Systematic Review of Pregnancy After Myomectomy: The Risk of Uterine Rupture.

INTRODUCTION

A myoma is the most common pelvic mass in the urogenital tract and can cause various symptoms. Myomectomy is sometimes performed as treatment. A myomectomy prior to pregnancy can cause some risks or complications. The most feared complication is a uterine rupture, with an incidence of 0.60%-0.75% reported in the literature up to 2012. The aim of this study is to review recent literature on the risk of uterine rupture during labour following a myomectomy.

MATERIALS AND

METHODS

To identify new insights, an extensive literature search was performed in the following databases: MEDLINE (PubMed), Embase, Web of Science and Cochrane Library. Articles published between 1 April 2013 and 31 October 2023 were included. The articles were screened for inclusion or exclusion by two reviewers. A total of 31 articles were included.

RESULTS

A total of 13,381 pregnant women with a history of myomectomy were included. The estimated overall risk of uterine rupture during pregnancy and labour was 0.30% (40/13.381; 95% CI: 0.21-0.41). Th included studies did not provide sufficient data to determine the specific risk of uterine rupture during a trial of labour after myomectomy (TOLAM). The risk of uterine rupture was significantly higher (p = 0.04) when the uterine cavity had been entered during the myomectomy (3/44 or 6.82%) compared to when it was not entered (4/336 or 1.19%) with an odds ratio of 6.07. The type of myomectomy (laparoscopic, open or robotic) did not significantly influence the risk. No consistent data were available to identify other potential risk factors.

CONCLUSION

This systematic review found an incidence of uterine rupture during pregnancy and labour of 0.30% after a previous myomectomy. Entry into the uterine cavity during myomectomy appears to significantly increase the risk. Large, high-quality prospective studies are needed to confirm this finding and to identify additional risk factors.