Why your clinician may recommend a 37‑week C‑section after myomectomy
If you’ve had a prior myomectomy (surgical removal of uterine fibroids) or you have significant fibroids in pregnancy, your obstetrician may recommend a planned cesarean birth before 39 weeks—often around 37 weeks. The goal is to balance two priorities: reducing the (low but real) risk of uterine rupture during labor after a uterine surgery, and avoiding unnecessary early‑term delivery.
In guidance from obstetric societies, including the American College of Obstetricians and Gynecologists (ACOG), planned delivery between 37 weeks 0 days and 38 weeks 6 days is reasonable for people with a history of myomectomy that necessitates cesarean delivery, with the exact timing individualized to your surgical history and current pregnancy (ACOG: Medically Indicated Late‑Preterm and Early‑Term Deliveries).
Understanding the timing: early‑term versus full‑term
ACOG and the Society for Maternal‑Fetal Medicine define early‑term as 37 weeks 0 days through 38 weeks 6 days, and full‑term as 39 weeks 0 days through 40 weeks 6 days. Babies born at early‑term generally do well, but they have higher risks of transient breathing problems, low blood sugar, and short NICU stays compared with those born at 39–40 weeks. When there’s a clear medical reason—like a prior uterine surgery with rupture risk—the benefits of earlier delivery can outweigh these risks.
Why a cesarean after myomectomy?
The decision hinges on how your uterus was incised and repaired during the myomectomy. Deeper, full‑thickness incisions or those that enter the uterine cavity can weaken the scar and raise the chance of uterine rupture during labor. Published estimates suggest the overall risk of rupture after myomectomy is low (often cited around 0.5–1%), but it is higher with extensive or multiple full‑thickness incisions. Because rupture can be sudden and dangerous for both mother and baby, many clinicians recommend a planned cesarean—and to schedule it before labor is likely to start on its own.
Key factors your team considers:
- Type of myomectomy (open, laparoscopic, or hysteroscopic) and whether the uterine cavity was entered
- Number, size, and location of fibroids removed and the number of uterine incisions
- Quality of closure and operative report details
- Current pregnancy factors (placenta location, fetal growth, presence of active fibroids)
What if you go into labor before the scheduled date?
Call your obstetric team or go to labor and delivery right away if you have regular contractions, vaginal bleeding, or if your water breaks before your scheduled cesarean. If you’ve been advised to avoid labor because of rupture risk, you will usually have an expedited cesarean once you arrive. Induction of labor is generally avoided in people whose prior myomectomy requires a cesarean birth.
Do you need steroid shots or a lung‑maturity test before 37‑week delivery?
For medically indicated deliveries at 37 weeks, antenatal corticosteroids (e.g., betamethasone) are not typically recommended. Steroids are used mainly between 34 weeks 0 days and 36 weeks 6 days if delivery is likely within 7 days, to reduce newborn breathing problems. Similarly, amniocentesis to test fetal lung maturity is no longer recommended to justify early‑term delivery. If there’s a medical indication (like prior myomectomy with rupture risk), the delivery should proceed based on that indication rather than a lung‑maturity test.
How fibroids affect pregnancy and the cesarean plan
Most fibroids stay stable in pregnancy, but they can increase risks of malpresentation (baby not head‑down), preterm birth, placental problems, cesarean delivery, and postpartum hemorrhage. Large or strategically placed fibroids can sometimes influence the surgical approach—for example, the surgeon may adjust the uterine incision to avoid a fibroid, and in rare cases a classical (vertical) uterine incision might be needed. Your team will plan ahead, often using late‑pregnancy ultrasound to map fibroid size and location.
Can fibroids be removed during the cesarean? Historically, removing fibroids at the time of cesarean was avoided due to bleeding risk. More recent data suggest that in carefully selected cases, an experienced surgeon can safely remove certain fibroids during cesarean with appropriate preparation. This is individualized—ask your surgeon about risks, benefits, and whether removal is advisable in your case.
