Risk of Uterine Rupture after Laparoscopic Myomectomy: Korean National Health Insurance Data

Study Objective

To evaluate the association between a history of myomectomy and obstetric complications, and to investigate whether risks vary by surgical approach.

Design

This population-based cohort study included singleton primiparous women who delivered between January 1, 2006, and December 31, 2022.

Setting

Logistic regression models were used to estimate adjusted odds ratios (aORs) for various obstetric outcomes, controlling for potential confounders. Additional subgroup analyses were conducted based on the surgical approach: laparotomy, laparoscopy, or vaginal myomectomy.

Patients or Participants

Among 237,531 women initially identified, those with missing body mass index (BMI) data were excluded, resulting in a final analytic cohort of 199,826. Participants were categorized into myomectomy (n = 8,675) and non-myomectomy (n = 191,151) groups. This patients were originated from Korean National Insurance data.

Interventions

NA

Measurements and Primary Results

A history of myomectomy was associated with increased risks of multiple obstetric complications, including mild and severe preeclampsia (aOR 1.48 and 1.69, respectively), placenta previa (aOR 1.73), preterm labor (aOR 1.23), PPROM (aOR 1.22), and threatened abortion (aOR 1.26; all p < 0.001). Interestingly, the risk of uterine rupture was significantly lower in the myomectomy group (aOR 0.70, 95% CI 0.58–0.84). Stratified analysis revealed that laparotomy was associated with the highest complication burden, while vaginal and laparoscopic myomectomy showed relatively lower or neutral risk profiles.

Conclusion

Myomectomy increases the risk of adverse obstetric outcomes; however, because minimally invasive surgical approaches do not increase the rate of uterine rupture, minimally invasive myomectomy remains a feasible option for women of reproductive age.