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Peng-Hui Wang, M.D., Ph.D. Department of Obstetrics and Gynecology

Peng-Hui Wang, M.D., Ph.D. Department of Obstetrics and Gynecology Taipei Veterans General Hospital National Yang-Ming University 王 鵬 惠 台北榮民總醫院婦產部 國立陽明大學醫學院婦產科學系 5 May 2008. 王 鵬 惠. Submucosal fibroids. Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠. Submucosal fibroids.

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Peng-Hui Wang, M.D., Ph.D. Department of Obstetrics and Gynecology

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  1. Peng-Hui Wang, M.D., Ph.D. Department of Obstetrics and Gynecology Taipei Veterans General Hospital National Yang-Ming University 王 鵬 惠 台北榮民總醫院婦產部 國立陽明大學醫學院婦產科學系 5 May 2008 王 鵬 惠

  2. Submucosal fibroids Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  3. Submucosal fibroids • the strongest association with lower ongoing pregnancy rates • odds ratio, 0.5, 95% CI=0.3-0.8, • primarily through decreased implantation 王 鵬 惠 Klatky PC et al. AJOG 2008;198:357-66.

  4. Intramural fibroids Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  5. 信者恆信 Inramural fibroids • Cumulative pregnancy rates appeared slightly lower in patients with intramural fibroids 36.9% vs 41.1%, which may reflect biases in the literature • Experienced more miscarriages, 20.4% vs 12.9%. Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  6. Fibroids and Obstetric Outcomes + + Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  7. Obstetric outcomes & fibroids + ? + Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  8. Obstetric outcomes & fibroids Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  9. Obstetric outcomes & fibroids • Adverse obstetric outcomes are rare and may reflect age or other differences in fibroid populations. • Increased risk of • malpresentation (OR=2.9; 95% CI=2.6-3.2), • cesarean (OR=3.7; 95% CI=3.5-3.9), • preterm delivery (OR= 1.5; 95% CI=1.3-1.7) • The incidence of labor dystocia was low (7.5%). Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  10. Inramural or subserosal fibroids • There was no conclusive evidence that intramural or subserosal fibroids adversely affect fecundity. Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  11. Myomectomy or UAE (UVO) • More prospective, controlled trials are needed to assess the effects of myomectomy or UAE (UVO). • Good maternal and neonatal outcomes are expected in pregnancies with uterine fibroids. 睜眼說瞎話 Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  12. Myomectomy or UAE (UVO) Klatky PC et al. AJOG 2008;198:357-66. Klatky PC et al. AJOG 2008;198:357-66. 王 鵬 惠

  13. Our experience and recommendation Peng-Hui Wang, M.D., Ph.D. Department of Obstetrics and Gynecology Taipei Veterans General Hospital National Yang-Ming University 王 鵬 惠 台北榮民總醫院婦產部 國立陽明大學醫學院婦產科學系 5 May 2008 王 鵬 惠

  14. Myomectomy Fertil Steril http://dx.doi.org/10.1016/j.fertnstert.2007.10.006. 王 鵬 惠

  15. LUVO 王 鵬 惠

  16. 王 鵬 惠

  17. Recommendations • Basically, the choice of uterine myoma treatment depends on the patient’s age, the reason for treatment, the issue of fertility preservation, and the patient’s preference. Fertil Steril http://dx.doi.org/10.1016/j.fertnstert.2008.02.134. 王 鵬 惠

  18. Recommendations • No symptoms, no treatment. • The method in the management of myomas has been multidisciplinary in the past years, including an expectant management, medical therapy, surgical intervention, uterine artery embolization, or ablative techniques. • Frequently, these relative less invasive procedures are designed to retain the uterus. • An interesting and relatively well conducted study was requested. Expert Opin Emerg Drugs. 2008 Mar;13(1):119-33. 王 鵬 惠

  19. 問 題 及 討 論 王 鵬 惠

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