When it is oportune to avoid cesarean myomectomy? An analysis of possible factors influencing duration of treatment in the intensive care unit

Abstract

Back ground: Ce sar ean myomectomy (CM) is a con tro ver sial is sue, even rel a tively con tra in dicated in ob stet ric prac tice. Re cent re ports showed that CM is not as so ci ated with in creased mor bidity, but those are lack ing the data about risks of in ten sive care unit (ICU) treat ment. Aim: The authors eval u ated the fac tors af fect ing the du ra tion of ICU treat ment in pa tients af ter CM. Ma te rial and Meth ods: The study in cluded 57 women who under went CM and were post op er a tively ad mit ted and treated in ICU. Cor re la tion anal y sis was used to es timate the ef fect of var i ous pa ram e ters on the du ra tion of ICU treat ment. Re sults: There was a highly sig nif icant cor re la tion be tween du ra tion of ICU treat ment and num ber of post op er a tive trans fu sions (p=0.001), du ra tion of sur gery (p=0.007), intraoprative hem orrhage (p=0.008) and myoma di am e ter (p=0.009). Dura tion of ICU treat ment was also cor re lated with gesta tional age, hy per ten sive syn drome in preg nancy, pre op er a tive hematocrit and he mo glo bin val ues, number of intraoperative trans fu sions, post op er a tive hemor rhage and re peated myomectomy. Con clu sions: In our re port, lon ger ICU tretment was re quired in cases of perioperative hem or rhage, pro longed sur ger ies and those re quir ing perioperative trans fu sion. Pa tients who have had pre vi ous myomectomy, with lower preop er a tive hemoglobine and hematocrit vaues and bigger myomas are at risk of pro longed ICU treat ment. Key words: Ce sar ean myomectomy; myomectomy; ce sar ean sec tion; com pli ca tions; in ten sive care unit. IN TRO DUC TION A high per cent age of ce sar ean sec tion (CS) in women with myomas is well doc u mented; how ever, the cesar ean myomectomy (CM) is still a con tro ver sial is sue, even rel a tively con tra in di cated in ob stet ric ex pe ri ence 1-3. Con versely, many re ports showed that CM was not as soci ated with in creased mor bid ity 2-6. Now a days, CM is consid ered to be an in ter ven tion with more fa vor able

Cesarean myomectomy in modern obstetrics: More light and fewer shadows

“…Finally, the literature on CM safety in patients with previous myomectomy lacks articles and the current data provide conflicting results, given that some investigations excluded women with a previous myomectomy . While some authors report favorable outcomes, there is evidence indicating the possibility of a higher rate of complications in such cases . The latest literature does not provide any strong evidence on the management of recurrent myoma during CS.…”

“…Obstetric intensive care unit (ICU) admissions have also been described in the literature . Sparic et al .…”

“…Although the study was biased due to the liberal ICU admission policy, a high rate of 55.88% was recorded (57 cases) . A successive report investigated the factors influencing the duration of ICU treatment: patients who had a previous myomectomy, lower preoperative hemoglobin and hematocrit, and bigger myomas were at risk of prolonged ICU treatment . Their operations were longer overall, and the results strongly underlined the importance of a tailored surgical technique with lower morbidity risks …”

Myomectomy for Fibroids during Cesarean Section: A Randomized Controlled Trial

“…The current literature conflicting results are indicating the trial to provide any strong evidence on the CM safety and applicability (4) .…”