskunde - afstudeerrichting gynaecologie-verloskunde
Publicatiejaar
2018
Promotor(en)
prof. dr. S. Weyers, dr. T. Hamerlynck
Kernwoorden