Strengths and Limitations
A limitation of this study was our lack of data on number, size, or type of myomas, type of closure after myomectomy, number of suture layers, and use of electrocauterization, which may have important clinical significance. Also, there was no information on the type of myomectomy (laparoscopic, open, hysteroscopic, or robot-assisted) or type of conception (natural, OS, OS-IUI, or IVF). Last, data about gestational age at uterine rupture was not available.
However, this study included the largest population in the group with a history of diagnosed myoma(s) with and without myomectomy. In addition, the nationwide design of the original database can provide more generalized outcomes in pregnancies with diagnosed myoma(s) and with previous myomectomy. In addition, to our knowledge, this is the first study about incidence of uterine rupture in women with myomectomy, according to delivery time interval after myomectomy. The incidence of uterine rupture was highest within one year after surgery, which suggests that pregnancy with or without ART should be delayed at least 3-6 months. Last, we compared pregnancy outcomes in three groups: women with diagnosed myoma(s), with previous myomectomy, and without a diagnosed myoma or myomectomy. Although both groups of women with myoma and women with previous myomectomy showed adverse pregnancy outcomes, women with a previous myomectomy demonstrated more risks of adverse pregnancy outcomes, including preterm birth, low birth weight, cesarean section, and uterine rupture. These results might be useful in counseling when a woman, who might become pregnant later on, is diagnosed with uterine myoma.