title: Perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy.
abstract: OBJECTIVE
  Because of concerns about uterine rupture, many obstetricians recommend elective Caesarean section for women with a prior myomectomy. This practice has led to an increased rate of elective CS and subsequently of repeat Caesarean sections. The purpose of this study was to evaluate the perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy.
  
  
  METHODS
  We conducted a survey of 49 practising obstetricians from July 2012 to January 2013, using a standard questionnaire. This included questions on labour and delivery after myomectomy by laparotomy or laparoscopy.
  
  
  RESULTS
  Overall, the inter-respondent agreement was fair (kappa 0.3; P < 0.001). There was no significant difference in the likelihood that respondents would allow vaginal delivery after myomectomy by laparotomy and by laparoscopy (27% and 14% if the uterine cavity was entered and 76% and 71% if the uterine cavity was not entered, respectively). However, the likelihood that respondents would allow vaginal delivery was significantly reduced if the uterine cavity was entered, regardless of the surgical approach (P < 0.001). Entry into the uterine cavity during myomectomy also significantly increased the likelihood that obstetricians would recommend elective CS rather than induction of labour. There was no significant difference in practice regarding the use of oxytocin with amniotomy, oxytocin infusion, or prostaglandins.
  
  
  CONCLUSIONS
  Despite a lack of evidence, obstetricians consider entry into the uterine cavity at myomectomy to be an important factor in determining the method of delivery, the use of oxytocin, and delivery by elective Caesarean section. This was independent of the myomectomy approach.
authors: Department of Obstetrics and Gynecology, McGill University, Montreal QC.
authors: Hélène S
authors: HS
authors: Weibel
authors: Department of Obstetrics and Gynecology, Université de Montréal, Montreal QC.
authors: Radomir
authors: R
authors: Jarcevic
authors: Department of Obstetrics and Gynecology, McGill University, Montreal QC.
authors: Robert
authors: R
authors: Gagnon
authors: Department of Obstetrics and Gynecology, McGill University, Montreal QC.
authors: Togas
authors: T
authors: Tulandi
mesh_terms: D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects; D007743:Labor, Obstetric; D010535:Laparoscopy / Q000009:adverse effects; D009774:Obstetrics / Q000379:methods*; D010121:Oxytocin; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D012307:Risk Factors; D011795:Surveys and Questionnaires; D063186:Uterine Myomectomy / Q000009:adverse effects* / Q000379:methods; D014597:Uterine Rupture / Q000517:prevention & control
chemical_list: D010121:Oxytocin
keywords: obstetric delivery; survey; uterine myomectomy