Elective cesarean myomectomy: A report of two cases

Abstract

Myomectomy at the time of cesarean section has traditionally been discouraged due to the risks of hemorrhage and increased postoperative morbidity. However with the new frontiers in surgical practice, successfully performed cesarean myomectomies in selected patients has continuously been reported. Two cases of multiple uterine leiomyoma coexisting with pregnancy were selected, counseled, and had elective cesarean myomectomy. The first patient was a 38-year-old primigravida with 22 years history of subfertility. Her antenatal period was largely uneventful. Her evaluation revealed a singleton pregnancy coexisting with multiple uterine fibroid. At 38 weeks of gestation, she had cesarean section and myomectomy. Thirty-six seedlings were removed. The largest was 12 Χ 8 cm and she lost 1 L of blood. She was discharged home on the 8 th postoperative day in good condition. The second case was a 33-year-old primigravida who was diagnosed with uterine fibroid in pregnancy. She also had an uneventful antenatal care and at 38 weeks gestational age, she had the removal of a huge intramural leiomyoma from the lower uterine segment (12 Χ 14 cm) during cesarean section to get access to the baby. She lost 1.2 L of blood and was transfused two pints of blood. Her postoperative condition was satisfactory. She was discharged home on the 7 th postoperative day. Cesarean myomectomy can be successfully performed with careful planning, patient selection, and skillful surgery. However, blood transfusion services should be available.