Objective: To evaluate population characteristics and obstetrical complications post-myomectomy vs. fibroids in situ. Design: Retrospective cohort study. Setting: Hospital discharges from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (2004-2014). Population: 14,206 pregnancies post-myomectomy and 81,517 with fibroids in situ. Methods: Multivariate logistic regression with adjustment. Main Outcome Measures: Pregnancy, delivery, and neonatal outcomes. Results: Post-myomectomy patients were younger, with lower BMIs, higher IVF use, more commonly Caucasians or Hispanics, and had higher rates of pregestational diabetes, smoking, illicit drug use, previous cesarean delivery, and multiple gestations, compared to the in situ fibroids group. Post-myomectomy patients had decreased rates of gestational hypertension (aOR 0.87, 95%CI 0.77-0.97), eclampsia (aOR 0.76, 95%CI 0.32-0.81), gestational diabetes (aOR 0.83, 95%CI 0.77-0.90), spontaneous vaginal deliveries (aOR 0.09, 95%CI 0.08-0.11), postpartum hemorrhage (aOR 0.77, 95%CI 0.68-0.88), and intra-uterine fetal death (aOR 0.64, 95%CI 0.43-0.97). Conversely, they had increased risks of placenta previa (aOR 1.40, 95%CI 1.20-1.64), preterm delivery (aOR 1.16, 95%CI 1.07-1.24), cesarean section (aOR 8.64, 95%CI 7.71-9.69), uterine rupture (aOR 2.21, 95%CI 1.31-3.74), transfusions (aOR 1.79, 95%CI 1.59-2.02), and congenital anomalies (aOR 2.35, 95%CI 2.01-2.75). Conclusions: The in situ fibroid group experienced different complications than the post-myomectomy group. Pregnancies post-myomectomies could benefit from additional screening or interventions during pregnancy to reduce complications from malplacentation and ensure delivery in specialized centers to mitigate risks. Patients should be counseled regarding these potential risks. Increased understanding of the role of myomectomies on reproductive outcomes requires further prospective studies.