Time to conceive after myomectomy: should we advise a minimum time interval? A systematic review

Margueritte, François; Adam, Camille; Gauthier, Tristan

doi:10.1016/j.rbmo.2021.05.016

Cited by 21 publications

(13 citation statements)

References 103 publications

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“…The mean time appears to be 17.6 months. The shortest time from myomectomy to pregnancy was a mean of 4.3 months, with a uterine rupture occurrence rate of 0.5% occurring at a mean gestational age of 31 weeks [37]. No linear relationship was observed between the gestational age at the event and the time interval from myomectomy to conception.…”

Section: Discussionmentioning

confidence: 90%

The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review

Balulescu,

Brasoveanu,

Pirtea

et al. 2024

JPM

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Study objective: The objective of this systematic review is to investigate the impact of laparoscopic myomectomy techniques on pregnancy outcomes, with a specific focus on the correlation between the type of suture used during the procedure and the incidence of uterine rupture. Additionally, the study aims to examine how the localization and size of myomas, key factors in laparoscopic myomectomy, may influence fertility outcomes. Data Sources: extensive searches were conducted using MDPI, PubMed, Web of Science, and Cochrane Library databases from 2008 to November 2023. Methods of Study Selection: The study involved women of reproductive age diagnosed with fibroids who underwent surgical removal of fibroids using either laparotomy or laparoscopy. The evaluation of pregnancy outcomes focused on indicators such as live birth rates, miscarriage rates, stillbirth rates, premature delivery rates, and cases of uterine rupture. Quality assessment was systematically performed by employing the National Institutes of Health Study Quality Assessment Tools, with the subsequent formulation of clinical recommendations that were meticulously graded in accordance with the robustness of the underlying evidence. Results: The pregnancy outcomes post-myoma treatment, as reflected in one of the presented tables, show a promising number of pregnancies and live births, but also indicate the potential risks of miscarriages and preterm births. The diversity in outcomes observed among various studies underscores the imperative for tailored patient care, as well as the necessity for additional research aimed at optimizing fertility and pregnancy outcomes following myoma treatment. Conclusion: This study offers insights into the criteria for patient selection and intraoperative methodologies specifically related to laparoscopic myomectomy. To enhance our understanding of the associations between fibroid characteristics (location, size) and reproductive outcomes, additional research is warranted, particularly through well-designed clinical trials.

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Section: Discussionmentioning

confidence: 90%

The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review

Balulescu,

Brasoveanu,

Pirtea

et al. 2024

JPM

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“…Finally, there are insufficient data to advise a minimal time interval between myomectomy and conception [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Large Submucosal Uterine Leiomyoma Prolapse Into the Vagina After Complicating a Pregnancy: A Case Report

Almusaylim,

Darwish,

Alahmad

et al. 2023

Cureus

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Uterine leiomyomas are the most common pelvic neoplasm in females. They are non-cancerous monoclonal tumors that develop from the fibroblasts and smooth muscle cells of the myometrium. They can develop in females of reproductive age and post-menopausal as well. When symptomatic, they frequently manifest as abnormal uterine bleeding and/or pelvic pain or pressure. Reproductive effects are also possible in fibroids such as infertility and poor pregnancy outcomes. In this report, we present a case of a 39-year-old woman, G9P4A4, GA 16 weeks who came to the ER with an incomplete abortion at home after which she had large multiple uterine submucosal fibroids prolapsing into the vagina. On ultrasound, the placenta was still inside, and a large submucosal anterior uterine fibroid and a posterior uterine fibroid were found with sizes 10x10 cm and 2x3, respectively. Evacuation and curettage (E&C) could not be completed because fibroids were obstructing and limiting the access. The patient was managed medically and then discharged, after which she came back with prolapsing uterine fibroids and part of the placenta. In the end, she was managed by hysteroscopic myomectomy.

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“…24 Myometrial injury during myomectomy, particularly when it involves the opening of the uterine cavity, is a well-known risk factor for uterine rupture during pregnancy. 31 Due to the absence of an established waiting period after surgical treatment, [32][33][34] these factors become critically important in the management of patients who desire pregnancy. The status of "scarred uterus" may influence clinicians to opt for a cesarean section, which significantly increases the maternal-fetal risks associated with this surgical procedure.…”

Section: Surg I C Al Approach To T Ype 3 Uterine Fib Roids: Anatomi C...mentioning

confidence: 99%

The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties

Favilli,

Mazzon,

Etrusco

et al. 2023

Intl J Gynecology & Obste

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Uterine leiomyomas (ULs) are non‐cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological condition affecting the female genital tract. Despite the volume of available research, many aspects of ULs remain unresolved, making it a “paradoxical disease” where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification “subserosal, intramural and submucosal”, facilitating a detailed examination of individual ULs impact on the female reproductive system. The “type 3 UL” is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique “hybrid” between a submucous and an intramural UL, that may exert a detrimental “double hit” mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid.

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Time to conceive after myomectomy: should we advise a minimum time interval? A systematic review

Cited by 21 publications

References 103 publications

The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review

The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review

Large Submucosal Uterine Leiomyoma Prolapse Into the Vagina After Complicating a Pregnancy: A Case Report

The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties

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