A safe procedure for myomectomy during cesarean section

A Acar,A Pekin,F Ercan,F Kılıç,H Görkemli,M Sarıkaya,O Balcı

doi:10.12891/ceog4376.2019

A Acar, A Pekin + Show 5 more

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https://doi.org/10.12891/ceog4376.2019

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Abstract

Purpose of Investigation: A retrospective cohort study was performed to identify whether myomectomy at the time of cesarean delivery leads to an increased risk of intrapartum and short-term postpartum complications. The authors’ aim is to investigate the short-term outcomes of women who have undergone a cesarean myomectomy. Materials and Methods: This study included the cases that had undergone cesarean myomectomy between January, 2008 and December, 2015. Two hundred twenty-seven pregnant women with uterine myomas who delivered via cesarean section were identified. One hundred two women underwent cesarean myomectomy. The authors compared the maternal characteristics, type of myomas, neonatal weight, and operative outcomes between the two groups. Results: Two group analysis revealed that there were no significant differences in the mean hemoglobin change (1.5 ± 1.0 vs. 1.2 ± 0.9 mg/dL), and the length of hospital stay (3.9 ± 1.2 vs. 3.3 ± 1.4 days) between two groups. The operative time of myomectomy group was significantly longer (88.5 ± 19.5 vs. 58.0 ± 20.4 min, p < 0.01). No patient in either group required hysterectomy or embolization. Conclusions: Myomectomy during cesarean delivery does not appear to result in an increased risk of intrapartum or short-term postpartum morbidity.

Highlights

Uterine fibroids are the most common benign tumors of reproductive age with an incidence rate between 3.2% and 5% in pregnancy [1-3]
Ma et al [8] and Tinelli et al [9] suggested that cesarean myomectomy did not increase the risk of intraoperative hemorrhage, and uterine atony compared to cesarean sections without myomectomy
For defining the obstetric outcomes and risks of myomectomy procedure during cesarean delivery, we evaluated the pregnant women with uterine fibroids treated at our institute over a seven year-period

Summary

Introduction

Uterine fibroids are the most common benign tumors of reproductive age with an incidence rate between 3.2% and 5% in pregnancy [1-3]. Due to increasing tendency towards delayed childbearing, the incidence of pregnant women with fibroids increase gradually with advanced maternal age [4]. Cesarean section with myomectomy is considered to be dangerous due to increased vascularity of the pregnant uterus causing severe intraoperative bleeding tendency and risk of uterine atony [6]. Myomectomy during cesarean section is not always a hazardous procedure and it can be performed without significant complications by experienced obstetricians [7]. Ma et al [8] and Tinelli et al [9] suggested that cesarean myomectomy did not increase the risk of intraoperative hemorrhage, and uterine atony compared to cesarean sections without myomectomy

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Discussion

Conclusion