Evaluation of safety of caesarean myomectomy: A prospective study

Abstract

Background: Uterine myomas are the most common benign tumour of female reproductive tract and the prevalence of myomas in pregnancy has been reported to be 2%to 5% . Myomectomy during cesarean section has traditionally been discouraged due to risk of intractable haemorrhage and fear of hysterectomy. But recently large scaled studies indicated that cesarean myomectomy could be safely performed in majority of cases without any serious or life threatening complications.
 Materials and Methods: This prospective study was done at Ibn Sina Medical College Hospital, Dhaka, Bangladesh between January 2016 and December 2016. Fifty patients were recruited into the study, 25 patients had undergone myomectomy during cesarean section and 25 patients had undergone only cesarean section.
 Results: Average value of haemoglobin both pre and post-operatively was 12.31±1.22 g/dl and 10.64±1.51 g/dl for patients who had cesarean section with myomectomy and 11.61±1.3 g/dl and 10.3±1.7 g/dl in the other group in which cesarean section without myomectomy was performed. The difference in average haemoglobin for patients who had a cesarean section and myomectomy was 1.41 while those who had caesarean section alone was 1.32±1.12. This was not significant. The average duration of operation was longer in patient who had cesarean section and myomectomy (54.32±18.06 mins) than those who had caesarean section alone (38.54±8.42mins). The incidence of hemorrhage was5.45±1.23% and 5.23±1.03% respectively and the mean length of postoperative hospitalization was2.42±1.45and 2.17±0.70 days and no hysterectomy was needed in any group. Blood transfusion was given in 6 patients with 3 patients in each group. Sixty eight percent of the fibroids were subserous and in the body of the uterus.
 Conclusion: Cesarean myomectomy is a safe and effective procedure and does not increase the incidence of intraoperative and postoperative complications.
 Bangladesh Crit Care J March 2019; 7(1): 40-43

Myomectomy for Fibroids during Cesarean Section: A Randomized Controlled Trial

“…Consistently, in the studies of Sakinci et al (6) and Guler et al (7) , myomectomy added 15, 14 min to the CS duration. Morzak et al (8) and Nargis et al (9) reported a significant difference regarding the operation time and the hospital stay length In another similar study, the CS duration was only 4.94 minutes longer in the myomectomy group than it was in the nonmyomectomy group, which was not a significant difference (10) . Significant or not, all these findings reveal acceptable extensions, particularly when compared to performing a second operation to remove myomas that were not removed during CS.…”

A prospective study of simultaneous myomectomy with cesarean section at a tertiary care hospital

“…These findings are in accordance with the study conducted by Hassiakos et al and Nargis et al where the majority of patients were having sub serosal myomas. 13,14 In the study by Adesiyun et al, a total of 46 fibroids were removed in the 22 patients, of them 52.2% were subserous, 34.8% were intramural and 6 were submucous, 69.9% fibroids were between 6-10cms size. 15 The most common location of fibroid being corpus anterior (64%) with 14% being posteriorly located fibroid.…”