Pregnancy outcome and deliveries following laparoscopic myomectomy

Abstract

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.

Reconstructive Endoscopic Myomectomy

“…Increased adhesion formation has also been described following this procedure (16). Furthermore, several authors (17)(18)(19) have also reported cases of uterine rupture/dehiscence following LM. More attention should be paid to careful uterine repair following this laparoscopic procedure.…”

Reproductive outcomes following robotic myomectomy

“…1 However, when pregnancy is desired, the technique appears particularly advantageous in that it could reduce the risk of postoperative adhesions compared with laparotomy. [18][19][20] Uterine rupture and abnormal placentation have been cited as possible complications following myomectomy due to weakening of myometrial integrity. The rate of uterine rupture after abdominal myomectomy has been estimated as <1% in most studies.…”

“…21 Other studies have demonstrated a 0 to 1% risk of uterine rupture following laparoscopic myomectomy. 20,[22][23] Similarly, the rate of uterine rupture following RALM has been reported anywhere between 0 to 1.1%. 24,25 Since we first began to perform RALM in our institution, we have maintained a database concerning patient outcomes after undergoing this procedure.…”

Clinical experience and fertility outcome after uterine artery occlusion and embolization

“…Laparoscopic myomectomy, rather than abdominal myomectomy, is naturally favoured by patients because it is less invasive and requires a shorter recovery time [1]. Myomectomy is less desirable for women who wish to avoid the possibility of conversion to hysterectomy and who desire a safe pregnancy without a risk of uterine rupture [2][3][4].…”