Top

Published in:

01-08-2014 | Review Article

The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis

Authors: J. Claeys, I. Hellendoorn, T. Hamerlynck, J. Bosteels, S. Weyers

Published in: Gynecological Surgery | Issue 3/2014

Abstract

Fibroids may give rise to specific obstetrical complications such as pain due to degeneration, fetal malpresentation, or placenta previa. For all these reasons, surgical resection of the fibroid may be indicated before a pregnancy is pursued. The occurrence of a uterine rupture is a rare but severe complication of myomectomy. This study seeks to review the risk of uterine rupture during pregnancy and/or labor after laparoscopic myomectomy in comparison with laparotomic myomectomy. A systematic search of the literature through search strategies in MEDLINE (PubMed) and Embase (Embase.com) from January 1970 up to March 2013 was performed. We used the following MeSH terms and free text words: gynecologic surgical procedures, gynecologic surgery, leiomyoma, fibromyoma, fibroids, myoma, uterine tumors, and pregnancy complication. Our data show that the risk of uterine rupture during labor and delivery is low (0.75 %). Compared with traditional open myomectomy, the risk of uterine rupture during pregnancy is not significantly higher after a laparoscopic approach (P = 0.119). More elective cesarean sections are performed after laparoscopic myomectomy compared with the conventional open technique (P = 0.001). Our conclusions are supported by statistical pooling of observational studies of generally low methodological quality. The risk of uterine rupture after myomectomy is low (0.75 %). The available evidence in the literature does no allow discouraging attempts for childbirth per viam naturalem after previous myomectomy, regardless of the technique used. Randomized studies are needed before definitive evidence-based recommendations can be given.

Available only for authorised users

Parker W, Einarsson J, Istre O, Duboisson J et al (2010) Risk factors for uterine rupture after laparoscopic myomectomy. J Minim Invasive Gynecol 17(5):551–554PubMedCrossRef

Murphy D (2006) Uterine rupture. Obstet Gynecol 18:135–140

Hoffmeyr G, Say L, Gulmezoglu A et al (2005) WHO systematic review of maternal mortality and morbidity; the prevalence of uterine rupture. BJOG 112:1221–1228CrossRef

Pritts EA (2001) Fibroids and infertility: a systematic review of the evidence. Obstet Gynecol Surv 56:483–491PubMedCrossRef

Adesiyun A, Ojabo A, Durosinlorun-Mohmmed A et al (2008) Fertility and obstetric outcome after caesarean myomectomy. J Obstet Gynaecol 28(7):710–712PubMedCrossRef

Bajekal N, Li T et al (2009) Fibroids, infertility and pregnancy wastage. Hum Reprod Update 6(6):614–620CrossRef

Bernard G, Darai E, Poncelet C, Benifla J, Madelenat P et al (2000) Fertility after hysteroscopic myomectomy: effect of intramural myomas associated. Eur J Obstet Gynecol Reprod Biol 88:85–90PubMedCrossRef

Bonito M, Gulemi L, Basili R, Roselli D et al (2007) Myomectomy during first and second trimester of pregnancy. Clin Exp Obstet Gynecol 34(3):149–150PubMed

Campo S, Campo V, Gambadauro P et al (2003) Reproductive outcome before and after laparoscopic or abdominal myomectomy for subserous or intramural myomas. Eur J Obstet Gynecol Reprod Biol 110:215–219PubMedCrossRef

10.

Celik C, Acar A, Cicek N, Gezginc K, Akyurek C et al (2002) Can myomectomy be performed during pregnancy? Gynecol Obstet Investig 53:79–83CrossRef

11.

Connolly G, Doyle M, Barrett T, Byrne P, De Mello M, Harrison R et al (2000) Fertility after abdominal myomectomy. J Obstet Gynaecol 20(4):418–420PubMedCrossRef

12.

