Our Summary

This research study looked at the effect of a surgical procedure called myomectomy on pregnancy outcomes. The study involved over 200,000 Japanese women who gave birth in 2020. A small percentage of these women had previously had a myomectomy, a surgery that removes fibroids (non-cancerous growths) from the uterus. The researchers found that women who had undergone a myomectomy were more likely to experience serious complications during pregnancy. Specifically, they had a higher risk of uterine rupture (a tear in the wall of the uterus) and placenta accreta (a condition where the placenta grows too deeply into the uterine wall). Women who had a myomectomy were over twice as likely to experience placenta accreta and 14 times more likely to experience a uterine rupture. These findings suggest that having a myomectomy can increase the risk of these pregnancy complications.

FAQs

  1. What is a myomectomy and why is it performed?
  2. According to the research study, what are the increased risks for women who have undergone a myomectomy and are pregnant?
  3. How much more likely are women who had a myomectomy to experience placenta accreta or a uterine rupture during pregnancy?

Doctor’s Tip

A doctor may advise a patient considering myomectomy to discuss their fertility goals and pregnancy plans before proceeding with the surgery. They may recommend closely monitoring the patient during pregnancy and delivery to prevent and manage any potential complications. It is important for patients to weigh the potential benefits of myomectomy against the increased risks of pregnancy complications and make an informed decision in consultation with their healthcare provider.

Suitable For

Typically, patients who are recommended for a myomectomy are those who have symptomatic fibroids that are causing significant pain, heavy menstrual bleeding, or fertility issues. Myomectomy may be recommended for women who wish to preserve their fertility and have fibroids that are impacting their ability to conceive or carry a pregnancy to term. Additionally, myomectomy may be recommended for women who have fibroids that are causing recurrent miscarriages or other pregnancy complications. It is important for patients considering a myomectomy to discuss the potential risks and benefits with their healthcare provider to determine if the procedure is appropriate for their individual situation.

Timeline

Before a myomectomy:

  • Patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, frequent urination, and difficulty getting pregnant
  • Patient undergoes a thorough evaluation including physical examination, ultrasound, and possibly MRI to diagnose fibroids and evaluate the need for surgery
  • Patient discusses treatment options with their healthcare provider, including the risks and benefits of myomectomy
  • Patient may undergo pre-operative testing such as blood tests and imaging studies to ensure they are a suitable candidate for surgery

During a myomectomy:

  • Patient undergoes surgery to remove fibroids from the uterus, either through traditional open surgery, laparoscopic surgery, or robotic-assisted surgery
  • Surgery typically takes 1-4 hours depending on the size and number of fibroids
  • Patient may stay in the hospital for 1-2 days after surgery for monitoring and pain management

After a myomectomy:

  • Patient may experience pain, cramping, and fatigue in the days following surgery
  • Patient is advised to rest and avoid strenuous activities for several weeks to allow the uterus to heal
  • Patient may experience changes in menstrual bleeding and fertility after surgery
  • Patient follows up with their healthcare provider for post-operative care and monitoring of any potential complications

Overall, a myomectomy can provide relief from symptoms caused by fibroids and improve fertility, but it also carries risks of complications such as infection, bleeding, and injury to surrounding organs. It is important for patients to discuss the risks and benefits of myomectomy with their healthcare provider and carefully consider their options before undergoing surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with myomectomy surgery?
  2. How will my fertility be affected by undergoing a myomectomy?
  3. What is the likelihood of the fibroids returning after a myomectomy?
  4. How long is the recovery time after a myomectomy and what can I expect during the recovery process?
  5. Are there alternative treatment options for my fibroids that do not involve surgery?
  6. Will my future pregnancies be affected by having had a myomectomy?
  7. Are there any specific steps I should take to reduce the risk of complications during pregnancy after a myomectomy?
  8. How will my ongoing care and monitoring be managed after the myomectomy surgery?
  9. Can you provide me with information on the success rates of myomectomy in terms of symptom relief and fertility outcomes?
  10. Are there any lifestyle changes or precautions I should take before and after myomectomy surgery?

Reference

Authors: Komatsu H, Taniguchi F, Harada T. Journal: Int J Gynaecol Obstet. 2023 Sep;162(3):977-982. doi: 10.1002/ijgo.14767. Epub 2023 Mar 30. PMID: 36998147