Abstract
Objective
Uterine fibroids affect 2–10 % of pregnant women. Although usually asymptomatic, they
may be associated with pregnancy complications. Myomectomy is preferably avoided antenatally,
however, it has been reported in symptomatic cases that did not respond to conservative
management. The aim of this study was to summarize the published literature and present
the reported outcomes and associated risks of this procedure.
Study Design
A systematic research of the literature was conducted in PubMed/MEDLINE, Scopus and
the Cochrane Library, including case reports and case series. An effort was made to
numerically analyse all parameters included in the case reports.
Results
Overall, 54 relevant articles were identified, including 97 patients. The median gestational
age at diagnosis was 13 (range 6–26) weeks, while the median age at myomectomy was
16 (range 6–26) weeks. Abdominal pain, not responding to medical treatment was the
most common indication for surgery. The median number of fibroids removed per patient
was one (range 1–5). Most of them were subserous pedunculated or subserous and fundal.
Laparotomy (78.4 %) was the principal surgical approach, however, laparoscopic and
vaginal operations were also reported. The median duration of surgery was 53 (range
20–150) min. The histopathology revealed necrosis and degeneration as the main findings
of removed fibroids. The pregnancy outcome was favourable in most of the cases, with
few complications reported.
Conclusion
Based on the limited published data, myomectomy during pregnancy appears as a safe
procedure in cases of symptomatic uterine fibroids not responding to conservative
management and therefore it may be considered, following appropriate counselling regarding
the associated risks.
Keywords
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References
- Uncertainties about laparoscopic myomectomy during pregnancy: a lack of evidence or an inherited misconception? A critical literature review starting from a peculiar case.Minim Invasive Ther Allied Technol. 2015; 24: 189-194https://doi.org/10.3109/13645706.2014.987678
- Pregnancy-preserving myomectomy: preliminary report on a new surgical technique.Eur J Contracept Reprod Health Care. 2008; 13: 323-326https://doi.org/10.1080/13625180802075281
- Fibroid in pregnancy: characteristics, complications, and management.Postgr Med J. 2011; 87: 819-828https://doi.org/10.1136/postgradmedj-2011-130319
- Myoma and myomectomy: Poor evidence concern in pregnancy.J Obs Gynaecol Res. 2017; 43: 1789-1804https://doi.org/10.1111/jog.13437
- Uterine myomectomy in pregnant women.Fetal Diagn Ther. 2001; 16: 116-119https://doi.org/10.1159/000053893
- First trimester myomectomy as an alternative to termination of pregnancy in a woman with a symptomatic uterine leiomyoma: a case report.J Med Case Rep. 2011; 5: 571https://doi.org/10.1186/1752-1947-5-571
- Myomectomy during early pregnancy.Mil Med. 2000; 165: 162-164
- Three cases of laparoscopic myomectomy performed during pregnancy for pedunculated uterine myomas.Arch Gynecol Obs. 2012; 286: 1209-1214https://doi.org/10.1007/s00404-012-2441-0
- Ultrasound diagnosis of uterine myomas and complications in pregnancy.Obs Gynecol. 1993; 82: 97-101
- Myomas of the uterus in pregnancy: ultrasonographic follow-up.Am J Obs Gynecol. 1980; 138: 16-19https://doi.org/10.1016/0002-9378(80)90005-8
- Successful myomectomy during pregnancy.Hum Reprod. 2003; 18: 1699-1702https://doi.org/10.1093/humrep/deg318
- Myomectomy during pregnancy: a feasible option.J Obs Gynaecol Res. 2009; 35: 173-175https://doi.org/10.1111/j.1447-0756.2008.00873.x
