Abstract
BACKGROUND: To systematically evaluate risk factors associated with pregnancy-related uterine rupture following laparoscopic myomectomy (LM) and provide evidence-based guidance for clinical decision-making. METHODS: A comprehensive search of PubMed, Embase, Web of Science, and other databases was conducted to identify observational studies published up to March 31, 2025. Relevant data on risk factors for post-LM uterine rupture during pregnancy were extracted, and meta-analysis was performed using RevMan 5.4. RESULTS: Eleven high-quality studies encompassing 188,769 patients were included. Meta-analysis revealed that larger fibroid size (MD = 0.54; 95% confidence intervals [CI]: 0.29-0.79), elevated prepregnancy body mass index (BMI) (MD = 2.93; 95% CI: 2.20-3.66), earlier gestational age (MD=-3.01; 95% CI: -4.94 to -1.08), history of pregnancy (odds ratio [OR] = 2.82; 95% CI: 1.82-4.37), scarred uterus (OR = 2.49; 95% CI: 1.04-5.97), and prior uterine surgery (OR = 7.05; 95% CI: 2.43-20.40) were significantly associated with increased risk of uterine rupture (all P < .05). No statistically significant associations were observed for age, preconception BMI, blood transfusion, and other evaluated factors. CONCLUSION: Pregnancy-related uterine rupture after LM is associated with multiple factors, including fibroid size, elevated BMI, and placental abnormalities. Careful preoperative risk assessment, optimization of suturing techniques, and enhanced pregnancy monitoring are recommended to mitigate risk.