Pregnancy and obstetric outcome after laparoscopic myomectomy in our hospital

Abstract

Objectives: Uterine myomas are frequently occurring benign tumors that are characterized by symptoms such as anemia and dysmenorrhea, and may lead to infertility. In this study, we examined the efficacy of laparoscopic myomectomy, as well as pregnancy and obstetric outcome after the surgery in patients with uterine myomas who were infertile or wished to conceive.Methods: Of 300 patients who underwent laparoscopic myomectomy in our hospital, 78 who wished to conceive before or after surgery, and whose factors contributing to infertility were identified, were selected as subjects. The factors measured during/after the surgery included uterine weight, number of myomas, maximum diameter of myomas, blood loss, and operative time. The pregnancy rate and obstetric outcome after the surgery were also examined. Results: The pregnancy rate after the surgery was 53.8%; the pregnancy rate was as high as 73.0% in women who had no other factors contributing to infertility except uterine myomas. Spontaneous pregnancies occurred in 85.7% of the patients and 14.3% required assisted reproductive technology (ART). Forty-four pregnancies were confirmed in 42 patients after surgery. Of these 44 pregnancies, 20.4% resulted in spontaneous abortions and 79.5% culminated in a successful delivery. Nine gravidas (25.7%) were delivered vaginally and 26 gravidas (74.3%) had caesarean sections. The only complication noted was a case of serious bleeding after expulsion of the placenta during a caesarean section.Conclusion: In patients who wish to conceive and have no other obvious factors contributing to infertility except uterine myomas, laparoscopic myomectomy improves the pregnancy rate. It is necessary to establish strict indications for laparoscopic myomectomy, taking complications during pregnancy and delivery into consideration, and to improve the surgeon's skills.