Uterine fibroids are the most common benign tumors of the female reproductive organs, with an incidence of 20% to 30% and a trend of rejuvenation in recent years. Although fibroids are benign tumors, they can seriously affect the health and quality of life of women of childbearing age, and can also lead to infertility, spontaneous abortion, premature delivery and obstructed labor. For symptomatic, large or fast-growing fibroids, the traditional treatment method is mainly surgery. In recent years, with the rapid development and wide application of gynecologic endoscopic techniques, surgical treatment of uterine fibroids has gradually developed in the direction of minimally invasive hysteroscopic and laparoscopic surgical treatment that preserves the uterus and fertility, and the number of myomectomies removed before childbirth has increased, thus increasing the number of women who are pregnant again after surgery. In this issue, we report several cases of uterine rupture during pregnancy after laparoscopic myomectomy. In this paper, we present the relevant issues for the reference of the clinical workers in light of these case reports. 1. Indications for surgical treatment of uterine fibroids Surgery for uterine fibroids should be strictly indicated, i.e., uterus larger than 10 weeks of gestation, excessive menstruation followed by anemia, symptoms of bladder and rectal compression, rapid growth of fibroids and ineffective conservative treatment. For women who have not yet had children, surgery should be performed after excluding other factors that lead to infertility or recurrent miscarriage. 2.Surgical treatment of uterine fibroids Surgery for uterine fibroids mainly includes: 1.laparoscopic hysterectomy; 2.laparoscopic myomectomy (LM); 3.hysteroscopic myomectomy (TCRM); 4.surgery to block the blood supply of uterine fibroids. The choice of surgical methods should be based on a variety of factors such as the size, location, number of fibroids, the patient’s age, symptoms, the requirement and willingness to have children, etc. It is advisable to choose minimally invasive surgical methods that are simple to operate, less traumatic, quicker to recover, less likely to produce complications or sequelae, and to strictly master the indications and contraindications of various treatment methods. The skill and experience of the surgeon, the hospital’s equipment and the overall level of anesthesia guarantee the successful completion of the surgery. This article focuses on the last 3 types of procedures related to perinatal medicine. (a) Laparoscopic myomectomy ①Pioneering and improvement of LM: LM preserves the uterus, does not affect ovarian blood flow, and preserves the reproductive function. Its advantages are minimally invasive, rapid recovery, and reduced postoperative pain and adhesions. However, there are conflicting views on its indications, reproductive prognosis, especially postoperative uterine rupture, and postoperative recurrence rate. The advantages of pneumoperitoneum compared with pneumoperitoneum-infused laparoscopy are: (1) no complications related to carbon dioxide infusion; (2) the procedure is performed mainly with instruments used for open surgery, which is easy to operate and exact suturing; (3) shorter operative time and lower cost; and (4) myomas ≥8 cm in diameter can be removed. The disadvantage is the lack of compression of small vessels by the pneumoperitoneum to stop bleeding. The indications and contraindications for LM are as follows: (1) the operator is skilled in laparoscopic suturing; (2) the minimum diameter of interstitial or subplasma leiomyoma is ≥4 cm, the maximum diameter is ≤10 cm, and the tipped leiomyoma is preferred; (3) the number of leiomyoma is ≤10; (4) the possibility of leiomyoma malignancy is excluded. Contraindications: (1) signs of malignancy in the uterus; (2) pregnant uterus; (3) diameter <3>10; (5) tumor is too large and affects the operative field, generally the tumor exceeds 12 cm should not be operated; (6) tumor growth site is special and difficult to operate, such as the cervical area, in the broad ligament, near the ureter, bladder or uterine vessels. Among them, (5) and (6) are relative contraindications. In cases of excessive uterine size, preoperative GnRH-a treatment for 3 months or intraoperative blockade of the uterine artery (uterinearteryocclusion,UAO) may be used. Some studies have demonstrated that UAO does not affect ovarian function. (iii) LM incision and intraoperative bleeding: Sizzi et al. prospectively studied 2050 cases of LM. 37% were performed with vasoconstrictors, longitudinal incision, and 0-1 poglactin sutures in 1 to 2 layers. The complication rate was 11.0% (225/2050), with the most serious complication being hemorrhage (14 cases, 6.8%). It has been pointed out that the blood vessels in the uterus are distributed horizontally, and the incision of the uterus should not be made longitudinally; transverse incision is less bleeding and facilitates in vivo suturing. The incidence of uterine rupture in LM postoperative pregnancy: the incidence of rupture and perforation of the uterus without surgical trauma during pregnancy, labor, and postpartum is 1/2500 to 1/1200. the incidence of uterine rupture in LM postoperative pregnancy is about 0.5% to 1.5%, much