- Can myomectomy be performed during pregnancy?.Gynecol Obstet Invest. 2002; 53: 79-83https://doi.org/10.1159/000052997
- Management of uterine fibroids in pregnancy: recent trends.Curr Opin Obs Gynecol. 2015; 27: 432-437https://doi.org/10.1097/gco.0000000000000220
- Laparoscopic approach to fibroid torsion presenting as an acute abdomen in pregnancy.Jsls. 2013; 17: 665-667https://doi.org/10.4293/108680813x13794522666400
- Uterine fibroid torsion during pregnancy: a case of laparotomic myomectomy at 18 weeks’ gestation with systematic review of the literature.Case Rep Obs Gynecol. 2017; 20174970802https://doi.org/10.1155/2017/4970802
- Isobaric (gasless) laparoscopic myomectomy during pregnancy.J Minim Invasive Gynecol. 2005; 12: 379-381https://doi.org/10.1016/j.jmig.2005.05.012
- Laparoscopic myomectomy during pregnancy resulting in septic necrosis of the myometrium.BJOG. 2003; 110: 876-878
- How should painful cystic degeneration of myomas be managed during pregnancy? A case report and review of the literature.Iran J Reprod Med. 2011; 9: 243-246
- Myomectomy as a pregnancy-preserving option in the carefully selected patient.Fetal Diagn Ther. 2002; 17: 101-103https://doi.org/10.1159/000048017
- Pyomayoma during pregnancy: a case report and review of the literature.J Obs Gynaecol Res. 2013; 39: 383-389https://doi.org/10.1111/j.1447-0756.2012.01947.x
- Laparoscopic management of a twisted ovarian leiomyoma in a woman with 10 weeks’ gestation: case report and literature review.Medicine. 2016; 95: e5319https://doi.org/10.1097/MD.0000000000005319
- Symptomatic uterine fibroids in pregnancy - wait or operate? Own experience.Ginekol Pol. 2019; 90: 320-324https://doi.org/10.5603/GP.2019.0058
- Vaginal myomectomy in pregnancy: a report of two cases.South Med J. 2010; 103: 1058-1060https://doi.org/10.1097/SMJ.0b013e3181efb552
- Vaginal myomectomy for semipedunculated cervical myoma during pregnancy.AJP Rep. 2014; 4: 37-40https://doi.org/10.1055/s-0034-1370352
- Spontaneous reduction of an incarcerated gravid uterus after myomectomy in the second trimester: a case report.Medicine. 2019; 98e14731https://doi.org/10.1097/MD.0000000000014731
- Myomectomy during the first trimester associated with fetal limb anomalies and hydrocephalus in a twin pregnancy.Prenat Diagn. 2001; 21: 848-851https://doi.org/10.1002/pd.155
- Myomectomy in pregnancy.J Obs Gynaecol. 2007; 27: 628-630https://doi.org/10.1080/01443610701538372
- Successful myomectomy in early second trimester of pregnancy.J Obs Gynaecol. 2007; 27: 196-197https://doi.org/10.1080/01443610601137911
- Successful myomectomy in the second trimester of pregnancy.Adv Biomed Res. 2019; 8: 60https://doi.org/10.4103/abr.abr_236_18
- Successful myomectomy during pregnancy: a case report.Reprod Heal. 2005; 2: 6https://doi.org/10.1186/1742-4755-2-6
- Hemoperitoneum caused by a bleeding myoma in pregnancy.Acta Clin Croat. 2010; 49: 197-200
- Multiple laparotomic myomectomy during pregnancy: a case report.Arch Gynecol Obstet. 2011; 284: 613-616https://doi.org/10.1007/s00404-011-1939-1
- Inevitable myomectomy in pregnancy.J Obs Gynaecol. 1997; 17: 377-378https://doi.org/10.1080/01443619750112925
- Laparoscopic excision of a pedunculated uterine leiomyoma in torsion as a cause of acute abdomen at 10 weeks of pregnancy.Am J Case Rep. 2015; 16: 505-508https://doi.org/10.12659/AJCR.893382
- Laparoscopic removal of a 1500-g symptomatic myoma during the second trimester of pregnancy.J Am Assoc Gynecol Laparosc. 1995; 2: 457-462https://doi.org/10.1016/s1074-3804(05)80070-2
- A case of laparoscopic myomectomy performed during pregnancy for subserosal uterine myoma.J Obs Gynaecol. 2011; 31: 180-181https://doi.org/10.3109/01443615.2010.538774
