Does the Surgical Approach Used for Myomectomy Influence the Morbidity in Subsequent Pregnancy?

This is a retrospective analysis of post-myomectomy pregnancies beyond 20 weeks' gestation in a teaching hospital for a 16-year period. There were 117 pregnancies, with complete data available for 112 pregnancies, in 81 women. A total of 92 deliveries followed myomectomy at laparotomy, 1 at laparoscopy and 19 at hysteroscopy. Of 72 labours, 22 were induced and 33 were augmented. Ten of those who laboured were delivered by caesarean section. The most common indication for intra-partum caesarean section was poor labour progress. There were no significant differences in neonatal outcome for babies delivered after labour compared with elective caesarean section. Maternal blood loss was however significantly higher with elective caesarean section (OR 2.01; 95% CI 1.96 - 2.06, p < 0.001). We report one uterine rupture at 36 weeks' gestation that followed laparoscopic myomectomy. These data do not support the view that myomectomy performed at laparotomy or hysteroscopy warrant avoiding labour or oxytocic administration. Laparoscopic myomectomy may be associated with a greater risk of scar rupture.