Cesarean myomectomy outcome in a Nigerian district hospital

Abstract

Background: Myomectomy is best planned and carried out when the uterus is not gravid, as this will increase the chance of a normal pregnancy with no complication attributable to the fibroid during pregnancy. However, in the developing parts of the globe, especially in Africa where uterine fibroid is most common. Although myomectomy during pregnancy is discouraged, there are situations when it becomes inevitable. Aim: The aim of the study was to analyze the outcome of 42 consecutive Cesarean myomectomy done under the supervision of a Sabbatical obstetrician and gynaecologist at a district hospital in Nigeria. Subjects and Methods: This was a prospective, descriptive study of all patients who underwent Cesarean Myomectomy between November 2011 and October 2012 in a Obio Cottage Hospital, Port Harcourt, Nigeria. Myomectomy done at the time of Cesarean section (CS). The main outcome measures were number, location, and size of the fibroids removed, intraoperative blood loss, intra and post‑operative complications, need for blood transfusion, and length of hospital stay. Data was entered into SPSS Vs 16 software and analysed. T-test was used to compare means and fishers exact test was carry out associations on non parametric data. Level of significance was set at P<0.05. Results: Four Hundred and Fourty Six womens were delivered by Cesarean section and 42 of these had Cesarean myomectomy. Between 1 and 23 uterine fibroids were removed from each patient. The biggest fibroid was 18 cm in diameter and it weighed 3.8 kg. The mean blood loss was 695.7 mls. (250-1600 mls). There were no significant intra‑operative complication and the mean length of hospitalization was 4.17 days (2.48). Three patients had one unit of blood transfusion while the fourth had seven. One patient had postoperative wound infection two weeks after discharge from the hospital. Conclusion: This series has added to the growing evidence of the safety of myomectomy during Cesarean section.