Cesarean Myomectomy Group Research Articles

Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study.

The safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques. This retrospective multicentric case-control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted. There was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS (p > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus (p > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization (p > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups. This study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.

Consequences of Concurrent Myomectomy and Caesarean Section versus Caesarean Section Alone in the Last Two Decades: Systematic Review and Meta-Analysis

Background: Performing myomectomy concurrently with a caesarean section has been controversial for many decades. Objective: The present study mainly aims to evaluate the consequences of concurrent myomectomy and caesarean section versus caesarean section alone. Methods: In this systematic review, we have followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic resources, such as MEDLINE, Cochrane, EMBASE, Scopus, and PubMed, were searched. A total of 3057 articles were reviewed. Of these, 33 met the inclusion criteria and were included in the final analysis. The reviewed outcomes were hemoglobin (Hb) before and after the operation, blood transfusion rate, hemorrhage, operation time, duration of hospitalization, and complications, such as fever. Results: A meta-analysis of 33 articles with 5586 participants in the caesarean myomectomy (CM) group and 2935 participants in the caesarean section (CS) group showed a statistically significant Hb decrease in the CM group [MD = 0.26, CI=95%(-0.33 to -0.19)]. The transfusion rate was higher in the CM group [OR=0.39(0.42-0.67)], and intraoperative hemorrhage was higher in the CM group [OR=0.56 (0.45 - 0.75) CI=95%]. The mean operation time [MD=1.17(1.10 -1.24) CI=95] and hospitalization time [MD=0.41 (0.34-0.48) CI=95%] were significantly higher in the CM group. There was no significant difference in the incidence of fever between the two groups [MD =1.06, CI=95%, p=0.923(0.78-1.43)]. Conclusion: Concurrent CM is associated with a reduction in mean Hb and an increase in operation time and hospitalization time; however, it prevents additional surgery and costs; it is worthwhile to perform myomectomy at the time of caesarean section, especially by experienced surgeons with necessary preparations.

Risk factors based on myoma characteristics for predicting postoperative complications following cesarean myomectomy.

To evaluate the influence of myoma characteristics on cesarean myomectomy and to demonstrate its additional advantages. Retrospective data were collected from 292 women with myomas who had undergone cesarean section at Kangnam Sacred Heart Hospital between 2007 and 2019. We performed subgroup analysis according to the type, weight, number, and size of myomas. Preoperative and postoperative hemoglobin levels, operative time, estimated blood loss, length of hospital stay, incidence of transfusion, uterine artery embolization, ligation, hysterectomy, and postoperative complications were compared among subgroups. There were 119 patients who had cesarean myomectomy and 173 who had cesarean section only. An increase in postoperative hospitalization and operation time was observed in the cesarean myomectomy group compared to that in the caesarean section only group (mean difference, 0.7 days, p = 0.01, 13.5 minutes, p <0.001). Estimated blood loss, hemoglobin differences, and transfusion rates were higher in the cesarean myomectomy than in the cesarean section only group. There were no differences in postoperative complications (fever, bladder injury, and ileus) between the two groups. No hysterectomy cases were reported in the cesarean myomectomy group. In subgroup analysis, the larger and heavier the myoma, the higher the risk of bleeding that led to transfusion. Estimated blood loss, differences in hemoglobin, and transfusion rate increased depending on myoma size and weight. A significant increase in postoperative hospitalization was observed in women with larger and heavier myomas. However, there was no statistical difference among the three types of myomas. In cesarean myomectomy, larger (≥ 10 cm), and heavier myomas (≥ 500 g), were associated with postoperative outcomes, but not the number or type of myoma. The safety of cesarean myomectomy is not inferior to that of caesarean section only, considering its positive effects such as gynecological symptom relief and avoidance of the next surgery.

The trend in cesarean myomectomies and the risk of obstetrical complications in Korea

BackgroundTo evaluate pregnancy outcomes and the risk of adverse obstetrical outcomes of cesarean myomectomy (CM) compared with cesarean section (CS) only, and to investigate the trend of surgeons in choosing CM.MethodsA retrospective cohort study was performed on all patients who underwent CS complicated by leiomyoma at two university hospitals between January 2010 and May 2020. All patients were categorized into the CM (341 women) or CS-only (438 women) group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups.ResultsWomen who underwent CS only were significantly more likely to have a previous myomectomy and multiple leiomyoma history than women who underwent CM. The gestational age at delivery and pregnancy complications were significantly higher in the CS-only group. The mean size of the leiomyomas was larger in the CM group than in the CS-only group (5.8 ± 3.2 cm vs. 5.2 ± 3.1 cm, P = 0.005). The operation time and history of previous CS and preterm labor were higher in the CM group. The leiomyoma types differed between the two groups. The subserosal type was the most common in the CM group (48.7%), and the intramural type was the most common in the CS-only group. Patients in the CM group had fewer than three leiomyomas than those in the CS-only group. Preterm labor and abnormal presentation were relatively higher in the CM group than in the CS-only group, concerning leiomyoma presence. There were no significant differences in the preoperative and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07–1.25; P < 0.001) and operation time > 60 min (OR = 2.461; 95% CI: 1.45–4.15) were significant independent predictors of adverse outcomes after CM.ConclusionsCM should be considered a reliable and safe approach to prevent the need for another surgery for remnant leiomyoma. Herein, surgeons performed CM when uterine leiomyomas were large, of the subserosal type, or few. Standardized treatment guidelines for myomectomy during CSs in pregnant women with uterine fibroids should be established.