Pre‑op planning: what to expect
- Review of prior operative reports: Details from your myomectomy help refine timing and surgical planning.
- Group B strep (GBS) screening: Typically done at 36–37 weeks. If positive, antibiotics are given during labor or before cesarean after membranes are ruptured.
- Labs and consent: Blood count, blood type and screen; informed consent for cesarean, possible transfusion, and backup plans.
- Medications and fasting: You’ll receive instructions about when to stop eating/drinking. Many hospitals give an antacid before surgery.
- Hemorrhage preparedness: Your team may plan uterotonics (to help the uterus contract), tranexamic acid, and crossmatched blood on standby, especially if fibroids are large.
Day‑of‑surgery: how the cesarean typically unfolds
Most planned cesareans are done with regional anesthesia (spinal or combined spinal‑epidural), allowing you to be awake. A low transverse skin incision is common. The uterine incision is usually low and horizontal as well, but if fibroids obstruct the typical location, your surgeon will choose the safest approach to reach the baby while minimizing bleeding and future risk. After birth, you can expect delayed cord clamping unless there’s a concern, and early skin‑to‑skin contact if mother and baby are well.
Newborn considerations at 37 weeks
Early‑term babies usually do very well. Compared with delivery at 39–40 weeks, they have a modestly higher chance of transient tachypnea (fast breathing), brief oxygen support, hypoglycemia, temperature instability, or short NICU observation. Your care team schedules the cesarean as late as safely possible to reduce these risks while avoiding labor onset.
Recovery and what comes next
- Pain control and mobilization: Early movement reduces blood clot risk and supports recovery.
- Bleeding monitoring: Fibroids can increase postpartum hemorrhage risk; your team will monitor closely.
- Breastfeeding: Most people can breastfeed after a 37‑week cesarean; lactation support is available.
- Future pregnancies: Your operative note will guide future plans. If a classical uterine incision was required, future deliveries will also be by planned cesarean, typically earlier (around 36–37 weeks). If a standard low transverse incision was used and there’s no other contraindication, future timing may differ.
Smart questions to ask your obstetrician
- Did my prior myomectomy enter the uterine cavity or involve multiple deep incisions?
- Why is 37 weeks the safest timing in my case? Could we aim for later if all remains stable?
- What is the plan if I start contracting before my scheduled date?
- Will any fibroids be removed during my cesarean? What are the pros and cons?
- What type of uterine incision do you anticipate, and how might that affect future deliveries?
Bottom line
A scheduled cesarean at 37 weeks after a significant myomectomy is a precautionary plan to prevent labor‑related uterine rupture while still aiming for a gestational age when most babies thrive. The exact timing should be individualized, based on your prior surgery and current pregnancy details, and decided through shared decision‑making with your care team.
References and trusted resources
- ACOG. Medically Indicated Late‑Preterm and Early‑Term Deliveries. Committee Opinion No. 831. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/07/medically-indicated-late-preterm-and-early-term-deliveries
- ACOG/SMFM. Definition of Term Pregnancy. Committee Opinion No. 579. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/11/definition-of-term-pregnancy
- ACOG. Avoidance of Nonmedically Indicated Early‑Term Deliveries and Associated Neonatal Morbidities. Committee Opinion No. 765. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/avoidance-of-nonmedically-indicated-early-term-deliveries-and-associated-neonatal-morbidities
- ACOG. Antenatal Corticosteroid Therapy for Fetal Maturation. Committee Opinion No. 713. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/antenatal-corticosteroid-therapy-for-fetal-maturation
- ACOG & CDC. Prevention of Group B Streptococcal Early‑Onset Disease in Newborns. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns
- SMFM Consult Series: Fibroids in Pregnancy—Management (overview). https://www.smfm.org/publications
- NIH/NICHD. Uterine Fibroids. https://www.nichd.nih.gov/health/topics/uterine
