Myomectomy, an alternative to a hysterectomy, is a surgical procedure that involves removing uterine fibroids, which are mostly benign and made up of connective tissue and muscle cells. The procedure preserves the uterine tissue, allowing for future pregnancy.
In a recent study, Lin et al. and colleagues concluded that hysteroscopic myomectomy increases the risk of placenta accreta spectrum (PAS) in the subsequent pregnancy. This study was published in the American Journal of Obstetrics & Gynecology.

This nationwide cohort study was conducted in Taiwan. National Health Insurance Research Database was used. The data included all pregnant patients who gave birth between 2008 and 2017. A 1:1 propensity-score estimation matching analyzed the impact of myomectomy on the PAS risk. The study compared different methods of myomectomy with the control group.
The effect of myomectomy on placenta accreta spectrum risk in subsequent pregnancies is still debated. This study aimed to examine the impact of myomectomy on PAS risk and explored different myomectomy techniques.
Key findings from this research study are:
Out of 1,371,458 pregnant patients, 11,255 pregnant patients had a history of myomectomy.
PAS risk in pregnant patients with a history of myomectomy was higher compared to those without myomectomy history, with 0.96% vs. 0.20% incidence and adjusted odds ratio of 2.28.
Of those with a history of myomectomy, 5,045 pregnant patients received laparotomic myomectomy, 3,973 received laparoscopic myomectomy, and 1,742 received hysteroscopic myomectomy.
PAS incidence in the hysteroscopic group was higher than in the laparotomic or laparoscopic groups.
The adjusted odds ratio for PAS was 3.88 in the hysteroscopic group compared to subjects without a history of myomectomy.

As acknowledged, the study was funded by the National Taiwan University Hospital.
They said, “In this large nationwide cohort study, we showed that myomectomy, especially hysteroscopic myomectomy, is tied to a greater risk of PAS in the subsequent pregnancy.
Reference:
Lin, M., Hsu, H., Tan, E. C., Shih, J., Chien‐Nan, L., Yang, J., Tai, Y., Torng, P., Chen, S., Li, H. Y., & Lin, S. (2023). Risk of placenta accreta spectrum following myomectomy: a nationwide cohort study. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2023.11.1251