Pregnancy and delivery after laparoscopic myomectomy

Abstract

Study objective: To assess the factors influencing pregnancy outcome and evaluate vaginal birth after laparoscopic myomectomy (VBALM).

Design: Retrospective study (Canadian Task Force classification II-2).

Setting: University hospital.

Patients: One hundred eight patients who wanted a child after laparoscopic myomectomy (LM) and a follow-up of at least 6 months.

Intervention: Laparoscopic myomectomy.

Measurements and main results: Forty-seven pregnancies occurred in 40 patients. As for the factors considered to contribute to pregnancy after LM, COX regression analysis showed that pregnancy after LM correlated positively with the diameter of the largest myoma (OR 1.06, 95% CI 1.02-1.10, p = .004) and negatively with the age of the patient at the time of LM (OR 0.88, 95% CI 0.80-0.98, p = .02) and the number of enucleated myomas (OR l.17, 95% CI 1.01-1.37, p=0.04). Vaginal birth after LM was managed in accordance with the standard management of vaginal birth after cesarean section (VBAC) in our hospital. Delivery after LM was accomplished in 32 pregnancies. Vaginal birth after laparoscopic myomectomy was attempted in 23 pregnancies (71.9%) and vaginal birth successful in 19 (82.6%) of these 23 pregnancies. Vaginal birth after LM was unsuccessful in four patients, as labor did not occur during more than 2 weeks after the expected date of delivery in two patients, and cesarean section was performed to prevent fetal asphyxia during the course of delivery in two patients. In the 18 patients (19 pregnancies) with successful VBALM, the diameter of the largest myoma at LM was 68.7 +/- 18.4 mm, the number of enucleated myomas was 2.9 +/- 2.1, and the number of hysterotomies was 2.5 +/- 1.8. As for the depth of the largest myoma, this was intramural in 12 patients, submucosal in 2 patients and subserosal in 4 patients. None of the patients, regardless of whether they had a successful VBALM or not, suffered uterine rupture during or after delivery.

Conclusion: Since nearly complete suturing is possible in LM as in laparotomy, vaginal delivery can be accomplished safely without uterine rupture even after LM, provided that delivery is managed as in VBAC.