Introduction
Uterine myomas (leiomyomata, fibroids) are the most common tumor of the
reproductive tract, with a prevalence of 20–25%1 and
a cumulative incidence of 70% in women of reproductive
age.2
It has been reported that the presence of fibroids is associated with
infertility, spontaneous abortion, fetal malpresentation, placenta
previa, preterm birth, cesarean section, and peripartum
hemorrhage.3 Although surgical interventions such as
myomectomy have been tried in infertile women without specific causes,
it is unclear whether the treatment of uterine fibroids can improve
pregnancy outcomes, except for cavity-distorting myomas (submucosal, or
intramural with a submucosal component).4 The most
serious concern in pregnancies after myomectomy is the risk of uterine
rupture, which can result in significant increased morbidity and
mortality for both the mother and the fetus. The incidence of uterine
rupture after prior myomectomy has been reported to range from 0.2 to
3.7% in women with prior myomectomy.5 There is no
consensus on the optimal interval between myomectomy and conception.
In US Census Bureau population projections, it was estimated that
myomectomies are predicted to increase 31% between 2007 and
2050.6 In Korea, the number of women who underwent
myomectomy have increased 37.3% between 2006 and
2010.7 Women in their 30s and 40s, who are a major
population for pregnancy, have been major candidates for myomectomy.
Because there is insufficient evidence that myomectomy improves
pregnancy outcomes, a practice committee of the American Society for
Reproductive Medicine (ASRM) reported that myomectomy is generally not
advised for improving pregnancy outcomes in asymptomatic women with
non-cavity-distorting myomas.8 The Society of
Obstetricians and Gynaecologists of Canada (SOGC) also recommended
against myomectomy in women with intramural fibroids (hysteroscopically
confirmed intact endometrium) and otherwise unexplained infertility,
regardless of their size.9
The purpose of this study was to evaluate adverse pregnancy outcomes in
women with a history of diagnosed myoma or myomectomy, including
prevalence of uterine rupture in women with myomectomy, according to the
time interval after myomectomy.