Myoma and myomectomy: Poor evidence concern in pregnancy

Abstract

Aim: Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. Methods: Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. Results: Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10–30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. Conclusions: Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal–fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.