Page 39 - World Journal of Laparoscopic Surgery

Pregnancy Outcomes Following Laparoscopic Myomectomy

RESULTS Soriano D et al (2003), found that of 106 infertile women
Kucera E et al (2006), in their report analyzed 69 patients after with uterine leiomyoma, of whom 88 women underwent
LM. The conception rate after LM was 56.5%. They didn’t laparoscopic myomectomy and 18 laparoconversion. No
observe any increased incidence of fetomaternal morbidity or difference in the pregnancy rate was noted between the laparos-
severe pregnancy and labor related complications. There was copic and laparoconversion groups (48 and 56%, respectively).
no uterine rupture after LM in their group. The cesarean section There was no difference between the two groups as regards the
was rate 44.8%. LM in infertile patient is one of the most common rates of pregnancy-related complications and vaginal delivery.
surgical procedures. The appropriate surgical management of No uterine rupture occurred. They concluded that laparoscopic
uterine scar is mandatory. Skilled reproductive surgeon must myomectomy is feasible and safe, and should be considered for
perform this operation. The pregnancy following LM is at high- infertile women with uterine fibroids. Fertility and pregnancy
risk with increased caesarean section rate. outcomes following laparoscopic myomectomy are comparable
Paul PG, et al (2006), reported that uterine rupture during with those following myomectomy after laparoconversion.
pregnancies following laparoscopic myomectomy is rare Landi S et al (2003), described that of 72 women were
following single-layer myometrial closure. Of the 217 women pregnant at least once after laparoscopic myomectomy. Four
followed up, 115 had pregnancies subsequent to a laparoscopic women conceived twice and four are pregnant as of this writing.
myomectomy. Of 141 pregnancies, there were 87 cesarean One multiple pregnancy occurred. Twelve pregnancies resulted
sections, 19 vaginal deliveries, 29 abortions and 6 ectopic in first-trimester miscarriage, one in an ectopic pregnancy, one
pregnancies. There were no incidents of uterine scar rupture in in a blighted ovum, and one in a hydatiform mole. One patient
any of these pregnancies. underwent elective first-trimester termination of pregnancy.
Goldberg J et al (2006), showed that although most Thirty-one women had vaginal delivery at term and 26 were
pregnancies following uterine artery embolization have good delivered by cesarean section. No case of uterine rupture or
outcomes, myomectomy should be recommended as the dehiscence occurred.
treatment of choice over uterine artery embolization in most Stringer NH et al (2001), found that laparoscopic suturing
patients desiring future fertility. Pregnancy rates following of the endometrial cavity in three layers does not prevent future
myomectomy, both via laparoscopy and laparotomy, are in the pregnancies, and pregnancies can progress to term and in some
50-60% range, with most having good outcomes. Both cases be delivered vaginally without dehiscence.
myomectomy and uterine artery embolization are safe and Dubuisson JB et al (2000), found that ninety-eight patients
effective fibroid treatments, which should be discussed with became pregnant at least once after LM, giving a total of 145
appropriate candidates. Pregnancy complications, most pregnancies. Among the 100 patients who had delivery, there
importantly preterm delivery, spontaneous abortion, abnormal were three cases of spontaneous uterine rupture. Because only
placentation and postpartum hemorrhage, are increased one of these uterine ruptures occurred on the LM scar, the risk
following uterine artery embolization compared to myomectomy. of uterine rupture was 1.0% (95% CI 0.0-5.5%). Seventy-two
Seracchioli R et al (2006), reported that of the 514 women patients (72.0%) had trials of labor. Of these, 58 (80.6%) were
followed up, 158 pregnancies were achieved. There were 43 delivered vaginally. There was no uterine rupture during the
(27.2%) spontaneous abortions, 4 (2.6%) ectopic pregnancies, trials of labor. Spontaneous uterine rupture seems to be rare
and 1 (0.6%) therapeutic abortion. Only 27 patients (25.5%) had after LM. When performing LM, particular care must be given
vaginal deliveries, whereas 79 (74.5%) underwent cesarean to the uterine closure.
section. No instances of uterine rupture were recorded. Their Seinera et al (2000), described that the pregnancy outcome
preliminary results confirmed that LM, performed by an expert of 54 patients submitted to laparoscopic myomectomy at their
surgeon, could restore reproductive capacity, allowing patients institution and prospectively followed during subsequent
to have a successful pregnancy. pregnancies. A total of 202 patients underwent laparoscopic
Campo S et al (2003), analyzed that myomectomy significantly myomectomy. A total of 65 pregnancies occurred in 54 patients
improves pregnancy outcome in patients with subserous or who became pregnant following surgery. No cases of uterine
intramural fibroids, probably removing a plausible cause of rupture occurred. A cesarean section was performed in 45 cases.
altered uterine contractility or blood supply. Out of 128 patients In terms of the safety of laparoscopic myomectomy in patients
submitted to myomectomy, we considered eligible for this study who become pregnant following surgery, their results were
only the 41 patients wishing to conceive after surgery and who encouraging. They suggested that further studies are needed
did not present any plausible infertility factor, apart from the to provide reliable data on the risk factors and the true incidence
removed myomas. Their results suggest that the main of uterine rupture.
determinants of pregnancy rate after surgery are patient age, Nezhat CH et al (1999), analyzed that of the 115 women,
diameter and intramural localization of the myomas and type of there were 42 pregnancies in 31 patients. Two women were lost
surgery. to follow-up. Of the remaining 40 pregnancies, six ended with

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