Our Summary

This study looked at the effect of a previous myomectomy (a surgery to remove fibroids from the uterus) on future pregnancies and births. Between 2002 and 2014, 469 women who had undergone myomectomies were contacted for a phone interview. Out of this group, 152 became pregnant after their surgery. The researchers looked at how the surgery was performed and the outcomes of their pregnancies. They found that 66.4% of the women tried to deliver their babies naturally (vaginal delivery), and 21.8% had a planned cesarean section. Of the women who tried vaginal delivery, 90.4% were successful. Importantly, there were no cases of uterine rupture (a serious complication where the uterus tears), and all babies were born alive. The researchers concluded that trying vaginal delivery after a myomectomy is generally safe and can be considered as an option. They also found that doctors were more likely to recommend a cesarean section if they had entered the uterine cavity during the myomectomy.

FAQs

  1. What is the likelihood of a successful vaginal delivery after a myomectomy?
  2. Is there a risk of uterine rupture during delivery after a myomectomy?
  3. Does the type of myomectomy performed affect the recommended type of delivery for future pregnancies?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is that trying vaginal delivery after the surgery is generally safe and can be considered as an option. It is important to discuss your options with your healthcare provider and follow their recommendations based on your individual circumstances. Additionally, if your doctor entered the uterine cavity during the myomectomy, they may be more likely to recommend a cesarean section for future pregnancies.

Suitable For

Patients who are typically recommended myomectomy are those who have symptomatic fibroids (such as heavy menstrual bleeding, pelvic pain, or pressure), women who wish to preserve their fertility, and women who have had recurrent miscarriages or infertility related to fibroids. Additionally, women who have large fibroids that are causing significant symptoms or complications, such as infertility or recurrent miscarriages, may also be recommended for myomectomy.

Timeline

Before myomectomy:

  1. Patient experiences symptoms of fibroids such as heavy menstrual bleeding, pelvic pain, and pressure.
  2. Patient consults with a doctor and undergoes diagnostic tests to confirm the presence of fibroids.
  3. Doctor recommends myomectomy as a treatment option.
  4. Patient undergoes pre-operative testing and preparation for surgery.

After myomectomy:

  1. Patient undergoes surgery to remove fibroids from the uterus.
  2. Patient recovers in the hospital for a few days before being discharged.
  3. Patient experiences post-operative pain and discomfort, which is managed with pain medication.
  4. Patient follows post-operative care instructions provided by the doctor, including rest, avoiding strenuous activities, and monitoring for any signs of infection.
  5. Patient follows up with the doctor for post-operative check-ups to monitor recovery and address any concerns.
  6. Patient may consider future pregnancies and consult with the doctor about the potential impact of the myomectomy on fertility and pregnancy outcomes.

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 having a myomectomy?
  3. What is the success rate of becoming pregnant after a myomectomy?
  4. Will I be able to have a vaginal delivery after my myomectomy, or will a cesarean section be necessary?
  5. How long should I wait after my myomectomy before trying to conceive?
  6. Will my previous myomectomy surgery impact the health of my pregnancy or the delivery of my baby?
  7. Will I need any additional monitoring or care during my pregnancy due to my previous myomectomy?
  8. Are there any specific precautions I should take during pregnancy or delivery because of my myomectomy?
  9. What are the chances of uterine rupture or other complications during labor and delivery after myomectomy?
  10. Are there any restrictions on future pregnancies or delivery methods as a result of my myomectomy surgery?

Reference

Authors: Gambacorti-Passerini ZM, Penati C, Carli A, Accordino F, Ferrari L, Berghella V, Locatelli A. Journal: Eur J Obstet Gynecol Reprod Biol. 2018 Dec;231:198-203. doi: 10.1016/j.ejogrb.2018.10.007. Epub 2018 Oct 3. PMID: 30396109