First author | Type of study | Study details | Results/conclusions | Limitations |
---|---|---|---|---|
Burton[2] | Retrospective | n = 106 gravid patients with myomas → 14 ex-laps: six gravid myomectomies, all pedunculated with stalks < 5 cm in diameter; patients operated on for abdominal mass and pain or failed conservative management | Six myomectomies: one lost to follow-up; five term deliveries. Entire cohort: 75% live births, 21% S/TAB, 4% lost to follow-up, 13% PTL, 13% surgery | Size of myomas and GA at time of myomectomy not reported; cannot compare tx versus conservative tx with data presented |
Carolis[3] | Retrospective (first and second trimester) | n = 18 (6 weeks to 24 weeks): Same surgical criteria as Mollica [5]; myoma size ranging 2 cm to 40 cm | 14 term C/S; one assisted delivery at 36 weeks; one term vaginal delivery; one miscarriage one day post-operatively with infection; one lost to follow-up | Small sample size of patients with myomectomy in first trimester; one of whom was lost to follow-up |
Celik[4] | Case series (second trimester) | n = 5 myomectomies after failing conservative management with mean GA of 18 weeks and myoma size ranging 10 cm to 20 cm | Mean GA at time of delivery was 39 weeks | Small sample size |
Mollica[5] | Prospective (first and second trimester) | n = 106 gravid patients with myomas, 10 weeks to 19 weeks: 18 myomectomies for recurrent pain, large (> 10 cm) or 'rapidly growing' myomas, or 'medium-large' myomas in lower uterine segment or affecting placental site | Myomectomy versus conservative: pregnancy loss: 0% versus 13.6%; PROM: 5.6% versus 22.7%; preterm labor: 5.6% versus 21.6%; post-C/S hyst: 0% versus 4.5% | GA not compared to outcomes |
Lolis[6] | Prospective (second trimester) | n = 622 gravid patients with myomas: 16 with complications of pregnancy → 13 myomectomies for rapidly growing, failing conservative management, and distance from endometrial cavity > 5 mm versus three expectant management; myomas ranged in size from 105 g to 2274 g | Myomectomy versus conservative: pregnancy loss: 8.7% versus 33.3% → Myomectomy: one SAB after surgery at 15 weeks and one C/S at 29 weeks for placenta previa Conservative: PPROM at 22 weeks with PPH requiring hysterectomy | Small number of patients with pregnancy complications due to myomas |
Makar[8] | Case report (second trimester) | n = 1: 14 week pregnant patient presented with progressive lower abdominal pain and an ex-lap showed a 12 cm pedunculated myoma in the pouch of Douglas | 'Gravid myomectomy should only be performed during 14th to15th weeks' | Conclusions limited to14 weeks to 15 weeks |
Bonito[9] | Case series (first and second trimester) | n = 5 myomectomies for symptomatic patients whose myomas were resistant to conservative management | three spontaneous deliveries and two Cesarean sections | Small sample size |