Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study.
BACKGROUND
This prospective study was designed to evaluate the operative morbidity and reproductive outcome in patients who had secondary myomectomy for recurrent symptomatic uterine fibroids.


METHODS
A total of 58 women were subjected to a secondary myomectomy via the abdominal route. The operative morbidity such as blood loss, presence of adhesions and febrile index were estimated and the pregnancy outcome over a 2-4 year period of follow-up.


RESULTS
The mean age and standard deviation (+/- SD) of the women was 35 (+/- 2.4) years. Nineteen patients (33%) had a postoperative temperature vertical line 100 degrees F and the estimated blood loss ranged from 159-2500 ml (median 700 ml). Seven patients (12%) required blood transfusion and one had a hysterectomy due to haemorrhage. Nine women (15.5%) became pregnant but only five (56%) had live births. Those with successful pregnancies tended to be younger with a mean age of 31.8 (+/- 2.6) years versus 35 (+/- 1.8) years, (P = 0.08, non-significant) and had fewer uterine leiomyomata; median with range values, 2 (1-6) versus 7 (6-15). The variables which best predicted the postoperative likelihood of pregnancy were; age, presence of tubal adhesions and the number of uterine fibroids.


CONCLUSIONS
This prospective study showed a high operative morbidity and a poor fertility outcome after a repeat myomectomy. The factors affecting successful outcome in a logistic regression model were age, tubal adhesions and number of uterine fibroids.
Frederick
J
J
Department of Obstetrics, Gynaecology and Child Health, University Hospital of the West Indies, Kingston 7, Jamaica, WI. jfrederick@jamweb.net
Hardie
M
M
Reid
M
M
Fletcher
H
H
Wynter
S
S
Frederick
C
C
D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015331:Cohort Studies; D005184:Fallopian Tube Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007889:Leiomyoma / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies; D012086:Reoperation; D012098:Reproduction; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology; D014594:Uterine Neoplasms / Q000601:surgery*