A 33-year-old woman undergoes laparoscopic myomectomy for a 6 cm intramural fibroid. The uterine closure is performed in layers with barbed suture. She conceives 6 months later. At what gestational age is the risk of uterine rupture highest, and what is the recommended delivery plan?
- A First trimester; elective termination recommended
- B During labor; elective cesarean at 38 to 39 weeks before onset of labor ✓
- C Second term; elective cesarean at 37 to 38 weeks
- D Postpartum; vaginal delivery is safe with prior myomectomy
Correct answer: B. During labor; elective cesarean at 38 to 39 weeks before onset of labor
Explanation
Uterine rupture after myomectomy is rare but most likely to occur during labor when uterine contractions stress the scar. Elective cesarean delivery at 38 to 39 weeks before the onset of labor is recommended after full-thickness myomectomy that enters the endometrial cavity. The risk is lower when the cavity is not entered, but most guidelines still recommend cesarean delivery for deep intramural myomectomy. Vaginal delivery may be considered in selected cases with superficial myomectomy.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.