DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172530

A study on safety and feasibility of caesarean myomectomy: at a private institute

Amrita Rai, Manju G. Mishra

Abstract


Background: Myomectomy at the time of caesarean delivery is controversial because of the risk of intractable hemorrhage and increased postoperative morbidity. The incidence of myoma associated with pregnancy is reported at 0.3-5%, with a majority of myomas not requiring surgical intervention during pregnancy or delivery. Recent studies consider it to be safe in selected patients and thus allow women to have a better obstetric outcome in future pregnancies, and to avoid hysterectomy. It relieves symptoms associated with fibroids and negates the need for later surgery or sonographic follow-ups for the fibroid after delivery.

Methods: We performed a prospective cohort study of 15 patients with myomas who underwent myomectomy at the time of Caesarean section at MGM Hospital between January 2016 and December 2016. In a predesigned proforma, patient’s details such as age, parity, antenatal course, gestational age at delivery, type of Caesarean section, size and location of the fibroids, blood loss, postoperative morbidity and perinatal outcome were noted.

Results: The incidence of hemorrhage in the study group was 20%. There was no significant increase in the incidence of postpartum fever (6.6%), operating time (50 min), and length of postpartum stay (5.6 days). No patient required hysterectomy. Size of fibroid did not appear to affect the incidence of hemorrhage, although intramural myomas were more associated with hemorrhage.

Conclusions: This study shows that myomectomy during caesarean section is a safe procedure and is not associated with major intraoperative and postoperative complications.


Keywords


Caesarean delivery, Fibroid, Myoma, Myomectomy

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References


Kwawukume EY, “Caesarean myomectomy,” African Journal of Reproductive Health. 2002;6(3):38-43.

Wallach EE, “Myomectomy,” in Te Linde's Operative Gynaecology, J. D. Thompson and J. A. Rock, Eds., JB Lippincott Company, New York, NY, USA, 1992:647-62,

Omigbodun AO and Fawole AO, “Myomectomy during pregnancy and delivery. Is it safe? commentary,” Tropic J Obstetr Gynaecol. 2005;22(1):1-3.

Agboghoroma CO, Efetie ER, and Umezulike AC, “Unavoidable caesarean myomectomy: a case report,” Tropic J Obstetr Gynaecol. 2005;22(1):81-2.

Muram AD, Gillieson MS, Walters JH. Myomas of the uterus in pregnancy: Ultrasonographic follow-up. Am J Obstet Gynecol. 1980;138:16-9.

Kaymak BO, Ustunyurt E, Okyay RE, Kalyoncu S, Mollamahmutoglu Myomectomy during Cesarean section. Int J Gynecol Obstet. 2005;89:90-3.

Hasan CF, Armugam K, Sivanesaratnam V. Uterine leiomyomata in pregnancy. Int J Gynecol Obstet. 1990;34:45-8.

Davis JL, Ray-Mazumder S, Hobel CJ, Baley K, Sassoon D. Uterine leiomyomas in pregnancy: A prospective study. Obstet Gynecol. 1990;75:41-4.

Nwagha UI, Agu KA, Nwankwo TO, and Egbuji CC. “Emergency myomectomy during pregnancy: a case report,” Tropic J Obstetr Gynaecol. 2005;22(1):79-80.

Okoro O and Onwere S, “Myomectomy during pregnancy,” Pakistan Journal of Medic Sci. 2007;23(5):771-3.

Rice JP, Kay HH, and Mahony BS, “The clinical significance of uterine leiomyomas in pregnancy,” Americ J Obstetri Gynecol. 1989;160(5):1212.

Ortac JF, Gungor M, Sonmezer M. Myomectomy during Cesarean section. Int J Gynecol Obstet.1999;67:189-90.

Roman KAS, Tabsh KMA. Myomectomy at the time of Cesarean delivery: retrospective cohort study. BMC pregnancy and childbirth. 2004;4:14.

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

Kwon OSY, Kim TH, Jeong JH, Lee CN. Is myomectomy safe during Cesarean section? Korean J Perinatol. 2003;14:154-9.

