Myomectomy at time of cesarean delivery: a retrospective cohort study

Abstract

BackgroundMyomectomy at time of cesarean delivery is traditionally discouraged because of the risk of hemorrhage. A retrospective cohort study was performed to determine whether myomectomy at time of cesarean delivery leads to an increased incidence of intrapartum and short-term postpartum complications.MethodsA computer search of medical records from May 1991 to April 2001 identified a total of 111 women who underwent myomectomy at time of cesarean delivery and 257 women with documented fibroids during the index pregnancy who underwent cesarean delivery alone. Charts were reviewed for the following outcome variables: change in hematocrit from preoperative to postoperative period, length of operation, length of postpartum stay, incidence of postpartum fever, and incidence of hemorrhage. Hemorrhage was defined as a change in hematocrit of 10 points or the need for intraoperative blood transfusion.ResultsThe incidence of hemorrhage in the study group was 12.6% as compared with 12.8% in the control group (p = 0.95). There was also no statistically significant increase in the incidence of postpartum fever, operating time, and length of postpartum stay. No patient in either group required hysterectomy or embolization. Size of fibroid did not appear to affect the incidence of hemorrhage. After stratifying the procedures by type of fibroid removed, intramural myomectomy was found to be associated with a 21.2% incidence of hemorrhage compared with 12.8% in the control group, but this difference was not statistically significant (p = 0.08). This study had 80% power to detect a two-fold increase in the overall incidence of hemorrhage.ConclusionIn selected patients, myomectomy during cesarean delivery does not appear to result in an increased risk of intrapartum or short-term postpartum morbidity.

Leaving fibroids at caesarean section, is it safe?

“…Apart from risk of severe haemorrhage, there appears to be no other absolute contraindication to routine caesarean myomectomy. Roman and Tabsh [3] in their retrospective study concluded that in selected patients, myomectomy during caesarean section does not appear to result in an increased risk of intra-partum or short-term post-partum morbidity. This view was supported by Kaymac et al [4] in their retrospective case control study.…”

Caesarean Myomectomy : Feasibility and Safety = عملية إستئصال ورم الرحم العضلي أثناء إجراء العملية القيصرية : إمكانية إجراء العملية و السلامة

“…Myomectomy during Caesarean section has traditionally been discouraged due to the risk of uncontrollable haemorrhage, unless the myoma is pedunculated. 11 Recent studies have described techniques to minimise blood loss at Caesarean myomectomy including uterine tourniquet, bilateral uterine artery ligation, and electrocautery. 10,12,13 In our series, stepwise devascularisation was required to control atonic PPH in one patient; in another patient uterine artery balloon catheters were placed preoperatively.…”

“…However, a number of authors have recently shown that myomectomy at Caesarean does not increase the risk of haemorrhage. 2,[10][11][12][13][14][15][16][17][18][19][20][21] We present a series of 8 cases where myomectomy was performed during Caesarean section for large lower segment fibroids ranging in size from 4 to 12 cms. The antenatal course, perioperative management, and postoperative morbidity are discussed.…”

Unavoidable myomectomy during cesarean section: a case report

“…It also carries increased risk of postoperative morbidity. On the other hand, some investigators suggested that myomectomy may be performed during cesarean section in selected patients (5)(6)(7).…”