Our Summary

This study reviews existing research on a rare type of ectopic pregnancy – where the embryo implants outside the womb – called myomectomy scar pregnancy (MSP). In MSP, the embryo implants itself in a scar left by a previous operation to remove fibroids from the uterus (a myomectomy). The authors searched various databases for studies published during a 20-year period, using keywords related to MSP. From 111 studies, 28 were selected for review, comprising of 4 retrospective studies and 24 case reports. They found that MSP is usually diagnosed using ultrasound, with MRI scans used for more complex cases. The most common treatment was surgery, specifically cesarean sections and myometrial repairs, while medical treatment with a drug called methotrexate was used less often. The authors concluded that diagnosing and treating MSP is challenging due to its rarity. There is currently no agreement on the best treatment for different cases, and further research is needed to establish standard diagnostic and treatment methods, and to assess the long-term outcomes for patients.

FAQs

  1. What is a myomectomy scar pregnancy (MSP)?
  2. How is a myomectomy scar pregnancy usually diagnosed and treated?
  3. Why is diagnosing and treating MSP considered challenging and what further research is needed?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to closely follow post-operative instructions to ensure proper healing and minimize the risk of complications. This may include avoiding heavy lifting, strenuous exercise, and sexual activity for a certain period of time, as well as taking prescribed medications as directed. It is also important to attend follow-up appointments to monitor recovery and address any concerns.

Suitable For

Patients who are typically recommended myomectomy include those with symptomatic fibroids, infertility issues caused by fibroids, heavy menstrual bleeding, pelvic pain, or pressure symptoms. Myomectomy may also be recommended for women who wish to preserve their fertility, as it removes the fibroids while leaving the uterus intact. In cases of myomectomy scar pregnancy, patients who have previously undergone a myomectomy and are now experiencing a pregnancy implanted in the scar tissue may be recommended for treatment with surgical or medical interventions.

Timeline

Before myomectomy:

  1. Patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or rectum.
  2. Patient undergoes a series of tests such as ultrasound, MRI, and possibly a biopsy to confirm the presence of fibroids.
  3. Patient discusses treatment options with their healthcare provider, including myomectomy as a surgical option.

After myomectomy:

  1. Patient undergoes the myomectomy surgery to remove the fibroids from the uterus.
  2. Patient may experience some pain and discomfort post-surgery, which can be managed with pain medication.
  3. Patient will have regular follow-up appointments with their healthcare provider to monitor their recovery and ensure there are no complications.
  4. Patient may need to undergo fertility treatments if they are trying to conceive after myomectomy.
  5. Patient may experience relief from symptoms such as heavy menstrual bleeding and pelvic pain after the fibroids have been removed.

What to Ask Your Doctor

  1. What is myomectomy scar pregnancy (MSP) and how is it different from a regular ectopic pregnancy?
  2. How is MSP diagnosed, and what imaging tests are typically used for diagnosis?
  3. What are the treatment options for MSP, and what factors determine which treatment is recommended?
  4. What are the risks and potential complications associated with the different treatment options for MSP?
  5. Will I need to undergo surgery for MSP, and if so, what type of surgery is typically performed?
  6. Are there any non-surgical treatment options available for MSP, such as medication?
  7. How likely is it that MSP will recur in future pregnancies, and what steps can be taken to reduce this risk?
  8. What is the prognosis for patients with MSP, and are there any long-term implications to consider?
  9. Are there any specific follow-up care recommendations for patients who have been diagnosed and treated for MSP?
  10. Are there any ongoing research studies or clinical trials related to MSP that I may be eligible to participate in?

Reference

Authors: Sorrentino F, Vasciaveo L, Greco F, Giansiracusa E, D’Antonio F, Lucidi A, Etrusco A, Laganà AS, Stabile G, Nappi L. Journal: Medicina (Kaunas). 2025 Apr 29;61(5):817. doi: 10.3390/medicina61050817. PMID: 40428776