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Table 1 Summary of studies, case reports and case series

From: First trimester myomectomy as an alternative to termination of pregnancy in a woman with a symptomatic uterine leiomyoma: a case report

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
  1. C/S: cesarean section; ex-lap: exploratory laparatomy; GA: gestational age; hyst: hysterectomy; PPH; postpartum hemorrhage; PPROM: preterm premature rupture of membranes; PROM: premature rupture of membranes; PTL: preterm labor; S/TAB: spontaneous/therapeutic abortion.