Abstract
Objectives
The primary aim was to assess if a clinical consensus regarding the management of
pregnancy post myomectomy existed amongst consultant obstetricians and gynaecologists.
Secondary objectives were to evaluate factors which influence the clinician’s decision
making in this group of women.
Study design
Electronic survey sent to all consultants working in the North Central and East London
deanery, Kent Surrey and Sussex deanery and Imperial NHS Trust to assess opinions
on mode of birth post myomectomy, intervals advised to pregnancy post myomectomy,
factors influencing the management of delivery in the scarred uterus post myomectomy,
opinions on induction of labour and questions relating to operative notes.
Results
209 consultant responses received between 07/03/2022–07/05/2022 (44% response rate);
77% (161/209) practicing obstetricians and gynaecologists, 10% (21/109) pure gynaecologists
and 13% (27/209) pure obstetricians.
The majority would support a vaginal birth after open myomectomy (75%) and laparoscopic
myomectomy (79%). No consensus was found as to the optimal time interval between myomectomy
and pregnancy. Higher frequency of performing myomectomy and a greater level of experience
were significantly associated with a shorter interval to pregnancy advised.
The most important operative factors influencing decision to support trial of labour
post myomectomy were breach of uterine cavity; location of fibroids removed and number
of incisions on the uterus. 77% believe women should be given a choice regarding mode
of delivery post myomectomy in a similar way to previous LSCS. 82.8% would support
enrolment of patients into a prospective trial to investigate delivery post myomectomy.
Conclusions
We present a comprehensive survey of clinician opinions on pregnancy post myomectomy
demonstrating that the majority of consultant obstetricians and gynaecologists sampled
would support vaginal birth post myomectomy; counselling patients in a similar way
to VBAC; a standardised myomectomy operation note and enrolment of patients in a future
prospective trial. Wide variation in opinion regarding interval to pregnancy post
myomectomy has been highlighted. We believe this information will facilitate counselling
discussions and empower women with subsequent pregnancies after myomectomy to make
an informed decision on mode of birth post myomectomy.
Keywords
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References
- Uterine leiomyoma: understanding the impact of symptoms on womens' lives.Reprod Health. 2014; 11https://doi.org/10.1186/1742-4755-11-10. PMID: 24476380; PMCID: PMC3909443
- A guide for the design and conduct of self-administered surveys of clinicians.Can Med Assoc J. 2008; 179: 245-252
- Trial of labor after myomectomy and uterine rupture: a systematic review.Acta Obstet Gynecol Scand. 2016; 95 (Epub 2016 May 25 PMID: 27154306): 724-734https://doi.org/10.1111/aogs.12920
Royal College of Obstetricians and Gynaecologists (RCOG). 2015. Green-top guideline number 45: Birth after previous caesarean section. Accessed at https://www.rcog.org.uk/media/kpkjwd5h/gtg_45.pdf.
- Pregnancy outcomes after vaginal trial of labour following myomectomy.The Journal of Minimally Invasive Gynaecology. 2018; 25
- Peri-procedural, pregnancy and peripartum complications in patients with laparoscopic or open myomectomy.Journal of Minimally Invasive Gynaecology. 2016; 23: 13-14
- Caesarean section in women following an abdominal myomectomy: a choice or a need?.Facts Views Vis Obgyn. 2020; 12: 57-60
- Prospective evaluation for the feasibility and safety of vaginal birth after laparoscopic myomectomy.J Minim Invasive Gynecol. 2008; 15: 420-424
- The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis.Gynecol Surg. 2014; 11: 197-206
- Non-hysteroscopic Myomectomy and Fertility Outcomes: A Systematic Review.J Minim Invasive Gynecol. 2021; 28 (Epub 2020 Oct 14 PMID: 33065260): 598-618.e1https://doi.org/10.1016/j.jmig.2020.10.006
- Perinatal outcomes of women undergoing cesarean delivery after prior myomectomy.J Matern Fetal Neonatal Med. 2020; 33: 2153-2158
National Institute of Health and Care Excellence (NICE). 2021. Caesarean Birth. Accessed at https://www.nice.org.uk/guidance/ng192/resources/caesarean-birth-pdf-66142078788805.
- Morbidity, fertility and pregnancy outcomes after myoma enucleation by laparoscopy versus laparotomy.Arch Gynecol Obstet. 2018; 297: 969-976
- Rupture of the uterus in patients with previous myomectomy and primary caesarean section scars: a comparison.J Obstet Gynaecol. 1996; 16: 16-21
- The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery.Am J Obstet Gynecol. 2005; 193: 1016-1023
- Time to conceive after myomectomy: should we advise a minimum time interval?.A systematic review Reprod Biomed Online. 2021; 43 (Epub 2021 May 30 PMID: 34353724): 543-552https://doi.org/10.1016/j.rbmo.2021.05.016
- Appraisal of national and international uterine fibroid management guidelines: a systematic review.BJOG. 2022; 129 (Epub 2021 Sep 30 PMID: 34532956): 356-364https://doi.org/10.1111/1471-0528.16928
- Myoma and myomectomy: Poor evidence concern in pregnancy: Myoma and myomectomy in pregnancy.J Obstet Gynaecol Res. 2017; 43: 1789-1804
- Ultrasonographic Features of Uterine Scar after Laparoscopic and Laparoscopy-Assisted Minilaparotomy Myomectomy: A Comparative Study.J Minim Invasive Gynecol. 2020; 27 (Epub 2019 Jul 10 PMID: 31301467): 148-154https://doi.org/10.1016/j.jmig.2019.03.026
- MRI evaluation of the uterine structure after myomectomy.Gynecol Obstet Invest. 2006; 61 (Epub 2005 Oct 20 PMID: 16244491): 106-110https://doi.org/10.1159/000089144
- Patients' Age, Myoma Size, Myoma Location, and Interval Between Myomectomy and Pregnancy May Influence the Pregnancy Rate and Live Birth Rate After Myomectomy.J Laparoendosc Adv Surg Tech. 2014; 24: 95-99
- Epidemiology of uterine fibroids: a systematic review.BJOG. 2017; 124 (Epub 2017 May 13 PMID: 28296146): 1501-1512https://doi.org/10.1111/1471-0528.14640
- Developmental and endocrine aspects of normal ovarian aging.Mol Cell Endocrinol. 1998; 145 (PMID: 9922101): 67-73https://doi.org/10.1016/s0303-7207(98)00171-3
- Predictors of leiomyoma recurrence after laparoscopic myomectomy.J Minim Invasive Gynecol. 2007; 14: 690-697
- Perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy.J Obstet Gynaecol Can. 2014; 36 (PMID: 24518911): 128-132https://doi.org/10.1016/s1701-2163(15)30658-7
West HM, Jozwiak M, Dodd JM. Methods of term labour induction for women with a previous caesarean section. Cochrane Database Syst Rev. 2017 Jun 9;6(6):CD009792. 10.1002/14651858.CD009792.pub3. PMID: 28599068; PMCID: PMC6481365.
Sierles FS. How to do research with self-administered surveys. Acad Psychiatry. 2003 Summer;27(2):104-13. 10.1176/appi.ap.27.2.104. PMID: 12824111.
- Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants.Gynecol Surg. 2017; 14
Article info
Publication history
Published online: March 13, 2023
Accepted:
March 10,
2023
Received in revised form:
March 8,
2023
Received:
November 6,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
