Myomectomy at Cesarean Delivery in Aba, Southeastern Nigeria

Abstract

INTRODUCTION: Myomectomy during cesarean delivery is usually avoided because of the risk of intractable hemorrhage. This study was undertaken to compare the efficacy and safety of cesarean myomectomy with a control group with uterine fibroids who had cesarean delivery without myomectomy. METHODS: A prospective clinical trial of cesarean myomectomy compared with cesarean delivery without myomectomy in women with uterine fibroids in pregnancy was carried out in Nigerian Christian Hospital, Aba, between March 2004 and March 2010. Thirty-four patients with uterine fibroids in pregnancy and who had cesarean delivery and myomectomy for various indications were selected. Thirty patients who also had uterine fibroids in pregnancy and had cesarean delivery alone were selected as control participants. RESULTS: The estimated blood loss, postoperative packed cell volume, and the need for blood transfusion and operation time were significantly higher in the cesarean myomectomy group when compared with those in the control group. Among patients in the study group, the need for blood transfusion and operation time were significantly higher in those who had greater than 10 myomas when compared with those who had less than 10 myomas. There was no significant difference in the incidence of postoperative fever and duration of hospital stay between the cesarean myomectomy patients and those in the control group. CONCLUSION: This study adds to growing body of evidence demonstrating the safety and efficacy of cesarean myomectomy in selected patients but it also shows that it should be carried out with caution and adequate cross matched blood, especially in patients with multiple fibroids.