higher than in non-LM and also higher than in TARM. before 2004, 15 cases of uterine rupture in LM postoperative pregnancy had been reported in the literature. The 16th case of postoperative uterine rupture after LM was reported by Malbert et al. in Italy in 2004. Since then, from 2005 to 2009, 7 more cases of uterine rupture in LM postoperative pregnancies at 20-35 weeks of gestation were retrieved from Medline. This phenomenon has been of great concern to the academic community. ⑤ Suggested duration of postoperative contraception after LM: Recent postoperative pregnancy, short healing time of scar tissue, poor local tissue elasticity and inflammatory cell infiltration. Most scholars believe that postoperative contraception should be used for six months to one year. (ii) Hysteroscopic myomectomy (TCRM) ① Preoperative pretreatment and indications for TCRM: The incidence of submucosal fibroids accounts for about 30% of uterine fibroids. In addition to submucosal fibroids, hysteroscopy can also remove intramural convex fibroids and fibroids close to the mucosa. Submucosal fibroids are often combined with chronic endometritis and have a higher risk of malignant transformation (smooth muscle sarcoma) or a tendency to bleed. Preoperative hysteroscopy should be routinely performed to exclude malignant lesions, which need to be determined by combined hysteroscopic ultrasound examination if necessary. To prevent fluid overload and hyponatremic encephalopathy, complications specific to hysteroscopic surgery, the duration of surgery should be strictly limited to 1h. Therefore, the uterine fibroids for TCRM surgery should not be too large, generally ≤5 cm in diameter is appropriate. For submucosal fibroids >5cm in diameter, oral gestodene or intramuscular GnRH-a drugs can be used for pretreatment to reduce the size of fibroids, increase the uterine cavity space, and reduce vascular regeneration to reduce intraoperative bleeding during TCRM, shorten the operative time, and decrease the difficulty of surgery. ② Pregnancy after TCRM with uterine rupture: TCRM is a minimally invasive procedure, and if there is no intraoperative uterine perforation, pregnancy can occur 2 months after surgery. Because the surgery is performed in the uterine cavity, even if the intermural myoma or type II submucosal myoma is removed close to the mucosa, the endometrium and muscle tissue covered by the surface of the myoma is first cut, the latter is a superficial muscle layer or submucosal layer, the muscle fibers are mostly longitudinal, with a small number of circumferential and oblique muscle fibers between them. In contrast, the hypertrophic muscle fibers were mainly circumferential, with a small number of oblique fibers and more blood vessels interspersed between the vascular layer and the submucosal layer, where the longitudinal and transverse muscle fibers were interspersed, were intact. The vascular network was also not damaged. Therefore, postoperative rupture of the pregnant uterus is rare. (iii) Surgery to block the blood supply to uterine fibroids This type of surgery refers to blocking the uterine artery that supplies blood to uterine fibroids and, if necessary, the anastomotic branch of the ovarian artery, so that the fibroids will atrophy, degenerate, stop growing and relieve the symptoms due to ischemia, and achieve the purpose of treatment. There are two main surgical methods as follows. ① Bilateral uterine artery embolization: It is clinically effective, minimally invasive, with few complications and low recurrence rate. 3 months after UAE treatment, the myoma shrinks, and 6 months it shrinks significantly. 5 years after surgery, the average myoma shrinkage rate is 40%~89%, and the recurrence rate is 10%~20%. The natural conception rate of those who have fertility requirement is 27%~52.27%. However, complications during pregnancy and delivery (please elaborate) are high. Usadi et al. reported a 16.3% spontaneous abortion rate and 12.5% abnormal placental attachment in postoperative pregnancies after UAE. Goldberg et al. reported a higher incidence of preterm delivery, antral abnormalities and postpartum hemorrhage in postoperative pregnancies after UAE than LM. The safety of UAE in patients with childbearing potential needs further study. ②Laparoscopic uterine artery ligation: It is used to treat symptomatic uterine fibroids, which can reduce the size of fibroids and effectively improve symptoms of excessive menstruation and dysmenorrhea. Its treatment effect is the same as that of UAE, but the patient does not have the severe abdominal pain as in UAE? With the development of minimally invasive gynecological techniques in the last 20 years, there are various options for the removal of symptomatic fibroids, such as open, laparoscopic, hysteroscopic, UAO, and UAE. The uterus is a reproductive organ and the choice and implementation of the procedure must take into account its impact on reproductive function and reproductive prognosis. Myomectomy is a simple procedure where removal of the fibroids facilitates fertility, but the surgical measures are unsafe and can lead to postoperative adhesions and pain, or even infertility; postoperative uterine rupture can lead to loss of the uterus or even loss of the patient. Operators must proceed with caution.