Caesarean Myomectomy: Safety and Feasibility of The Procedure

Abstract

Introduction: Frequency of uterine myomas has increased these days with factors like delayed child bearing and IVF conception in elderly pregnant women. The vascularity of uterus increased and thus myomectomy during caesarean was considered a risk. With advanced surgical techniques the risk has become minimal these days. Case Report: 42 year G4P3L3 presented with 36 weeks gestation with USG s/o 3 large uterine fibroid, 2 subserosal fibroids with largest of size 7.1 x 6.3 x 7.2 cms, and 1 intramural fibroid. Emergency LSCS was done for her due to fetal indication. Due to emergency nature of surgery the option of preoperative uterine artery embolisation was not feasible and hence decision of stepwise de-vascularisation was taken. The de-vascularisation was done at the level of B/L uterine arteries, utero ovarian anastomosis bilaterally followed by removal of the three myomas. Discussion: Majority of myomas do not require surgical intervention during pregnancy or delivery. It has been repeatedly stated in the literature that routine myomectomy during cesarean section should be avoided and should only be carried out in carefully selected patients. In our case, stepwise devascularisation was required to control the bleeding. Proper devascularization and experienced obstetricians can reduce the incidence of haemorrhage and hysterectomy. The approximate blood loss was only 400 ml signifying the importance of this approach to myomectomy during caesarean section.