Use of intramyometrial carbetocin in caesarean myomectomy to reduce hemorrhage
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20233657Keywords:
Fibroid, Post-partum hemorrhage, Myomectomy, Leiomyoma caesarean deliveryAbstract
Traditionally myomectomy is avoided during caesarean delivery because of potential excessive blood loss. As the size increases, blood supply of leiomyomas also increases in pregnancy, and specifically at term due to the effect of human chorionic gonadotropin. Carbetocin is an oxytocin analog. It is long acting and is effective in preventing blood loss. It has been used in myomectomy to prevent blood loss in non-pregnant uterus. We present a case report where it is used intramyometrial route during caesarean section. A 30-year-old multigravida of 38 weeks period of gestation with previous caesarean section, presented in labor. Her recent ultra sound report showed single live intrauterine fetus of 35 weeks 3 days with a single posterior wall fibroid. The woman requested for myomectomy along with caesarean delivery as she had heavy menstrual bleeding caesarean section was done and myomectomy was planned along with the caesarean section. Intramyometrial carbetocin 100 mcg was used to prevent excessive blood loss. The patient had an uneventful post-operative period. Intramyometrial carbetocin is an effective method to reduce blood loss in myomectomy during caesarean delivery.
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References
Sarais V, Cermisoni GC, Shimberni M, Alteri A, Papaleo E, Somigliana E, et al. Human chorionic gonadotropin as a possible mediator of leiomyoma growth during pregnancy: molecular mechanisms. Int J Mol Sci. 2017;18:9.
Ziecik AJ, Kaczmarek MM, Blitek A, Kowalczyk AE, Li X, Rahman NA. Novel biological and possible applicable roles of LH/hCG receptor. Mol Cell Endocrinol. 2007;269:51-60.
Laughlin SK, Baird DD, Savitz DA, Herring AH, Hartmann KE. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound screening study. Obstet Gynecol. 2009;113(3):630.
Exacoustos C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol. 1993;82(1):97-101.
Daya S, Ward S, Burrows E. Progesterone profiles in luteal phase defect cycles and outcome of progesterone treatment in patients with recurrent spontaneous abortion. Am J Obstet Gynecol. 1988;158(2):225-32.
Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2014;2014(8):CD005355.
Taher A, Farouk D, Mohamed Kotb MM, Ghamry NK, Kholaif K, A Mageed A Allah A, et al. Evaluating efficacy of intravenous carbetocin in reducing blood loss during abdominal myomectomy: a randomized controlled trial. Fertil Steril. 2021;115(3):793-801.
Zaima A, Ash A Fibroid in pregnancy: characteristics, complications, and management. Postgrad Med J. 2011;87:819-28.
Senturk MB, Polat M, Doğan O, Pulatoğlu Ç, Yardımcı OD, Karakuş R, et al. Outcome of Cesarean Myomectomy: Is it a Safe Procedure? Geburtshilfe Frauenheilkd. 2017;77(11):1200-6.
Goyal M, Dawood AS, Elbohoty SB, Abbas AM, Singh P, Melana N, et al. Cesarean myomectomy in the last ten years; A true shift from contraindication to indication: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;256:145-57.
Jaffer D, Singh PM, Aslam A, Cahill AG, Palanisamy A, Monks DT. Preventing postpartum hemorrhage after cesarean delivery: a network meta-analysis of available pharmacologic agents. Am J Obstet Gynecol. 2022;226(3):347-65.