Damiani A, Melgrati L, Marziali M, Sesti F et al (2003) Gasless laparoscopic myomectomy. J Reprod Med 48(10):792–798PubMed

13.

Davies A, Hart R, Magos A et al (1999) The excision of uterine fibroids by vaginal myomectomy: a prospective study. Fertil Steril 71(5):961–964PubMedCrossRef

14.

Febo G, Tessarolo M, Leo L, Arduino S, Wierdis T, Lanza L et al (1997) Surgical management of leiomyomata in pregnancy. Clin Exp Obstet Gynecol 24(2):76–78PubMed

15.

Gavai M, Hupuzi P, Papp Z et al (2006) Abdominal myomectomy as the alternative to hysterectomy: analysis of 504 cases. Orv Hetil 147(21):971–978PubMed

16.

Gerli S, Baiocchi G, Favilli A, Di Renzo G et al (2011) New treatment option for early spontaneous rupture of a postmyomectomy gravid uterus. Fertil Steril 96(2):97–98CrossRef

17.

Goldberg J, Pereira L, Berghella V, Diamond J, Daraï E, Seinera P, Seracchioli R et al (2004) Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy. Am J Obstet Gynecol 191:18–21PubMedCrossRef

18.

Grande N, Catalano G, Ferrari S, Marana R et al (2005) Spontaneous uterine rupture at 27 weeks of pregnancy after laparoscopic myomectomy. J Minim Invasive Gynecol 12:131CrossRef

19.

Guillaume A, Benjamin F, Spitzer M et al (1998) Myomectomy performed concurrently with tuboplasty. J Reprod Med 43(6):483–486PubMed

20.

Guillaume J, Benjamin F, Jean-Gilles M, Ajah M, Tabassi G, Kenel-Pierre C et al (2000) Myomectomy and tuboplasty performed at the same time in cases of distal tubal obstruction with associated fibroids. J Reprod Med 45(6):461–464PubMed

21.

Hagnère P, Denoual I, Souissi A, Deswarte S et al (2011) Rupture uterine spontanée après myomectomie. À propos d’un cas et revue de la littérature. J Gynécol Obstét Biol Reprod 40:162–165CrossRef

22.

Jedrzejczak P, Pawelczyk L, Grewling K, Pelesz M, Serdynska M et al (2004) The assessment of the fertilization ability and the course of pregnancy in women after laparoscopic myomectomy. Przegl Lek 61(2):65–69PubMed

23.

Kelly B, Bright P, MacKenzie I et al (2008) Does the surgical approach used for myomectomy influence the morbidity in subsequent pregnancy? J Obstet Gynaecol 28(1):77–81PubMedCrossRef

24.

Kucera E, Dvorska M, Krepelka P, Herman H et al (2006) Pregnancy after laparoscopic myomectomy—long-term follow-up. Ceska Gynekol 71(5):389–393PubMed

25.

Kumakiri J, Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Itoh S, Kinoshita K et al (2005) Pregnancy and delivery after laparoscopic myomectomy. J Minim Invasive Gynecol 12(3):241–246PubMedCrossRef

26.

Kumakiri J, Takeuchi H, Itoh S, Kitade M, Kikuchi I, Shimanuki H, Kumakiri Y, Kuroda K, Takeda S et al (2008) J Minim Invasive Gynecol 15(4):420–424PubMedCrossRef

27.

Leidi L, Brusati M, Vespa M et al (2007) A treacherous scar. Am J Obstet Gynecol 197(5):553PubMedCrossRef

28.

Li T, Mortimer R, Cooke I et al (1999) Myomectomy: a retrospective study to examine reproductive performance before and after surgery. Hum Reprod 14(7):1735–1740PubMedCrossRef

29.

Lolis D, Kalantaridou S, Makrydimas G, Sotiriadis A, Navrozoglou I, Zikopoulos K, Paraskevaidis E et al (2003) Successful myomectomy during pregnancy. Hum Reprod 18(8):1699–1702PubMedCrossRef

30.

