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Mahantesh Karoshi: Any Deep Myometrial Scar Needs Obstetric Planning in a Later Pregnancy
Mahantesh Karoshi/mahanteshkaroshi.co.uk
Sep 14, 2026, 18:11

Mahantesh Karoshi: Any Deep Myometrial Scar Needs Obstetric Planning in a Later Pregnancy

Mahantesh Karoshi, Co-Founder at Her Health Partnerships, shared on LinkedIn:

“Keyhole for a large fibroid (~9 cm)?

If pregnancy is still on the horizon, the route of myomectomy matters.

After removing a deep/large fibroid, the uterine wall needs a precise, multi-layered repair.

That reconstruction is technically harder through laparoscopic ports than with open surgery – less tactile feedback, less room to rebuild a thick myometrial bed.

Illustrative published comparison (Gil et al., 2020; HCUP-NIS):

  • Laparoscopic myomectomy – ~10.6 uterine ruptures per 1,000
  • Open myomectomy – ~4.2 per 1,000
    (Adjusted OR ~2.3 for rupture after laparoscopic vs. open)

Absolute risk remains low – but for fibroids typically >8–10 cm, many of us still favour open myomectomy when the priority is optimal uterine reconstruction for a future pregnancy.

Any deep myometrial scar needs obstetric planning in a later pregnancy (often a planned caesarean).

General information for clinicians and patients in conversation with their specialist – not personal medical advice.”

Mahantesh Karoshi: Any Deep Myometrial Scar Needs Obstetric Planning in a Later Pregnancy

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Fertility Fertility News laparoscopic myomectomy Large fibroid Mahantesh Karoshi Myomectomy OBGYN Open Myomectomy reproductive health Reproductive Medicine Women’s Health
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