- Myomectomy during pregnancy and caesarean section.Hum Reprod. 1995; 10: 1869-1870https://doi.org/10.1093/oxfordjournals.humrep.a136195
- Successful myomectomy of a bleeding myoma in a twin pregnancy.JRSM Short Rep. 2012; 3: 13https://doi.org/10.1258/shorts.2011.011087
- Intraoperative ultrasound assistance during myomectomy in pregnant woman.Ultrasound Obstet Gynecol. 2019; https://doi.org/10.1002/uog.21881
- Myomectomy in the second trimester of pregnancy: case report.Rev Bras Ginecol Obs. 2010; 32: 198-201https://doi.org/10.1590/s0100-72032010000400008
- Laparoscopic myomectomy at 25 weeks of pregnancy: case report.J Minim Invasive Gynecol. 2010; 17: 91-93https://doi.org/10.1016/j.jmig.2009.08.004
- Laparoscopic myomectomy of a subserous pedunculated fibroid at 14 weeks of pregnancy: a case report.J Med Case Rep. 2011; 5: 545https://doi.org/10.1186/1752-1947-5-545
- Vaginal removal of prolapsed pedunculated submucosal myoma during pregnancy.Adv Ther. 2007; 24: 903-906https://doi.org/10.1007/bf02849983
- Preoperative magnetic resonance imaging and antepartum myomectomy of a giant pedunculated leiomyoma.Obs Gynecol. 2008; 111: 577-579https://doi.org/10.1097/01.AOG.0000297314.62914.f7
- Unusual growth of a myoma during pregnancy.Fertil Steril. 2002; 78: 632-633https://doi.org/10.1016/s0015-0282(02)03297-1
- Laparoscopic tumorectomy for a primary ovarian leiomyoma during pregnancy: a case report.Oncol Lett. 2014; 8: 2523-2526https://doi.org/10.3892/ol.2014.2596
- Use of pre ‑ operative imaging for symptomatic uterine myomas during pregnancy : a case report and a systematic literature review.Arch Gynecol Obstet. 2018; https://doi.org/10.1007/s00404-018-4948-5
- Myoma and pregnancy: when medical treatment is not sufficient.J Gynecol Obs Biol Reprod. 2012; 41: 307-310https://doi.org/10.1016/j.jgyn.2011.10.002
- A successful antenatal myomectomy.Malays Fam Physician. 2012; 7: 42-45
- Vaginal birth after extensive myomectomy during pregnancy in a 39-year-old nulliparous woman.J Obs Gynaecol. 2006; 26: 374-375https://doi.org/10.1080/01443610600618648
- Laparoscopic myomectomy during pregnancy.Gynaecol Endoscopy. 1998; 7: 105-107https://doi.org/10.1046/j.1365-2508.1998.00167.x
- Myomectomy in early pregnancy—a case report.Gynecol Surg. 2006; 3: 228-229https://doi.org/10.1007/s10397-006-0210-4
- Successful myomectomy during pregnancy.Pak J Med Sci. 2012; https://doi.org/10.12669/pjms.284.2079
- Successful myomectomy during pregnancy for a large uterine fibroid causing intestinal obstruction: report of a case case report.J Young Pharm. 2015; 7https://doi.org/10.5530/jyp.2015.4.14
- Surgical management of leiomyomata during pregnancy.Obs Gynecol. 1989; 74: 707-709
- Pedunculated twisted myoma and pregnancy. Case report.Ginecol Obs Mex. 2009; 77: 441-444
- Laparotomic myomectomy in the 16th week of pregnancy: a case report.Case Rep Obs Gynecol. 2014; 2014154347https://doi.org/10.1155/2014/154347
- Successful myomectomy in early pregnancy for a large asymptomatic uterine myoma: case report.Pan Afr Med J. 2016; 24: 228https://doi.org/10.11604/pamj.2016.24.228.9890
- Laparoscopic surgery in pregnancy: long-term follow-up.J Laparoendosc Adv Surg Tech A. 2003; 13: 11-15https://doi.org/10.1089/109264203321235403
- Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and outcome reports.Hum Reprod. 2012; 27: 427-435https://doi.org/10.1093/humrep/der369
Article info
Publication history
Published online: August 24, 2020
Accepted:
August 21,
2020
Received in revised form:
July 29,
2020
Received:
April 22,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
