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Human Reproduction, Vol. 17, No. 11, 2967-2971, November 2002
© 2002 European Society of Human Reproduction and Embryology

Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study

J. Frederick1, M. Hardie, M. Reid, H. Fletcher, S. Wynter and C. Frederick

Department of Obstetrics, Gynaecology and Child Health, University Hospital of the West Indies, Kingston 7, Jamaica, W.I.

BACKGROUND: This prospective study was designed to evaluate the operative morbidity and reproductive outcome in patients who had secondary myomectomy for recurrent symptomatic uterine fibroids. METHODS: A total of 58 women were subjected to a secondary myomectomy via the abdominal route. The operative morbidity such as blood loss, presence of adhesions and febrile index were estimated and the pregnancy outcome over a 2–4 year period of follow-up. RESULTS: The mean age and standard deviation (± SD) of the women was 35 (± 2.4) years. Nineteen patients (33%) had a postoperative temperature 100°F and the estimated blood loss ranged from 159–2500 ml (median 700 ml). Seven patients (12%) required blood transfusion and one had a hysterectomy due to haemorrhage. Nine women (15.5%) became pregnant but only five (56%) had live births. Those with successful pregnancies tended to be younger with a mean age of 31.8 (± 2.6) years versus 35 (± 1.8) years, (P = 0.08, non-significant) and had fewer uterine leiomyomata; median with range values, 2 (1–6) versus 7 (6–15). The variables which best predicted the postoperative likelihood of pregnancy were; age, presence of tubal adhesions and the number of uterine fibroids. CONCLUSION: This prospective study showed a high operative morbidity and a poor fertility outcome after a repeat myomectomy. The factors affecting successful outcome in a logistic regression model were age, tubal adhesions and number of uterine fibroids.

Key words: operative morbidity/pregnancy outcome/secondary myomectomy/uterine fibroids

1 To whom correspondence should be addressed. E-mail: jfrederick{at}jamweb.net


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