With adequate experience and the use of high dose oxytocin infusion (intra- and post-operatively), myomectomy at cesarean section is not as hazardous as many now believe.

From July 1973 to December 1980, 6942 patients were admitted to the Gynaecology unit of the University of Benin Teaching Hospital, Benin City, Nigeria. Fifty-nine patients presented with gynatresia (vaginal atresia and stenosis), an incidence of 8.5 1000. The most common causes of this condition were caustic vaginitis, secondary to local herb pessary insertion, and circumcision. The resulting vaginal adhesions were effectively treated surgically by simple adhesiolysis . There was a low incidence of congenital gynatresia . As the large proportion of cases of acquired gynatresia were preventable, improvement in health education should further reduce incidence of this condition in our community.

At the University of Benin Teaching Hospital, Benin City, Nigeria, after our first publication titled "Inevitable Caesarean Myomectomy" 1 , we have since 1996 routinely carried out myomectomy during caesarean section. The result of our first 25 cases was published in 2001. 2 We have since then carried out more than 70 procedures of caesarean myomectomy. Our investigations on comparative blood loss, duration of surgery and morbidity at caesarean section, caesarean myomectomy and myomectomy will soon be published.Our findings and conclusions regarding blood loss during this once dreaded procedure are similar to those of Kwawukume. We are particularly interested in the fact that contrary to the previous widely held belief, no patient in his and our series suffered sufficient blood loss to require a hysterectomy. There was also no case fatality. However, his surgical technique for minimising blood loss differs significantly from ours. The use of tourniquet may be more cumbersome and more likely to be as effective as the use of high dose oxytocin. We also think it may be more traumatic to a recently pregnant uterus. In our series, we relied solely on high dose oxytocin infusion to bring about a bloodless operation field for the myomectomy that followed the delivery of the baby. It is also important to stress that the infusion of 30 units of oxytocin in 500ml of 5% dextrose in water over four hours was continued for 12-24 hours. Ben-Rafael et al in Tel Aviv, Israel, recently also reported similar results as ours using high dose oxytocin infusion in their

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