Pregnancy And Live Birth Rates After The Use Of Tourniquet In Abdominal Myomectomy: A Retrospective Cohort Study

Objective: To determine whether the incidence of pregnancy and live birth is similar in women of childbearing age undergoing abdominal myomectomy (AM) with the use of a pericervical tourniquet compared with women undergoing AM without the use of a tourniquet.Design: A multicenter retrospective cohort study was conducted, consisting of a retrospective chart review and a self-administered questionnaire on reproductive outcomes.Methods: Women of childbearing age (18-45 years old) who underwent AM at two tertiary care centers between June 2002 and 2012 were consecutively sampled. Unadjusted and multivariable regression analyses were used to compare the two groups.Results: In total, 1097 patients met inclusion criteria and 160 returned the questionnaire. After excluding patients who did not attempt to conceive postoperatively, 82 patients were included in the final statistical analysis. Twenty-eight percent of surgeries involved use of pericervical tourniquet. Unadjusted analysis did not identify a significant association between the use of tourniquet and incidence of live birth (p = 0.35), postoperative pregnancy (p = 0.98), or length of time attempting conception after surgery (p = 0.80). After adjusting for age, parity, whether uterine cavity was entered, and number of fibroids, there was no significant difference in incidence of live birth or postoperative pregnancy between the two groups.Conclusion: Our study suggests no significant association between use of tourniquet and pregnancy and live birth rates. Concerns about the tourniquet's impact on fertility may, therefore, be unfounded, and more widespread uptake of pericervical tourniquet during AM may contribute to limiting surgical blood loss. Further prospective research is warranted with larger sample sizes.