Cesarean Section After Fibroid Removal: Understanding the Risks & Options

Question
Hello,
My last menstrual period was around June 9th. I am 32 years old and have a set of twins age 8. They were delivered vaginally at 37 weeks. In March of 2003 I had a myomectomy to remove a fibroid tumor (~10cm) that was located in my uterus (wall). I am  now 6 weeks pregnant and my current ob/gyn has stated that I will need to have a c-section due to possibility of my uterus rupturing. Is this realy that cut and dry? Where can I go to research and find more information? I let her know that I was not interested in a c-section but she is being persistent. I remember the pain I was in from the myomectomy and cannot imagine trying to take care of a newborn in that condition. The incision on my stomach was ~3-4 inches below my navel and ~6inches long. There were no complications after the surgery. Your help is greatly appreciated.

Answer
It all depends on whether, when y8u had the myomectomy,the surgeons entered the uterine cavity to remove the fibroid that was on the wall of the uterus. If they did, indeed, enter the uterine cavity, you will have to deliver your next baby by cesarean section, due to the incision in the uterus and the risk of rupture of the uterus during labor due to the previous scar. There is a 1% risk of rupturing a uterus if you had a previous cesarean section. HOwever there is a greater risk of uterine rupture with a myomectomy because we do not know exactly where the incision was made (in the uterus) The skin incisioin that was made 3-4 inches below your belly button is not important. It is only the uterine incision that is significant. I would not allow a vaginal delivery in a woman who had a myomectomy in the past. It is not safe for the baby or for the patient.