Myomectomy during cesarean section

Ortaç, Fırat; Güngör, Mahmut; Sönmezer, Murat

doi:10.1016/s0020-7292(99)00129-0

Cited by 60 publications

(80 citation statements)

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“…Ortac et al reported 22 myomectomies during Caesarean for large fibroids (>5 cm) they suggested myomectomy for reducing post op sepsis. 17 In another study by Burton et al of the reported 13 cases of myomectomy at Caesarean section, only 1 case had intra-operative hemorrhage and they concluded it to be safe in selected patients. 18 In present study there was no intraoperative hemorrhage.…”

Section: Discussionmentioning

confidence: 96%

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Myoma in pregnancy and outcome after cesarean myomectomy

Valson

Nazer

Mukergee

2017

Int J Reprod Contracept Obstet Gynecol

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Background: The prevalence of leiomyoma is 30% to70% in reproductive women. In addition to causing menstrual disorders like menorrhagia, mass in abdomen, pain and it also negatively affect fertility and pregnancy outcome. Objectives of present study was to investigate the outcome in cases of pregnancy complicated by fibroids undergoing lower segment cesarean section (LSCS) in DM WIMS Medical College and Hospital, Wayanad, Kerala, where the prevalence of fibroids is high in reproductive women.Methods: Twelve cases of leiomyoma with pregnancy underwent LSCS with myomectomy following the delivery of the baby. The indications for myomectomy during LSCS taken into consideration were firstly the size of fibroids usually less than 5 cm, mainly single myoma complicating pregnancy and sites like sub serous and intramural. The suturing of the uterus was done using polyglycolic acid of size No. 1 and polyglycolic acid suture of 2 ‘0’ for closing the dead space and with good hemostasis the operation was completed. The indications for cesarean, the average operative time for surgery, the amount of blood loss, and postoperative complications like surgical site infections were noted and outcome recorded.Results: The time taken for surgery was about 45 minutes longer, average blood loss was approximately 300 ml to 500 ml more than for a routine LSCS. There was no surgical site infections or postpartum hemorrhage in any of the cases.Conclusions: Myomectomy with caesarean in selected cases with proper indications is safe and possible in selected cases. It avoids a second surgery with its associated morbidity.

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Section: Discussionmentioning

confidence: 96%

“…In spite of the above physiological advantage the incidence of hemorrhage during myomectomy is approximately 10% because of the increased blood flow to the uterus in pregnancy. 11,12 We report here 12 cases where myomectomy was done during the period January 2013 to December 2016.…”

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confidence: 99%

Myoma in pregnancy and outcome after cesarean myomectomy

Valson

Nazer

Mukergee

2017

Int J Reprod Contracept Obstet Gynecol

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“…Most obstetricians advise against myomectomy at the time of caesarean section 3 , unless the myoma is pedunculated 2,4 . Other experiences have been favourable and one group even advocates elective myomectomy in order to minimise post-operative sepsis and postpartum haemorrhage 5 . Most obstetricians would agree that myomectomy at the time of caesarean section should be carried out on only carefully selected women and only by senior obstetricians 4 .…”

Section: Discussionmentioning

confidence: 99%

“…A standard technique for myomectomy was used with no complications. Electrocautery and an argon beam coagulator to minimise blood loss have been described, with good results 5 .…”

Section: Discussionmentioning

confidence: 99%

Uterine torsion due to a fibroid, emergency myomectomy and transverse upper segment caesarean section

