Success rate of peripartum myomectomy during cesarean delivery: a hospital-based study

Abstract

Background: Although cesarean myomectomy was traditionally avoided because of hemorrhage risk, recent evidence suggests that it may be feasible in carefully selected women with appropriate surgical expertise and hemostatic support. Therefore, this study aimed to determine the success rate and short-term maternal outcomes of peripartum myomectomy performed during cesarean delivery.

Methods: This hospital-based observational study included 150 consecutive women with sonographic and/or intraoperative uterine fibroids undergoing cesarean delivery with planned peripartum myomectomy under spinal anesthesia at Salauddin Specialized Hospital, Dhaka, Bangladesh, between 2023 and 2025. The primary outcome was successful myomectomy without hysterectomy or abandonment. Secondary outcomes included postpartum hemorrhage, hemoglobin drop, transfusion, uterine atony, infection, hospital stay and in-hospital mortality.

Results: Mean maternal age was 31.2±5.4 years and mean gestational age was 38.1±1.7 weeks. Previous cesarean section was present in 52.0% of cases, while 58.7% were emergency procedures. Post-delivery myomectomy was performed in 96.7%. Mean operative time was 78.5±19.6 minutes and median blood loss was 850 mL (IQR 650–1100). Single fibroids occurred in 61.3% of patients, with a median size of 6.5 cm, mainly subserosal or intramural. Procedural success was achieved in 92.0%; hysterectomy and abandonment each occurred in 2.7%. Postpartum hemorrhage occurred in 12.0%, transfusion in 14.7%, fever in 10.7% and wound infection in 6.0%. Median hospital stay was 4 days, with no maternal deaths.

Conclusions: Cesarean myomectomy achieved a 92.0% success rate, with low hysterectomy rates and no maternal mortality. With careful patient selection, experienced surgeons and adequate hemorrhage-control measures, the procedure may be a feasible option for avoiding subsequent surgery.