Myomectomy During Cesarean Section: Why Do We Abstain From?

Güler, Aşkın Evren; Güler, Zeliha Çiğdem Demirel; Kıncı, Mehmet Ferdi; Mungan, M. Tamer

doi:10.1007/s13224-019-01303-6

Cited by 13 publications

(12 citation statements)

References 13 publications

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“…In addition, in the current study, a significant statistical difference (14 min) in the duration of surgery between the groups was noted. 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) .…”

Section: Discussionmentioning

confidence: 61%

“…In the recent study of Sakinci et al (6) , hospital stay length and duration of surgery were significantly longer in CM patients when compared with only CS patients. Another study compared cesarean myomectomy and cesarean delivery alone regarding the change of hemoglobin concentration, the need for blood transfusion, and the operative time and found only increased operative time in the cesarean myomectomy group (7) .…”

Section: Discussionmentioning

confidence: 99%

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Myomectomy for Fibroids during Cesarean Section: A Randomized Controlled Trial

Shabana¹,

Sayyed²,

Rezk³

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: There is a considerable debate about the management of myoma during cesarean section (CS). Recently, several studies indicated the safety and feasibility of undertaking myomectomy during CS. Objectives: To evaluate the safety, accessibility, and short-term morbidity of myomectomy for fibroids during cesarean section. Patients and Methods: This was a randomized controlled trial that included 72 patients who were admitted to the Obstetrics & Gynecology Department, Menoufia University Hospital with uterine fibroids during pregnancy; who were randomly allocated equally into a group of cesarean myomectomy (CM; n=36) and another group of CS only (n=36). The operative events and the outcome were recorded and analyzed. Results: CM group showed a longer duration of surgery and longer hospital stay, higher amount of blood loss, and higher mean pain sores, with a highly statistically significant difference (p = 0.000). No cases in both groups required blood transfusion or ICU admission. No statistically significant differences were noted between both groups as regards the fetal outcome measures (p=0.583 & 0.601). Conclusion: CM is safe and applicable in selected cases without deleterious maternal complications. Special precautions ought to be paid during the procedure, particularly in the intramural type and with large fibroids.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Myomectomy for Fibroids during Cesarean Section: A Randomized Controlled Trial

Shabana¹,

Sayyed²,

Rezk³

et al. 2021

The Egyptian Journal of Hospital Medicine

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“…Until the last decade, it was considered a dreadful surgery except for pedunculated sub-serosal fibroids. However, many researches have concluded that the procedure is not dangerous and does not lead to complications in the hands of an experienced obstetrician [ 6 ]. Kwawukume performed cesarean myomectomies on 12 patients and reported that enucleation was much easier in pregnancy due to increased softness of the tissue [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Cesarean myomectomy: a case report and review of the literature

Garg

Bansal

2021

J Med Case Reports

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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.

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“…They have also reported that none of the patients submitted to CM required blood transfusion [29]. Guler et al [30] showed that changes of preoperative, postoperative, and mean hemoglobin values were not significantly different between patients with intramural or subserosal CM and only CS only. Kim et al [14].…”

Section: Pro and Cons Of Cesarean Myomectomymentioning

confidence: 98%

Myomectomy during cesarean section or non-caesarean myomectomy in reproductive surgery: this is the dilemma

Tinelli¹,

Nezhat²,

Likić-Ladjević³

et al. 2021

Clinical and Experimental Obstetrics & Gynecology

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Nowadays it is quite common to encounter pregnants over 35 years with uterine fibroids (UFs), requiring cesarean section (CS). Large UFs may cause severe complications during delivery, as bleeding and hemorrhage, during vaginal or cesarean delivery. Frequently, the caesarean myomectomy (CM) is recommended, but generally obstetricians are reluctant to perform CM, since literature data do not agree on its surgical recommendation. CM is jet particularly controversial, due to increased risk of perioperative hemorrhage and cesarean hysterectomy, and UFs are often left in situ during cesarean section (CS). CM investigations are generally directed to myomectomy associated issues, whereas CS complications without CM are largely underreported. The risks of leaving UF for an interval myomectomy is underestimated and large UFs, left in uterus during CS, might cause significant early and late postoperative complications, even necessitating a relaparotomy and/or a subsequent hysterectomy. CM would be mandatory in some instances, whatever the UF diameter, to avoid further damage or complications. UFs management prior to CS should include a full counselling on pro and cons on the possible consequences of surgical decisioning. To illustrate what was discussed above, authors performed a narrative review with an expert opinion, reporting a case of a 31-year-old woman with a large UF who underwent a CS without myomectomy. Nine hours after CS, puerpera was submitted, for a massive postoperative hemorrhage and hemorrhagic shock, to an emergency relaparotomy with total hysterectomy without salpingo-oophorectomy.

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Myomectomy During Cesarean Section: Why Do We Abstain From?

Cited by 13 publications

References 13 publications

Myomectomy for Fibroids during Cesarean Section: A Randomized Controlled Trial

Myomectomy for Fibroids during Cesarean Section: A Randomized Controlled Trial

Cesarean myomectomy: a case report and review of the literature

Myomectomy during cesarean section or non-caesarean myomectomy in reproductive surgery: this is the dilemma

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