KSMFM factsheet on obstetric complications after myomectomy or adenomyomectomy: uterine rupture and placenta accreta spectrum

Pyeon SY, Seung Yeon Pyeon, Kwon H, Hayan Kwon, Hyeon Ji Kim, Kim HJ, Ho Yeon Kim, Kim HY, Ji-Hee Sung, Sung JH, Gi Su Lee, Lee GS, Han YJ, You Jung Han, Seol HJ, Hyun-Joo Seol, Park JS, Joong Shin Park
Obstetrics & Gynecology Science · 2026 · doi:10.5468/ogs.26214 · PMID:42893824
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This Korean factsheet reviews obstetric complications following myomectomy and adenomyomectomy, highlighting higher uterine rupture rates after adenomyomectomy and the associated risks of placenta accreta spectrum.

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This factsheet addresses the rising incidence of obstetric complications following fertility-preserving surgeries for uterine leiomyoma and adenomyosis in Korea. It highlights that while myomectomy carries a uterine rupture risk of 0.5-1.52%, adenomyomectomy presents a significantly higher risk ranging from 3.2 to 12.5%. The authors note that rupture can occur spontaneously before labor, complicating clinical prediction, and emphasize the associated high risk of placenta accreta spectrum disorders. Relevance to endometriosis: not mentioned; relevance to adenomyosis: centrally about adenomyosis — specifically the obstetric risks associated with adenomyomectomy.

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Abstract

Over the past 20 years, as the number of women of reproductive age in Korea diagnosed with uterine leiomyoma and adenomyosis prior to pregnancy has increased, fertility-preserving uterine surgeries such as myomectomy and adenomyomectomy have also increased. Although these surgeries can preserve fertility, they can cause serious obstetric complications, such as uterine rupture and placenta accreta spectrum (PAS). The incidence of uterine rupture after myomectomy is reported to be 0.5-1.52%, whereas the incidence after adenomyomectomy is considerably higher, ranging from 3.2 to 12.5%. A key clinical characteristic is that rupture can occur before labor regardless of gestational age, making clinical prediction difficult. Furthermore, myomectomy and adenomyomectomy carry a high risk of PAS, which can lead to severe maternal and neonatal morbidity. Therefore, women of childbearing age should receive sufficient counseling before deciding on surgery and undergo thorough prenatal care throughout pregnancy.
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| KSMFM factsheet on obstetric complications after myomectomy or adenomyomectomy: uterine rupture and placenta accreta spectrum | | Seung Yeon Pyeon1, Hayan Kwon2, Hyeon Ji Kim3, Ho Yeon Kim4, Ji-Hee Sung5, Gi Su Lee6, You Jung Han7, Hyun-Joo Seol8 , Joong Shin Park9.10 | 1Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea 2Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea 3Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea 4Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea 5Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 6Department of Obstetrics and Gynecology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea 7Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, School of Medicine, Seoul, Korea 8Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea 9Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea 10Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea | Correspondence: Hyun-Joo Seol, Email: [email protected] Joong Shin Park, Email: [email protected] | | Received: 24 June 2026 Revised: 23 August 2026 Accepted: 13 September 2026 | | Abstract | | Over the past 20 years, as the number of women of reproductive age in Korea diagnosed with uterine leiomyoma and adenomyosis prior to pregnancy has increased, fertility-preserving uterine surgeries such as myomectomy and adenomyomectomy have also increased. Although these surgeries can preserve fertility, they can cause serious obstetric complications, such as uterine rupture and placenta accreta spectrum (PAS). The incidence of uterine rupture after myomectomy is reported to be 0.5-1.52%, whereas the incidence after adenomyomectomy is considerably higher, ranging from 3.2 to 12.5%. A key clinical characteristic is that rupture can occur before labor regardless of gestational age, making clinical prediction difficult. Furthermore, myomectomy and adenomyomectomy carry a high risk of PAS, which can lead to severe maternal and neonatal morbidity. Therefore, women of childbearing age should receive sufficient counseling before deciding on surgery and undergo thorough prenatal care throughout pregnancy. | | Keywords: Uterine myomectomy; Adenomyosis; Adenomyomectomy; Uterine rupture; Placenta accreta spectrum | |

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