Myoma and myomectomy: Poor evidence concern in pregnancy

Abstract

Aim: Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. Methods: Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. Results: Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. Conclusions: Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

“…Previous studies have also reported increased adverse pregnancy outcomes, including abnormal placentation, such as placenta previa or placenta accreta, [10][11][12] preterm delivery, cesarean delivery, uterine rupture, and postpartum bleeding, in women with a history of myomectomy. [13][14][15][16] The true incidence of uterine rupture during subsequent pregnancy following myomectomy is di cult to establish, because most of the studies have been cases, case series, or small retrospective cohort studies that do not account for the total number of pregnancies achieved after myomectomy and their consequent outcomes.…”

“…There have been poor evidences about obstetric outcomes in women with myoma and previous myomectomy. 10 The purpose of this study was to evaluate adverse pregnancy outcomes in women with a history of diagnosed myoma or myomectomy, including prevalence of uterine rupture in women with myomectomy, according to the time interval after myomectomy.…”

Navigating through the maze of caesarean myomectomy: generating evidence

“…Incidence of uterine myomas in pregnancy varies from 1.6% to 12.6% with higher prevalence in elderly pregnant women or women undergoing in vitro fertilization. [7][8][9][10][11] They are commonly seen in African-American women with an incidence of 18% followed by 8% in white women and 10% in Hispanic women. 10 They are more common in primigravida over 35 years of age due to responsive growth to ovarian steroid hormones, estrogen and progesterone and are rarely seen before puberty.…”

“…[7][8][9][10][11] They are commonly seen in African-American women with an incidence of 18% followed by 8% in white women and 10% in Hispanic women. 10 They are more common in primigravida over 35 years of age due to responsive growth to ovarian steroid hormones, estrogen and progesterone and are rarely seen before puberty. 1,2 On physical examination around 42% of large fibroids (>5 cm) and 12.5% of smaller fibroids can be diagnosed.…”

The effect of high-intensity focused ultrasound guided by magnetic resonance therapy on obstetrical outcomes in patients with uterine fibroids – experiences from the main Polish center and a review of current data

“…Surgical myomectomy prolongs the time till birth as the patient requires adequate postsurgical healing. Besides, all patients after surgical myomectomy should be treated as high-risk of obstetric complications in case of a future pregnancy [48]. Furthermore, all kinds of UF surgeries, even minimally invasive methods, are procedures that could irreversibly change or injure the pelvic cavity and cause pelvic adhesions, which in turn might reduce further reproductive potential [49].…”