Maternal complications following caesarean myomectomy and caesarean alone-an observational comparative study

Uterine leiomyoma is the commonest tumour of female genital tract. Earlier myomectomy at caesarean sections was generally avoided due to fear of intractable haemorrhage and atonicity leading to subsequent hysterectomy and future fertility issues. The aim of this study is to compare the intra-operative and post-operative complications following caesarean myomectomy and caesarean section alone in antenatal patients with myomas. A hospital based observational comparative study was peformed on 38 antenatal woman with myomas, include 19 antenatal patients with myomas who were posted for caesarean myomectomy compared with age matched 19 antenatal women who were posted for caesarean alone , were selected for the study in the department of obstetrics and gynecology. In the present study patients mean age was of 30.8+5 yearsand 30.8+5 years respectively for caesarean myomectomy and caesarean group. Out of the 38 patients 15 patients were primipara and 13 patients were multipara. The duration of surgery for caesarean myomectomy was 65 ± 12.9minutes compared to 47.4 +4.2 minutes in caesarean only group. Out of the 38 patients mean and standard deviation of hemoglobin fall during surgery in caesarean myomectomy was 1.1+0.7gm/dl when compared to 0.7+0.2gm/dl in caesarean group. And 2 patients needed blood transfusions post-operatively in caesarean myomectomy compared one patient in caesarean group. The hospital stay in hours in caesarean myomectomy was 126.3±10.9 hours and 121.3±5.5 hours in caesarean group. None of them ended on obstetric hysterectomy. In this study, No significant difference was observed in haemoglobin change, incidence of intra-operative complications and length of hospital stay, in the caesarean myomectomy group as compared to other post caesarean group. The possibility of performing myomectomy during caesarean section has become a safe procedure with experienced surgeons and anaesthetic facilities

Myomectomy during cesarean section: is it a redundant or a feasible procedure?

Aim: The aim of this study was to evaluate the postoperative course of myomectomies performed during cesarean deliveries at a tertiary hospital and determine the safety of this procedure. Materials and Methods: The clinical characteristics and postoperative outcome of 64 patients who underwent cesarean myomectomy and 75 patients who underwent cesarean delivery only were compared retrospectively. The operative times and complete blood count (CBC) parameters obtained preoperatively and on the first and second postoperative days were recorded. The clinical course of each pregnancy and postoperative complications, such as bleeding necessitating blood transfusions, fever and uterine atony were recorded. Results: No difference was detected in the mean preoperative and postoperative days 1 and 2 CBC parameters between the two groups. The change between preoperative and postoperative day 1 mean CBC parameters was not significantly different between the two groups, however the mean change in the CBC parameters between preoperative day 1 and postoperative day 2 was statistically significantly higher in the myomectomy group (p = 0.034) when compared with the non-myomectomy group. The mean operative time in the cesarean myomectomy group was significantly longer than the non-myomectomy group (p = 0.004). Conclusions: A higher amount of blood loss is encountered in those who underwent cesarean myomectomy than those who underwent cesarean delivery only, however, because the incidence of severe hemorrhage is not significantly different between the two groups, hence the authors conclude that cesarean myomectomy is a safe and feasible procedure, for subserosal as well as for intramural ones.

Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas

ObjectiveTo determine whether myomectomy during cesarean delivery is safe and feasible among pregnant women with leiomyomas. MethodsIn a retrospective study, data were reviewed from pregnant women with uterine leiomyomas who delivered by cesarean at a center in Turkey between May 1, 2007, and April 30, 2014. Women were divided into two groups: cesarean myomectomy (CM) or cesarean only (CO). Data were analyzed for characteristics of the uterine leiomyomas, hematologic changes occurring between the preoperative and postoperative periods, duration of the operation, and length of hospital stay. ResultsOverall, 76 women formed the CM group and 60 formed the CO group. The mean diameter of the leiomyomas did not differ between CM and CO groups (4.6±2.5cm vs 5.2±2.2cm; P=0.175). More patients in the CM group than in the CO group had subserous (24 [31.6%] vs 7 [11.7%]; P=0.006) and uterine corpus (57 [75.0%] vs 30 [50.0%]; P=0.003) leiomyomas. Fewer patients in the CM group had intramural (44 [57.9%] vs 49 [81.7%]; P=0.003) and fundal (15 [19.7%] vs 25 [41.7%]; P=0.005) leiomyomas. ConclusionSurgeons were more likely to remove corporal and subserous leiomyomas than other types; size did not seem to affect decision making. CM can be a safe operation for some patients.

