One hundred and six pregnant women with uterine myomas were admitted to a clinical protocol for operative or conservative management of myomas. The criteria for decision to submit to surgery were: (i) recurrent pain; (ii) large or rapidly growing myomas; (iii) large or medium myomas located in the lower uterine segment or deforming the placental site. According to these criteria 18 patients underwent myomectomy (operative group) and 88 were conservatively treated (conservative group). Complications and fetoneonatal outcome were monitored. The data were also compared to a control group of 2463 normal pregnant women. No spontaneous abortion occurred in the operated group, while the conservative group had a 13.6% spontaneous abortion rate (control group: 9.3%). The operated group had the highest cesarean section rate (93.7%), but no post-cesarean hysterectomy. The conservative group had a higher cesarean section rate compared with the pregnant women without myomas (34% vs 16.3%, respectively); they also had a 4.5% post-cesarean hysterectomy rate compared with 0.12% in the control group. Fetoneonatal outcome was good both in the conservative and operated group. The only perinatal death regarded a patient with a large myoma who refused surgery and went into premature labour at 32 weeks of gestation. Therefore, our study demonstrates that myomectomy during pregnancy is of advantage when performed early on selected patients.