Published: 2019-10-23

Navigating through the maze of caesarean myomectomy: generating evidence

Fouzia Zahid A. Khan, Imose Itua


Management of myomas during pregnancy and labor is a contested subject so far. Currently no recommended national or international guidelines are in place resulting in conflicted opinion and management variation across the globe. Many obstetricians still discourage its practice due to fear of uncontrolled haemorrhage which may lead to unwanted hysterectomy in a reproductive age. However, some researchers have challenged the conventional perspective and argue that caesarean myomectomy (CM) is a safe procedure. The aim of this study is to examine all aspects of CM with an evaluative lens and to weigh its risk-benefit ratio.  For this purpose, we conducted a literature review of studies, including those from low-resource countries indexed in scientific databases like PubMed, Google Scholar and Scopus. Most recent articles that reported benefits, complications and different techniques to safely perform caesarean myomectomy with proven benefit for the patient were examined thoroughly so that solid evidence on pros and cons of caesarean myomectomy could be generated. There is a dire need to conduct large sample size studies or randomized controlled trials for the risk-benefit evaluation of CM and to produce evidence-based clinical conclusion.


Caesarean section, Caesarean myomectomy, Fibroid, Myomas, Myoma in pregnancy

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Khan AT, Shehmar M, Gupta JK. Uterine Fibroids: Current perspectives. Inter J Womens Health. 2014;6:95-114.

Odejinmi F, Oliver R, Mallick R. Is Ulipristal acetate the new drug of choice for medical management of uterine fibroids? Women’s Health. 2017;13(3):98-105.

Song D, Zhang W, Chames M. C. and Guo J. Myomectomy during cesarean delivery. Int J Gynecol Obstet. 2013;121:208-13.

Sparic R, Kadija S, Stefavonic A, Radjenovic SS, Ladjevic IL, Popovic J, et al. Cesarean myomectomy in modern obstetrics. More Light Fewer Shadows. 2017;43(5):798-804.

Doherty L, Mutlu L, Sinclair D, Taylor H. Uterine fibroids: clinical manifestations and contemporary management. Reprod Sci. 2014;21:1067-92.

Cardozo ER, Clark AD, Banks NK, Henne MB, Stegmann BJ, Segars JH. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol. 2012;206:211.e1-9.

Başaranoğlu S, Agacayak E, Deregözü A, İnegöl Gümüş I, Acet M, Gül T. Is caesarean myomectomy a safe procedure? A comparative study. Gynecol Obstet Repro Med. 2016:22.

Özcan A, Kopuz A, Turan V, Sahin C, Toz E, Aksoy S, et al. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure? Ginekol Pol. 2016;87(1):54-8.

Kwon DH, Song JE, Yoon KR, Lee KY. The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Sci. 2014;57:367-72.

Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta, D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res. 2017;43(12):1789-804.

Akkurt MO, Yavuz A, Eris Yalcin S. Can we consider cesarean myomectomy as a safe procedure without long-term outcome? J Matern Fetal Neonatal Med. 2017;30(15):1855-60.

Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynaecol. 2010;3:20-7.

Mangala JK, Sreedhar S, Sumathy S, Rajammal B. Retrospective study of 53 cases of caesarean myomectomy regarding its safety and feasibility. Int J Reprod Contracept Obstet Gynecol. 2016;5(4):1158-61.

Awoleke JO. Myomectomy during caesarean birth in fibroid-endemic, low-resource settings. Hindawi Publishing Corporation. Obstet Gynecol Int. 2013:Article ID 520834.

Bozini N, Baracat EC. The history of myomectomy at the medical school of University of Sau Paulo. Clinics (Sau Paulo). 2007;62(3):209-10.

Topcu HO, Iskender CT, Timur H, Kaymak O, Memur T, Danisman N. Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas. Int J Gynecol Obstet. 2015;130:244-6.

Dedes I, Schäffer L, Zimmermann R, Burkhardt T, Haslinger C. Outcome and risk factors of cesarean delivery with and without cesarean myomectomy in women with uterine myomatas. Arch Gynecol Obstet. 2017;295:27.

Akbas M, Mihmanli V, Bulut B, Yuksel IT, Karahisar G, Demirayak G. Myomectomy for intramural fibroids during caesarean section: A therapeutic dilemma. J Obstet Gynaecol. 2017;37(2):141-5.

Rai A, Mishra MG. A study on safety and feasibility of caesarean myomectomy: at a private institute. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):2765-70.

Valson H, Nazer T, Mukerjee S. Myoma in pregnancy and outcome after cesarean myomectomy. Int J Reprod Contracept Obstet Gynecol. 2017;6(6):2267-71.

Sultana R, Noor S, Nazar AF, Abbasi N, Bashir R, Khan B, et al. Safety of caesarean myomectomy. J Ayub Med Coll Abbottabad. 2012;24(2):120-1.

Machado LS, Gowri V, Al-Riyami N, Al-Kharusi L. Caesarean myomectomy: feasibility and safety. Sultan Qaboos Univ Med J. 2012;12(2):190-6.

Ehigiegba EA, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2001;75:21-5.

Brown D. Caesarean myomectomy-a safe procedure. A retrospective case-controlled study. J Obstet Gynaecol. 1999;19(2):139-41.

Tinelli A, Malvasi A, Mynbaev OA, Barbera, A, Perrone E, Guido M, et al. The surgical outcome of intracapsular cesarean myomectomy. A match control study. J Matern Fetal Neonatal Med. 2014;27:66-71.

Lee JH, Cho DH. Myomectomy using purse-string suture during caesarean section. Arch Gynaecol Obstet. 2011;283:35-3.

Incebiyik A, Hilali NG, Camuzcuoglu A, Vural M, Camuzcuoglu H. Myomectomy during caesarean: a retrospective evaluation of 16 cases. Arch Gynecol Obstet. 2014;289:569-73.

Desai BR, Patted SS, Pujar YV, Sherigar BY, Das SR, Ruge JC. A novel technique of selective uterine devascularization before myomectomy at the time of cesarean section: a pilot study. Fertil Steril. 2010;94(1):362-4.

Lin JY, Lee WL, Wang PH, Lai MJ, Chang WH, Liu WM. Uterine artery occlusion and myomectomy for treatment of pregnant women with uterine leiomyomas who are undergoing cesarean section. J Obstet Gynaecol Res. 2010;36(2):284-90.

Kaymak O, Ustunyurt E, Okyay RE, Kalyoncu S, Mollamahmutoglu L. Myomectomy during caesarean section. Int J Gynaecol Obstet. 2005;89:90-3.

Kwawukume EY. Caesarean myomectomy. Afr J Reprod Health. 2002;6(3):38-43.

Park BJ, Kim YW. Safety of cesarean myomectomy. J Obstet Gynaecol Res. 2009;35:906-11.

Kim YS, Chou SD, Bae DH. Risk factors for complications in patients undergoing myomectomy at the time of cesarean section. J Obstet Gynaecol Res. 2010;36:550-4.

Ortaç F, Güngör M, Sönmezer M. Myomectomy during cesarean section. Int J Gynaecol Obstet. 1999;67(3):189-90.

Seffah JD. Re-laparotomy after cesarean section. Int J Gynecol Obstet. 2005;88:253-7.

Sparic R, Guido M, Tinelli A. Cesarean myomectomy and possible risk factors for admission to intensive care unit: a retrospective study. Ginekol Pol. 2015;86:731-6.