Pregnancy after Laparoscopic Myomectomy
We evaluated the safety of laparoscopic myomectomy in 114 women (average age 37.1 yrs, mean 34.1 &plusmn; 3.6 yrs) who desired future pregnancy. The indications were pain (77.8%), abnormal bleeding (53.1%), and infertility (20.8%). Follow-up data were obtained by reviewing patient charts or returned questionnaires. Student's nonpaired two-way t test was used to compare characteristics of women with and without subsequent pregnancy complications. The average number of myomas was 3.0 &plusmn; 2.9 and the mean size was 5.9 &plusmn; 3.0 cm. In 52.4% of cases the deepest infiltrating myoma was intramural, in 42.9% subserosal, and in 4.7% pedunculated. Thirty-one pregnancies occurred in 29 women. Of the 26 that could be followed, 5 ended with vaginal delivery at term. Cesarean sections were performed in 14 women, 9 at term, 1 at 26 weeks, and 4 at unknown gestational age. Six women miscarried in the first trimester and one had an ectopic pregnancy. Spontaneous uterine rupture was not noted during pregnancy or at delivery. Compared with women with ectopic pregnancies, miscarriages, and preterm deliveries, those who delivered at term were younger (33.1 &plusmn;1.9 vs 36.6 &plusmn; 4.8 yrs, p <0.05) and had fewer myomas at surgery (1.9 &plusmn; 2.0 vs 4.8 &plusmn; 3.0, p <0.01). Those who had intramural myomas were most likely to develop complications during pregnancy. Uterine rupture during pregnancy and labor is a rare complication of myomectomy by laparotomy, and only a few cases have been reported after laparoscopic myomectomy.
Roemisch
M
Stanford Endoscopy Center for Training and Technology, 900 Welch Road, Suite 403, Palo Alto, CA 94304.
Nezhat
FR
Nezhat
A