Malzoni M, Sizzi O, Rossetti A, Imperato F et al (2006) Laparoscopic myomectomy: a report of 982 procedures. Surg Technol Int 15:123–129PubMed

31.

Malzoni M, Tinelli R, Cosentino F, Iuzzolino D, Surico D, Reich H et al (2010) Laparoscopy versus minilaparotomy in women with symptomatic uterine myomas: short-term and fertility results. Fertil Steril 93(7):2368–2373PubMedCrossRef

32.

Mara M, Maskova J, Fucikova Z, Kuzel D, Beslan T, Sosna O et al (2008) Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 31(1):73–85PubMedCentralPubMedCrossRef

33.

Marchionni M, Fambrini M, Zambelli V, Scarselli G, Susini T et al (2004) Reproductive performance before and after abdominal myomectomy: a retrospective analysis. Fertil Steril 82(1):154–159PubMedCrossRef

34.

Morita M, Asakawa Y et al (2006) Reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors. Reprod Med Biol 5:31–35CrossRef

35.

Nezhat C, Nezhat F, Roemisch M, Seidman D, Tazuke S, Nezhat C et al (1999) Pregnancy following laparoscopic myomectomy: preliminary results. Hum Reprod 14(5):1219–1221PubMedCrossRef

36.

Obed J, Omigbodun A et al (1996) Rupture of the uterus in patients with previous myomectomy and primary caesarean section scars: a comparison. J Obstet Gynaecol 16(1):16–21CrossRef

37.

Okoro O, Onwere S et al (2007) Myomectomy during pregnancy. Pak J Med Sci 23(5):771–773

38.

Pajszczyk-Kieszkiewicz T, Kazimierak W, Lech W, Lipecka-Kidawska E, Sieroszewski P, Kowalska-Koprek U et al (2002) Leiomyomas in pregnancy. Ginekol Pol 73(4):291–296PubMed

39.

Park W, Jeon Y, Lee J, Shin S et al (2006) Subserosal pregnancy in a previous myomectomy site: a variant of intramural pregnancy. J Minim Invasive Gynecol 13(3):242–244PubMedCrossRef

40.

Persin J, Hanousek L et al (2006) Results of conservative surgery of uterine fibroids—5 years of follow-up. Ceska Gynekol 71(4):322–325PubMed

41.

Ploszynski A, Gniadek R, Adamcio-Deptulska M, Mielnik J et al (1997) Myomectomy and long-term follow-up. Ginekol Pol 68(9):423–426PubMed

42.

Plotti G, Plotti F, Di Giovanni A, Battaglia F, Nagar G et al (2008) Feasibility and safety of vaginal myomectomy: a prospective pilot study. J Minim Invasive Gynecol 15(2):166–171PubMedCrossRef

43.

Ramarajan A, Achar S et al (2012) Successful pregnancy following extensive myomectomy in a case of uterine leiomyomatosis. Int J Gynecol Obstet 199:S459

44.

Ribeiro S, Reich H, Rosenberg J, Guglielminetti E, Vidali A et al (1999) Laparoscopic myomectomy and pregnancy outcome in infertile patients. Fertil Steril 71(3):571–574PubMedCrossRef

45.

Rossetti A, Sizzi O, Chiarotti F, Florio G et al (2007) Developments in techniques for laparoscopic myomectomy. J Soc Laparoendosc Surg 11(1):34–40

46.

Rovio P, Heinonen P et al (2006) Transvaginal myomectomy with screw traction by colpotomy. Arch Gynecol Obstet 273(4):211–215PubMedCrossRef

47.

Salfelder A, Lueken R, Gallinat A, Möller C, Busche D, Nugent W et al (1999) Laparoscopic myomectomy and pregnancy—results. Geburtshilfe Frauenheilkd 59(2):57–61CrossRef

48.

