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.