Ahikari QS, Goswami S. Cesarean myomectomy: A study of 14 cases. J Obstet Gynecol India. 2006;56:486-8.

Umezurike RC, Feyi-Waboso P. Successful myomectomy during pregnancy: A case report. Reprod Health. 2005;2:6.

Omar SSZ, Sivanesaratnam V, Damodaran P. Large lower segment myoma-myomectomy at lower segment Cesarean section: A report of 2 cases. Singapore Med J. 1999;40:109-10.

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

Ben-Rafael Z, Perri T, Krissi H, Dicker D, and Dekel A. “Myomectomy during cesarean section-a time to reconsider?” in Proceedings of the Abstracts of the 3rd World Congress on Controversies in Obstetrics, Gynecology and Infertility, Washington, DC, USA; 2002.

Gbadebo AA, Charles AA, and Austin O, “Myomectomy at caesarean section: descriptive study of clinical outcome in a tropical setting,” Journal of Ayub Medical College, Abbottabad. 2009;21(4):7-9.

Park BJ and Kim YW. “Safety of cesarean myomectomy,” Journal of Obstetrics and Gynaecology Research. 2009;’35(5)906-11.

Febo G, Tessarolo M, Leo L, Arduino S, Wierdis T, and Lanza L, “Surgical management of leiomyomata in pregnancy,” Clinic Experiment Obstetr Gynecol. 1997;24(2)76-8.

Bhatla N, Dash BB, Kriplani A, and Agarwal N, “Myomectomy during pregnancy: a feasible option,” J Obstetr Gynaecol Res. 2009;35(1):173-5.

Abasiattai AM, Bassey EA, Essien EU, and Utuk NM, “Inevitable myomectomy during caesarean section: a case report,” Niger J Clinic Pract. 2009;12(1):99-100.

Owolabi AT, Loto MO, Kuti O, Ehinmitan RR, and Ibrahim AY. “Unavoidable caesarean myomectomy: a case report,” Nepal Journal of Obstetrics and Gynaecology, vol. 2, no. 2, pp. 81–83, 2007.

Ehigiegba AE, Ande AB, and Ojobo SI, “Myomectomy during cesarean section,” International Journal of Gynecology and Obstetrics. 2001;75(1):21-5.

Li H, Du J, Jin L, Shi Z, and Liu M, “Myomectomy during cesarean section,” Acta Obstetricia et Gynecologica Scandinavica. 2009;88(2):183-6.

Rosati P, Exacoustas C, Mancuso S. Longitudinal evaluation of uterine myoma growth during pregnancy. J Ultrasound Med. 1992;11:511-5.

Myerscough PR. Munro Kerr’s Operative Obstetrics. 10th ed. London: Baillière Tindall Publications; Pelvic tumors. Other surgical complications in pregnancy, labor and the puerperium; 1982:203-411.

Katz VL, Dotters DJ, Droegemueller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynaecol. 1989;73:593-6.

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

Sapmaz E, Celik H, Altungul A. Bilateral ascending uterine artery ligation vs. tourniquet use for haemostasis in Cesarean myomectomy: a comparison. J Reprod Med. 2003;48:950-4.

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

Burton CA, Grimes DA, March CM. Surgical management of leiomyoma during pregnancy. Obstet Gynecol. 1989;74:70.

Brown D, Fletcher HM, Myrie MO, and Reid M, “Caesarean myomectomy-a safe procedure. A retrospective case controlled study,” Journal of Obstetr Gynaecol. 1999;19(2):139-41.

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

Cobellis G, Messalli EM, Stradella L, Pecori E, and Cobellis L, “Restitutio ad integrum of myometrium after myomectomy: different results in pregnant and non-pregnant patients,” Minerva Ginecologica. 2002;54(5):393-5.

Cobellis L, Messali EM, Stradella L. “Myomectomy during cesarean section and outside pregnancy: different outcomes of scars,” Minerva Ginecologica. 2002;54(6):483-6.

Olokoba AB, Salawu FK, Danburam A. “Viral hepatitides in voluntary blood donors in Yola, Nigeria,” Europ J Sci Res. 2009;31(3):329-34.