Sentilhes L, Sergent F, Berthier A, Catala L, Descamps P, Marpeau L et al (2006) Uterine rupture following operative hysteroscopy. Gynécol Obstét Fertil 34:1064–1070PubMedCrossRef

49.

Seracchioli R, Manuzzi L, Vianello F, Gualerzi B, Savelli L, Paradisi R, Venturoli S et al (2006) Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy. Fertil Steril 86(1):159–165PubMedCrossRef

50.

Sinclair D, Gaither K, Mason T et al (2005) Fertility outcomes following myomectomy in an urban hospital setting. J Natl Med Assoc 97(10):1346–1348PubMedCentralPubMed

51.

Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, Panunzi S, Spagnolo R, Imperato F, Landi S, Fiaccamento A, Stola E et al (2007) Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Surg 14(4):453–462

52.

Skrablin S, Banovic V, Kuvacic I et al (2005) Letters to the editor—brief communication. Successful pregnancy after spontaneous rupture of scarred uterus following fundal myomectomy. Eur J Obstet Gynaecol Reprod Biol 121(2):251–253CrossRef

53.

Soriano D, Dessolle L, Poncelet C, Benifla J, Madelenat P, Daraï E et al (2003) Pregnancy outcome after laparoscopic and laparoconverted myomectomy. Eur J Obstet Gynecol Reprod Biol 108(2):194–198PubMedCrossRef

54.

Suwadinata F, Gruessner E, Owandho C, Tinneberg H et al (2008) Pregnancy-preserving myomectomy: preliminary report on a new surgical technique. Eur J Contracept Reprod Health Care 13(3):323–326CrossRef

55.

Tinelli A, Hurst B, Hudelist G, Tin D, Stark M, Mettler L, Guido M, Malvasi A et al (2011) Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and outcome reports. Hum Reprod 27(2):427–435PubMedCrossRef

56.

Walid S, Heaton R et al (2010) Laparoscopic myomectomy: an intent-to-treat study. Arch Gynecol Obstet 281(4):645–649PubMedCrossRef

57.

Wong K, Tan J, Ang C, Ngu A et al (2010) Myomectomy scar ectopic pregnancy. Aust N Z J Obstet Gynaecol 50(1):93–98PubMedCrossRef

58.

Zollner U, Classen V, Steck T, Dietl J et al (2001) Fertility and pregnancy outcome after myomectomy. Geburtshilfe Frauenheilkd 61(4):213–219CrossRef

59.

Zwart J, Richters J, Öry F, De Vries J, Bloemenkamp K, Van Roosmalen J et al (2009) Uterine rupture in the Netherlands: a nationwide population-based cohort study. Int J Obstet Gynaecol 116:1069–1080CrossRef

60.

Bujold E, Goyet M, Marcoux S et al (2010) The role of uterine closure in the risk of uterine rupture. Obstet Gynecol 116:43–50PubMedCrossRef

61.

Roberge S, Chaillet N, Boutin A et al (2011) Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and the risk of uterine rupture. Int J Gynecol Obstet 115:5–10CrossRef

Title: The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis
Authors: J. Claeys
I. Hellendoorn
T. Hamerlynck
J. Bosteels
S. Weyers
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: Gynecological Surgery / Issue 3/2014
Print ISSN: 1613-2076
Electronic ISSN: 1613-2084
DOI: https://doi.org/10.1007/s10397-014-0842-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2014

When second-generation endometrial ablation fails—a review of 200 cases of endometrial ablation

Proposal of a modified transcervical endometrial resection (TCER) technique for menorrhagia treatment. Feasibility, efficacy, and patients’ acceptability

Laparoscopic ovarian reconstruction without suturing after cystectomy for endometrioma

Role of prophylactic antibiotics in endoscopic gynaecological surgery; a consensus proposal

Closed entry technique for the laparoscopic management of adnexal mass during pregnancy

The CROWN Initiative: journal editors invite researchers to develop core outcomes in women’s health