Making caesarean myomectomy safe and feasible: a 12 year single center experience

Priti Agrawal; Rishi Agrawal; Anandi Lobo; Jyotirmay Chandrakar

doi:10.18203/2320-1770.ijrcog20210704

Authors

Priti Agrawal Department of Obstetrics, Gynecology and Infertility, Aarogya Hospital and Test Tube Baby Center, Raipur, Chhattisgarh, India http://orcid.org/0000-0003-3969-8592
Rishi Agrawal Department of General and Laparoscopic Surgery, Aarogya Hospital and Test Tube Baby Center, Raipur, Chhattisgarh, India
Anandi Lobo Department of Pathology, Aarogya Hospital and Test Tube Baby Center, Raipur, Chhattisgarh, India
Jyotirmay Chandrakar Department of Anesthesia, Aarogya Hospital and Test Tube Baby Center, Raipur, Chhattisgarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20210704

Keywords:

APH, Cesarean myomectomy, Cesarean hysterectomy, Cesarean section, Fibroids and pregnancy, PPH

Abstract

Background: To standardize our protocol of caesarean myomectomy to make it safe and feasible for all patients.

Methods: This prospective study was conducted in Aarogya Hospital and test tube baby Centre, Raipur from 1^st January 2008 to 1^st August 2020. Total 45 patients who had documented fibroid in index pregnancy and consented for the procedure were included. B- Lynch sutures were prophylactically applied in all cases to prevent PPH.

Results: Our maximum patients were between the age of 20-30 years (66.67%) and 75.56% were primigravida. 44.45% cases were of intramural fibroids and in 53.34% cases the size of myoma was >5 cm. Malpresentation was seen in 15.56% cases. 62.22% myomas were removed through single incision. 33.33% patients had uneventful second CS with us with excellent scar healing in 93.33% cases. 20% cases had secondary infertility and are advised further evaluation to find cause of infertility.

Conclusions: The decision to proceed with elective myomectomy at time of CS should be approached with proper pre-operative evaluation of the patient, thorough counseling for hysterectomy if required, expert team, arrangement of blood and adequate correction of medical factors like anemia, hypertension, and diabetes mellitus. Prophylactic application of B -Lynch sutures in all the cases made a dramatic improvement in tone of uterus which we observed intra operatively.

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