EFFECT OF PRECONCEPTION MYOMECTOMY ON CONCEPTION, PREGNANCY AND BIRTH. SYSTEMATIC REVIEW

Abstract

Aim. To evaluate the impact of hysteroscopic, laparoscopic and open myomectomy on conception, pregnancy and birth by analysing the recent scientific literature. Methods. MEDLINE, CENTRAL, Wiley databases were searched. Using the PRISMA selection strategy, 9 publications were included in the systematic review. The articles were analysed and relevant information was described, such as the outcomes of pregnancies, deliveries and obstetric complications. Results. The analysis of 5 studies on laparoscopic and laparotomic myomectomy found that these interventions significantly improved the chances of conception (p < 0.001) and reduced the risk of miscarriage (p < 0.001). Also reduced the rate of natural births (p < 0.001) and increased the risk of preterm birth (p < 0.001). No statistical significance was found for other complications, such as uterine rupture and placental abnormalities (p = 0.0582). An analysis of 4 studies on hysteroscopic myomectomy found that hysteroscopic myomectomy significantly improved the chances of conception (p < 0.001) and reduced the risk of miscarriage (p = 0.00006). Other complications, such as caesarean section (p = 0.0646) and preterm birth (p = 0.7411), were not statistically significant. Conclusions. Myomectomy is the safest and most effective treatment for myomas in women seeking fertility preservation. This intervention improves the chances of conception, but laparoscopic and laparotomic myomectomy increases the risk of caesarean section and preterm delivery.