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

Authors

  • Medhavi Sharma Department of Obstetrics and Gynecology, AIIMS, Rajkot, Gujarat, India
  • Gaurav Sharma Department of Obstetrics and Gynecology, AIIMS, Rajkot, Gujarat, India
  • Shivangi Varshney Department of Obstetrics and Gynecology, AIIMS, Rajkot, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20230812

Keywords:

Blood transfusion, Cesarean section, Fibroids, Hysterectomy, Morbidity, Myomectomy

Abstract

Background: Simultaneous surgical removal of a previously diagnosed myoma during cesarean section is preferred these days to reduce multiple operative procedures. The aim of present study was to determine the safety, cost effectiveness and complications of myomectomy at the time of cesarean delivery and its related peri-operative morbidity.

Methods: This prospective study was conducted in total 50 pregnant cases during the period of 6 months. The analysis focused on age and gender, the number, size and location of fibroids, the need for hysterectomy and blood transfusion.

Results: The mean age of patient was 28.2 years. Out of the 50 patients, 66% were primiparous and only 17% were multiparous. 56% patients underwent caesarean section for indications like primigravida head floating, IUGR, oligohydroaminos. 48% patients had myoma size 2-4 cm. Most of the myomas were located anteriorly (64%). The most common type of leiyomyoma found was subserosal (31%) and 17% with intramural fibroid. Only one patient required post operative blood transfusion whereas none of the patients underwent hysterectomy.

Conclusions: Cesarean myomectomy is a safe and effective procedure and it is a feasible undertaking in experienced hands.

References

Novak ER, Woodruff JD. Myoma and other benign tumors of the uterus. In: Novak’s gynecologic and obstetric pathology with clinical and endocrine relations. W.B. Saunders: Philadelphia; 1979:260.

Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7.

Wallach EE. (1992) Myomectomy. In: Thompson JD, Rock JB, eds. Telinde’s Operative Gynaecology. 7th edn. Lippincott Company: New York; 1992:647-662.

Liu WM, Wang PH, Tang WL, Tzeng CR. Uterine artery ligation for treatment of pregnant women with uterine leiomyomas who are undergoing cesarean section. Fertil Steril. 2006;86(2):423-8.

Vergani P, Locatelli A, Ghidini A, Andreani M, Sala F, Pezzullo JC. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol. 2007;109(2 Part 1):410-4.

Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008;198(4):357-66.

Omar SZ, Sivanesaratnam V, Damodaran P. Large lower segment myoma- myomectomy at lower segment caesarean section- a report of two cases. Singapore Med J. 1999;40(2):109-10.

Kwawukume EY. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2002;76:183.

Tinelli A. Myoma in pregnancy and cesarean myomectomy: A matter of debate for a long time. Int J Gynecol Clin Pract. 2014;1:104.

Adesiyun AG, Ojabo A, Durosinlorun-Mohammed A. Fertility and obstetric outcome after caesarean myomectomy. J Obstet Gynaecol. 2008;28(7):710-2.

Agarwal K, Agarwal L, Agarwal A, Agrawal VK, Agarwal K. Caesarean Myomectomy: prospective study. NJIRM. 2011; 2(3) : 11-14.

Shavell VI, Thakur M, Sawant A, Kruger ML, Jones TB, Singh M, et al. Adverse obstetric outcomes associated with sonographically identified large uterine fibroids. Fertil Steril. 2012;97(1):107-10.

Hassiakos D, Christopoulos P, Vitoratos N, Xarchoulakou E, Vaggos G, Papadias K. Myomectomy during cesarean section: a safe procedure? Ann N Y Acad Sci. 2006;1092:408-13.

Nargis N, Karim MI, Loverine S. Evaluation of safety of caesarean myomectomy: A prospective study. Bangladesh Crit Care J. 2019;7(1):40-3.

Adesiyun A, Gbadebo A, Ameh A, Charles A, Ojabo O, Austin A. Myomectomy at caesarean section: descriptive study of clinical outcome in a tropical setting. J Ayub Med Coll Abbottabad. 2009;21(4):7-9.

Ortac F, Gungor M, Sonmezer M. Myomectomy during cesarean section. Int J Gynecol Obstet. 1999;67(3):189-90.

Roman AS, Tabsh KM. Myomectomy at time of cesarean delivery: a retrospective cohort study. BMC Pregnancy Childbirth. 2004;4:14.

Sapmaz E, Celik H. Bilateral ascending uterine artery ligation vs. tourniquet use for hemostasis in cesarean myomectomy. A comparison. J Reprod Med. 2003;48(12):950-4.

Cobellis L, Florio P, Stradella L, Lucia ED, Messalli EM, Petraglia F, et al. Electro-cautery of myomas during caesarean section – two case reports. Eur J Obstet Gynecol Reprod Biol. 2002;102:98-9.

Febo G, Tessarolo M, Leo L, Arduino S, Wierdis T, Lanza L. Surgical management of leiomyomata in pregnancy. Clin Exp Obstet Gynecol. 1997;24(2):76-8.

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Published

2023-03-28

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Original Research Articles