Rich

Stokes

2002

BJOG

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A 37-year old woman booked at nine weeks of gestation in her third pregnancy. Fourteen years previously she had had an uncomplicated emergency lower segment caesarean section at 37 weeks for fulminating pre-eclampsia. Two years later, she had a normal delivery at term without complication. She had laser treatment to the cervix in 1987 for CIN 1. There was no other gynaecological history of note.At booking, a singleton pregnancy of nine weeks of gestation was confirmed on scan. The uterus was retroverted but although the ultrasound report commented on the presence of an 11cm anterior wall fibroid, this was not documented in the woman's case notes. A senior radiographer performed her routine anomaly scan at 19 weeks of gestation. All was well and the placenta was noted to be posterior. Again, the fibroid was noted but was not documented in the notes. She was followed-up regularly by both the midwife and the hospital antenatal clinic. She remained well and symptom free. Throughout the antenatal period from 28 weeks onwards the presentation was thought cephalic and the uterine size compatible with her dates. At 37 weeks the head was reported as being engaged, with three-fifths of the head palpable per abdomen. At 39 weeks of gestation she was seen in the antenatal clinic by a senior member of staff who found that the head was now two-fifths palpable and recommended that the woman could have a trial of labour.She was seen at term plus four days in the antenatal clinic. The symphysis -fundal height was appropriate for her dates, but the fetus had a transverse lie. A caesarean section was booked for the following day. However, she went into labour during the night. At 2cm dilatation, an emergency caesarean section was performed under a spinal anaesthetic. The abdomen was opened by a Pfannensteil incision. The uterus was found rotated to the left by 180 degrees. The rotation was corrected manually without difficulty. A large anterior wall fibroid was found extending from the upper segment to the previous caesarean scar in the lower segment. The whole of the anterior aspect of the lower segment was covered with fibroid and dense bladder adhesions. It was impossible to feel the lower extent of the fibroid. The anaesthetist continued with the operation under a spinal anaesthetic. A longitudinal incision was made in the upper segment over the fibroid to enucleate the fibroid. A myomectomy was performed. The uterus was opened transversely during the dissection and the opening enlarged to deliver the baby. The decidua was sutured with interrupted sutures of polyglactin polymer and the myometrium closed in three layers with a continuous stitch of the same material, the deepest layer being repaired transversely and the more superficial layers longitudinally. The operation lasted for 75 minutes. Blood loss was estimated to be 600ml. Her haemoglobin concentration fell by 0.4gldL. A prophylactic antibiotic was administered. She recovered well and was discharged home on her sixth post-operative day. Postnatal examination showed no ...

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“…The size of myomas usually increases during pregnancy and may produce pressure injuries such as fetal malpresentation, hydronephrosis, preterm labour and torsion of uterus depending on number, size and location of myomas. Because myomectomy throughout cesarean delivery may lead to hemorrhage and uterinal atony, is not recommended by some authors (2)(3)(4). It also carries increased risk of postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

Unavoidable myomectomy during cesarean section: a case report

Aksoy¹,

Saraçoğlu²,

Aksoy³

et al. 2011

Health

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Since myomectomy throughout cesarean delivery may lead to hemorrhage and uterinal atony, it is not recommended. But, myomectomy has been reported during cesarean section in recent studies. We presented a patient with large intramural myoma who was diagnosed at 34 weeks of pregnancy and operated with an unavoidable cesarean-combined myomectomy. A 33-year-old unpursued primigravida was referred to emergency department with abdominal pain and amenorrhea of 34 weeks duration. A sonographic diagnosis of myoma in pregnancy was made. Cesarean section was required for fetal distress and alive 2300 g weighted male infant with Apgar score of 6 at one minute, was born. As uterine incision could not be closed because of the myoma, myomectomy was performed dur-ing cesarean section unavoidably. A single 970 g and 15 × 18 cm sized myoma was removed. The physical examinations were unremarkable in the postoperative period. Although there are case series that have demonstrated the safety of myomectomy during cesarean section, we concluded that myomectomy during cesarean section is not a safe procedure accept inevitable situations.

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Myomectomy during cesarean section

Cited by 60 publications

References 1 publication

Myoma in pregnancy and outcome after cesarean myomectomy

Myoma in pregnancy and outcome after cesarean myomectomy

Uterine torsion due to a fibroid, emergency myomectomy and transverse upper segment caesarean section

Unavoidable myomectomy during cesarean section: a case report

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