Successful Low-Dose Oxytocin Induction of Labor at 40+5 Weeks in a Primigravida With Prior Laparoscopic Myomectomy Preserving the Endometrial Cavity: A Case Report.

Induction of labor in women with a prior uterine scar from myomectomy remains a clinically challenging decision, primarily due to concerns about uterine rupture. The risk of rupture varies substantially depending on whether the endometrial cavity was entered during surgery, the depth of myometrial involvement, and the suturing technique employed. We report a case of a 30-year-old primigravida (G1P0) who had undergone laparoscopic myomectomy three years prior for a 5×3 cm subserosal-intramural fibroid, with multilayer uterine closure and without breach of the endometrial cavity. Following membrane sweeping at 39 weeks of gestation, spontaneous labor did not ensue. At 40+5 weeks, with a Bishop score exceeding six and cervical dilatation of 4 cm, oxytocin induction was commenced using a low-dose protocol (30 units in 500 mL). The patient delivered vaginally within 10 hours of oxytocin initiation. The neonate was born in good condition, weighing 3,130 g, measuring 51 cm, with APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scores of 9/10 and umbilical arterial cord pH of 7.32. No uterine rupture, neonatal morbidity, or other significant maternal complications were observed. This case supports the feasibility of low-dose oxytocin induction in carefully selected women with a prior laparoscopic myomectomy when the endometrial cavity was not entered and multilayer closure was performed, and contributes to the growing body of evidence that individualized intrapartum management may be appropriate in this setting.