PREDICTORS OF FETAL MALPRESENTATION IN WOMEN WITH A HISTORY OF MYOMECTOMY: THE ROLE OF FIBROID LOCATION AND SURGICAL TIMING

Objective: To evaluate whether fibroid location at the time of myomectomy and other fibroid characteristics predict fetal malpresentation in subsequent pregnancies. Design: Retrospective cohort study. Materials and Methods: Patients who underwent myomectomy and subsequent pregnancies at Staten Island University Hospital from 2019-2023 were reviewed. Variables collected included fibroid location classified by the FIGO leiomyoma subclassification system, fibroid size, weight, and number, myomectomy-to-delivery interval, estimated blood loss at myomectomy, presence of intraoperative adhesions, mode of conception, and prior abdominal surgical history. The primary outcome was fetal malpresentation at delivery, defined as any non-vertex presentation including breech, transverse, or oblique lie. Categorical variables were compared using chi-squared. Univariable logistic regression was performed for all continuous predictors, reported as odds ratios (OR) with 95% confidence intervals. Statistical significance was set at p < 0.05. Results: A total of 43 patients were included, of whom 7 (16.3%) had fetal malpresentation at delivery. Fibroid location was significantly associated with malpresentation (p = 0.022), with subserosal and pedunculated fibroids showing the highest malpresentation rate at 26.7% compared to 4.8% of patients with intramural fibroids. On univariable logistic regression, the myomectomy-to-delivery interval was the only continuous variable independently associated with malpresentation, with each additional month increasing the odds of malpresentation by 15.5% (OR 1.155, 95% CI 1.019–1.308, p = 0.048). Fibroid size, weight, and number of myomas were not significantly associated with malpresentation. Adhesions, IVF conception, and prior abdominal surgery also did not reach statistical significance. Conclusions: Subserosal and pedunculated fibroid location at the time of myomectomy and a longer myomectomy-to-delivery interval are associated with increased risk of fetal malpresentation in subsequent pregnancies. These findings suggest that fibroid location and surgical timing should be incorporated into preconception and prenatal counseling for patients with a history of myomectomy. Prospective studies with larger sample sizes are needed to validate these findings and clarify the underlying mechanisms.