Myomectomy at Cesarean Delivery in Aba, Southeastern Nigeria

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.

The safety of cesarean myomectomy in women with large myomas.

ObjectiveTo evaluate the safety of cesarean myomectomy in large myomas sized >5 cm.MethodsOne hundred sixty-five pregnant women with myomas who delivered via cesarean section were identified. Ninety-six women had cesarean section without myomectomy, and 65 women underwent cesarean myomectomy. We compared the maternal characteristics, neonatal weight, myoma types, and operative outcomes between two groups. We further analyzed cesarean myomectomy group according to myoma size. The large myoma was defined as myoma >5 cm in size. The maternal characteristics, neonatal weight, and myoma types were compared between two groups. We also compared the operative outcomes such as preoperative and postoperative hemoglobin, operative time, and hospitalized days between two groups.ResultsThere were no significant differences in the maternal characteristics, myoma types, neonatal weight and operative outcomes between cesarean section without myomectomy and cesarean myomectomy. The subgroup analysis according to myoma size (>5 cm or not) in cesarean myomectomy group revealed that there were no significant differences in the mean hemoglobin change (1.2 vs. 1.3 mg/dL, P=0.6), operative time (90.5 vs. 93.1 minutes, P=0.46), and the length of hospital stay (4.7 vs. 5.2 days, P=0.15) between two groups. The comparison of maternal characteristics, neonatal weight, and myoma types between two groups also showed no statistical significance.ConclusionCesarean myomectomy in patients with large myomas is a safe and effective procedure.

Safety of cesarean myomectomy

To examine the safety and appropriateness of uterine myomectomy during cesarean section. We conducted a retrospective analysis of 97 patients who underwent myomectomy during cesarean section and 60 patients who had uterine myomas, but underwent cesarean section only, between January 2000 and December 2007. Based on the patients' medical records, we conducted an analysis of the characteristics of the uterine myomas, hematologic changes that occurred between the preoperative and postoperative phases, complications, and length of hospital stay. Changes in hemoglobin values between the preoperative and postoperative phases, indicating the degree of intraoperative bleeding, were evaluated. There were no significant differences between the two groups (cesarean myomectomy group [1.2 +/- 1.2 g/dL] versus control group [1.1 +/- 1.3 g/dL]). There were no significant differences in the frequency of blood transfusion, incidence of postoperative fever, duration of surgery, and length of hospital stay between the two groups. In patients who received a blood transfusion intraoperatively, the increased amount was added to the hemoglobin changes between the preoperative and postoperative phases (adjusted value). The difference in the adjusted value of hemoglobin change did not reach statistical significance (cesarean myomectomy group [1.3 +/- 1.2 g/dL] versus control group [1.2 +/- 1.1 g/dL]). When the size of the uterine myoma exceeded 6 cm, the operative time was longer in the cesarean myomectomy group. Cesarean myomectomy is a safe surgical option with no significant complications if performed by an experienced practitioner.

Caesarean myomectomy-a safe procedure. A retrospective case controlled study

Sixteen women, with uterine fibroids in pregnancy, who were treated by caesarean myomectomy, were compared retrospectively with 16 women, without uterine fibroids who had caesarean section during the same period. Myomectomy was performed at caesarean section after delivery of the baby and the placenta, with the administration of intravenous oxytocin. The fibroid defects were occluded with continuous interlocking and fixed sutures. Routine caesarean section was performed on the subjects in the control group. The comparative efficacy of the procedure was measured by comparing pre- and post-operative haemoglobin levels, measured blood loss, need for blood transfusion, post-operative febrile morbidity and length of hospital stay in both groups. Caesarean myomectomy resulted in a mean blood loss of 495 ml (range 200-1000 ml) compared with 355 ml (range 150-900 ml) in the control group (P =0.907). The caesarean myomectomy group had a mean fall in haemoglobin level of 1.7 g/dl compared with a fall of 1.4 g/dl in the control group. There were no significant differences between the groups in the need for blood transfusion, post-operative febrile morbidity or length of hospital stay. The results indicate that caesarean myomectomy is safe and offers no significant increased risk to the patient over caesarean section alone. This is beneficial to the health sector by the avoidance of an interval myomectomy hence justifying the cost effectiveness of the procedure.