Caesarean myomectomy in a case of bad obstetric history and multiple fibroids: a case report

Authors

  • Kirty Nahar Department of Obstetrics and Gynecology, Apollo Hospitals International Ltd., Ahmedabad, Gujarat, India
  • Nikita Nahar Medical Student, NHL Municipal Medical College, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20202362

Keywords:

Caesarean section, Haemorrhage, Leiomyoma, Myomectomy

Abstract

Uterine myomas are being observed in pregnancy more frequently now than in the past, because many women are delaying child bearing till their late thirties, which is the time for the greatest risk of the myoma growth. Traditionally, obstetricians are trained to avoid myomectomies during caesarean sections as severe haemorrhages can occur, which may often necessitate hysterectomies. Pedunculated fibroids which can be easily removed are an exception. A 38-year-old, elderly female, G3 A2, 37 weeks pregnancy with bad obstetric history and multiple fibroids was admitted in Apollo Hospitals, Ahmedabad. She underwent high risk caesarean section followed by myomectomy. Four large and one small fibroid were removed. One posterior wall intramural fibroid 6×5 cm was lower down, hence not removed. Histopathological examination showed leiomyomata with degenerative changes, infarct and calcification. She didn’t have any intraoperative haemorrhage or any postpartum complications. On follow up after 6 weeks, patient was healthy, had no complaints. Caesarean scar was healthy. Ultrasound scan showed normal uterus with one posterior wall intramural fibroid 3×3 cm. With the advent of better anaesthesia, easy availability of blood and blood components, caesarean myomectomy is a safe surgical procedure when performed by experienced obstetrician in carefully selected patients. Intraoperative assessment of fibroids is important in decision making for caesarean myomectomy.

References

Okolo S. Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2008;22:571-88.

Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94:435-8.

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;113:630-5.

Strobelt N, Ghidini A, Cavallone M, Pensabene I, Ceruti P, Vergani P. Natural history of uterine leiomyomas in pregnancy. J Ultrasound Med. 1994;13:399-401.

Exacoustòs C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol. 1993;82:97-101.

Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol. 2006;107:376-82.

Omigbodun AO, Fawole AO. Myomectomy during pregnancy and delivery: is it safe? Commentary. Trop J Obstet Gynaecol. 2005;22(1):1-3.

Okoro O, Onwere S. Myomectomy during pregnancy. Pak J Med Sci. 2007;23(5):771-3.

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

Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol. 2000;95:764-9.

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

Neiger R, Sonek JD, Croom CS, Ventolini G. Pregnancy related changes in the size of uterine leiomyomas. J Reprod Med. 2006;51:671-4.

Vitale SG, Padula F, Gulino FA. Management of uterine fibroids in pregnancy: recent trends. Curr Opin Obstet Gynecol. 2015;27:432-7.

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.

Song D, Zhang W, Mark C, Guo. Myomectomy during caesarean section: a systematic review and meta-analysis. Int J Gynecol Obstet. 2013;121:208-13.

Hatrnaz FI, Güler O, Baflaranolu S, Tokgöz C, Klç GS. Endometrial myomectomy: a novel surgical method during cesarean section. J Matern Fetal Neonatal Med. 2018;31:433-8.

Davis JL, Ray-Mazumder SH, Hobel CJ, Baley KA, Sassoon DE. Uterine leiomyomas in pregnancy: a prospective study. Obstet Gynecol. 1990;75(1):41-4.

Bala R, Kamal P, Nagpal M, Singh S. Current status of cesarean section myomectomy-prospective ongoing study. Int J Reprod Contracept Obstet Gynecol. 2019;8(8):3189-93.

Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int J Gynecol Obstet. 2001;75(1):21-5.

Kaymak O, Ustunyurt E, Okyay RE, Kalyoncu S, Mollamahmutoglu L. Myomectomy during cesarean section. Int J Gynecol Obstet. 2005;89(2):90-3.

Topcu HO, Iskender CT, Timur H. Outcomes aіer caesarean myomectomy versus caesarean alone among pregnant women with uterine leiomyomas. Int J Gynecol Obstet. 2015;130:244-6.

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

Rice JP, Kay HH, Mahony BS. The clinical sLgnLficance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol. 1989;160:1212-6.

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;198:357-66.

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

Vergani P, Ghidini A, Strobelt N, Roncaglia N, Locatelli A, et al. Do uterine leiomyomas Lnfluence pregnancy outcome? Am J Perinatol. 1994;11:356-8.

Ohkuchi A, Onagawa T, Usui R, Koike T, Hiratsuka M. Effect of maternal age on blood loss during parturition: a retrospective multivariate analysis of 10,053 cases. J Perinat Med. 2003;31:209-15.

Laughlin SK, Stewart EA. Uterine leiomyomas: individualizing the approach to a heterogeneous condition. Obstet Gyneol. 2011;117:396-403.

Stewart EA. Clinical practice. Uterine fibroLds. N Engl J Med. 2015;372:1646-55.

Hasan F, Arumıgam 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.

Fletcher H, Frederick J. Abdominal myomectomy revisited. Progr Obstet Gynaecol. 2005;16:277-86.

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Published

2020-05-27

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Case Reports