Cesarean myomectomy: a case report and review of the literature

Abstract

Background Routine myomectomy at the time of cesarean section has been condemned in the past due to fear of uncontrolled hemorrhage and peripartum hysterectomy. It is still a topic of debate worldwide. However, in recent years, many case studies of cesarean myomectomy have been published validating its safety without any significant complications. Case presentation We describe the case of a 27-year-old gravida 2 para 1 live birth 1 North Indian woman with one previous lower segment caesarean section (LSCS) at 35 weeks with labor pains and scar tenderness. Her recent ultrasound (USG) report suggested a single live intrauterine pregnancy with an intramural fibroid of 8.6 × 6.5 cm located in the left anterolateral wall of the lower uterine segment. The patient was taken up for emergency cesarean section along with successful removal of the myoma, which was bulging into the incision line, causing difficulty in closure of the uterine wound. Prophylactically, oxytocin infusion, bilateral ligation of uterine arteries, and injection vasopressin (diluted) was administered to decrease the blood loss. The patient was discharged after 7 days without any complications. Conclusions Routine myomectomy at the time of cesarean section is not a standard procedure and is not accepted worldwide. However, it may be considered a safe option in carefully selected cases in the hands of an experienced obstetrician with appropriate hemostatic technique. Large multicenter randomized controlled trials should be conducted to evaluate the best practice guidelines for cesarean myomectomy.

Study on the method of enucleation of anterior uterine fibroids by transverse incision of the lower uterine segment during cesarean section

“…One patient in the study group had postpartum hemorrhage caused by multiple myoma evisceration, and two patients in the control group had complications of severe anemia before surgery; therefore, they were treated with blood transfusion before surgery. Myomectomy is feasible in a tertiary medical center, which equipped with adequate manpower and blood products [ 8 ].…”

“…Performing myomectomy simultaneously after the cesarean section has its own advantages and disadvantages. Previous studies have shown that simultaneous enucleation of uterine fibroids by cesarean section may increase the length of surgery and hospital stay, but this can reduce the future morbidity of patients due to multiple surgeries, anesthesia complications, and out-of-pocket costs [ 8 , 12 , 15 , 17 , 18 ]. As this study said, the operation time and average hospitalization stay were longer in the study group, which may be related to the higher proportion of major myomas (diameter ≥ 5 cm) in the study group than that in the control group.…”

“…In addition to pedicled uterine fibroids, enucleation of fibroids at the same time during cesarean section is not recommended [ 2 ]. However, with the progress of surgical hemostasis to prevent postpartum hemorrhage, many clinical studies have shown that cesarean section while eviscerating uterine fibroids can be a safe operation [ 5 – 7 ], for some patients can save the time and cost borne by reoperation [ 8 ].…”

Are Deliveries by Inverted T-Incision on the Rise Due to Fibroids?: A Case Report

“…Lower segment fibroids often result in a burdensome delivery, yet many published cases were nevertheless, managed by a lower segment CS [ 3 - 4 ]. The patient’s fibroid was occupying a large portion of the lower segment which extended into the upper segment.…”

“…Myomectomies during cesarean sections are both safe and sensible as they are far more common procedures nowadays, especially when the benefits outweigh the risks [ 3 - 4 ]. Klatsky et al studied the patterns of uterine fibroid effects on pregnancy outcomes.…”