Elsevier

Journal of Minimally Invasive Gynecology

Volume 22, Issue 6, September–October 2015, Pages 1022-1028
Journal of Minimally Invasive Gynecology

Original Article
Pregnancy Outcomes and Risk Factors for Uterine Rupture After Laparoscopic Myomectomy: A Single-Center Experience and Literature Review

https://doi.org/10.1016/j.jmig.2015.05.016Get rights and content

Abstract

Study Objective

To evaluate pregnancy outcomes after laparoscopic myomectomy (LSM), focusing on the risk of uterine rupture.

Design

Retrospective cohort study (Canadian Task Force classification III).

Setting

University hospital.

Patients

Of 676 women who visited the obstetrics department for a pregnancy after undergoing LSM performed at the same center between 1994 and 2012, we included the 523 women who had follow-up through the end of pregnancy.

Interventions

All patients underwent LSM, and their medical charts were retrospectively reviewed.

Measurements and Main Results

Multiple myomas were removed in 35.2% of cases, intramural-type lesions occurred in 46.5% of cases, and the mean myoma diameter was 4.9 cm. Pregnancy outcomes after LSM included 400 (76.5%) full-term deliveries and 100 (19.1%) vaginal deliveries, with other adverse outcomes being no different than the general population. The mean interval between LSM and pregnancy was 14 months, and only 3 (0.6%) cases of uterine rupture occurred during pregnancy. In analysis, by reviewing the published cases of uterine rupture, we found that the mean diameter, myoma number and type, and the rate of uterine suture were similar between the ruptured cases and all of our cases of LSM.

Conclusion

LSM can be safely used in women of reproductive age who want to become pregnant. Uterine rupture occurs in rare cases, regardless of myoma features, but further large-scale studies are required to ascertain the detailed effects of various surgical techniques.

Section snippets

Methods

We performed a retrospective review of medical records of all consecutive patients who underwent LSM at Cheil General Hospital and Women's Healthcare Center between August 1994 and December 2012, and later had a pregnancy, which was defined as a visible gestational sac on sonography. Regardless of the surgical indication and combined surgery performed, patients were included if all surgical specimens were benign and uterine leiomyomas were laparoscopically excised. We excluded cases of

Results

We identified a total of 676 women who had a pregnancy after LSM. Of the 676 patients, 153 women were lost to follow-up or had an ongoing pregnancy at the time of data collection. The remaining 523 women who were followed until the end of their pregnancies were included in the present study. The mean age of the patients was 31.7 years, and most (91.6%) were nulliparous (Table 1). One myoma was removed in 64.8% of cases, and multiple myomas were removed in 35.2% of cases. The mean diameter of

Discussion

Through approximately 20 years of experience, we demonstrated that LSM can be safely performed in women of reproductive age with acceptable surgical and obstetrical outcomes. Among 523 pregnancies, only 3 (0.6%) cases of uterine rupture occurred. We found no association between patient characteristics or clinical features of myomas and uterine rupture.

In a recent systemic review [6], the authors analyzed 9 randomized controlled trials (RCTs) that compared the outcomes of LSM and AM with regard

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    The authors declare no conflicts of interest.

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