Adverse obstetric outcomes associated with sonographically identified large uterine fibroids

Shavell, Valerie I.; Thakur, Mili; Sawant, A.; Krüger, Michael; Jones, Theodore B.; Singh, Manvinder; Puscheck, Elizabeth E.; Diamond, Michael P.

doi:10.1016/j.fertnstert.2011.10.009

Cited by 141 publications

(104 citation statements)

References 12 publications

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“…Some authors supported that the specific operative techniques such as tourniquet, uterine artery ligation, and pursestring suture are helpful to limit intraoperative bleeding during caesarean myomectomy [4,5]. Though, we did not use aforementioned techniques in present case, diluted vasopressin injection, correct surgical plane of dissection, double layered sutures, intraopeartive and postoperative uterotonic agents were effective in haemostasis.…”

Section: Discussionmentioning

confidence: 54%

Caesarean Myomectomy in a Cervical Fibroid: A Brief Communication

Tm¹,

Gp²,

Soman³

et al. 2017

IPCB

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Submit Manuscript | http://medcraveonline.com Compared to uterine corpus, cervical myomas pose a challenge due to its close relation with other organs like bladder, ureter and rectum. The surgical approach needs to be modified in each case. Surgical difficulties associated with these cases are poor access to myoma, difficulty in suturing and repairs, increased blood loss and distortion of the vital neighbouring structures in the pelvic cavity, making it vulnerable to injuries. The pregnancy poses a unique challenge of pregnancy related changes in fibroids and increased vascularity of the organ, making caesarean myomectomy a complicated procedure. Case ReportCervical fibroids, both in pregnant and non pregnant status are a clinically challenging situation for surgeons. We are discussing a case of 32 year female with term pregnancy incidentally detected to have a sessile cervical fibroid during her antenatal scans which had remained of the same size (6.5 x5cm) (Figure 1) throughout her pregnancy as usually happens in 70-80% of cases. The lady was asymptomatic. On examination a bulge was seen in the anterior upper vagina, pushing the cervix posteriorly. The term ultrasound showed 6x5cm fibroid in the supravaginal portion of the cervix (intracervical type) just below internal os. Since she had a history of a previous caesarean section with cervical fibroid, she was posted for elective caesarean at 39 completed wks. The questions to be answered at this point are 1. Whether to do a concurrent caesarean myomectomy? 2. Whether to proceed vaginally or abdominally? 3. Will a tourniquet help in reducing the blood supply to cervical myoma, if so at what level?Review of literature at this point said myomectomy during caesarean section could be generally recommended. The decision should be carefully taken in presence of surgical expertise and tertiary level care facilities. Depending on size and location of myomas, the associated risks are similar to those of isolated caesarean section [3]. Since lower uterine segment was free of a fibroid, she was delivered by a lower uterine segment transverse incision. After caesarean, an attempt was made for cervical examination through the hysterectomy wound, a 6.5 x5cm sessile fibroid occupying whole of the anterior lip of cervix was felt. The challenge here was, fibroid couldn't be reached easily or seen through the incision. The question, whether a vaginal examination will help in myomectomy? Was kept in mind. The diluted vasopressin injection was injected into the uterus. Bladder was dissected from vesicovaginal fascia (Figure 2) using mayo's scissors till the lower end of the cervix. Then the cervix was hooked up using left finger inside the cervical canal keeping in mind the location of the fibroid and its relation to the bladder and vagina, pushing the bladder safely down. A transverse incision was made in the anterior vaginal wall and then cervicotomy was done to reach the myoma. The myoma was enucleated (Figure 3) which weighed 100gms. Myoma bed was sutured in 2 layers (Figure 4...

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Section: Discussionmentioning

confidence: 54%

Caesarean Myomectomy in a Cervical Fibroid: A Brief Communication

Tm¹,

Gp²,

Soman³

et al. 2017

IPCB

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“…Shavell et al reported that pregnant women with myomas exceeding 5 cm in diameter were at a higher risk compared to patients with smaller or no myomas. 4 Studies undertaken in recent years came to the conclusion that bleeding was not excessive and the procedure was safe if the caesarean myomectomy was undertaken by experienced surgeons. 10,11 In Turkey, Ortac et al 12 reported no bleeding and no need for blood transfusion in patients with myomas exceeding 5 cm that had been operated with caesarean myomectomy.…”

Section: Discussionmentioning

confidence: 99%

“…This spectrum includes; the location and size (>5cm) of the myoma that frequently presents with abortion, malpresentation, placental abruption, intrauterine growth restriction (IUGR), placenta previa, abnormal placental invasion, preterm labour, preterm rupture of membranes (PROM), post-partum haemorrhage or bleeding requiring blood transfusion. 3,4 Caesarean myomectomy is avoided due to its fertility-reducing effects, including excessive post-partum bleeding and the resulting hysterectomy to control bleeding. 5 Specifically for myomas located in the lower segment or the posterior wall of the uterus, myomectomy is recommended to be performed right after the Csection.…”

Section: Introductionmentioning

confidence: 99%

Is Caesarean Myomectomy a Safe Procedure? A Comparative Study

Başaranoğlu

Ağaçayak

Deregözü

et al. 2016

Gynecol Obstet Reprod Med

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OBJECTIVE: Uterine myomas are the most common benign pelvic tumours observed during the reproductive period.Increased risks of haemorrhage and postoperative morbidity lead professionals to avoid myomectomy at the time of Cesarean (C-section). The present study retrospectively analysed the data of patients who had undergone C-section only and those that had undergone C-section and simultaneous myomectomy. STUDY DESIGN:The data of 42 patients (Group 1) who had underwent caesarean myomectomy and of 50 patients underwent C-section only (Group 2) out of 92 patients that had been taken into C-section on the basis of obstetric indications were retrospectively analysed in this study. The relevant patient data were recorded with the inclusion of demographic data, gestational week, and preoperative and postoperative laboratory findings. Types, locations and sizes (the largest diameter) of individual myomas were identified and noted. RESULTS:The mean diameter of myomas was 66.3±30.2 mm. Ten patients that had underwent caesarean myomectomy (23.8%) developed a need for intensive care. No statistically significant difference was found in laboratory parameters between Group 1 and Group 2. CONCLUSION:Caesarean myomectomy, when performed by experienced obstetricians, does not lead to a significant increase in maternal morbidity and mortality. Although the short-term effects of this procedure are known, there is a need for the conduct of more comprehensive studies to establish its longterm effects on fertility or how it will affect the next pregnancy processes.

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“…On the other hand, if myomectomy is avoided, it may increase the patient's risk of another operation that may unfavorably affect future pregnancies (17). Especially, large myomas >5 cm are associated with higher risk of adverse pregnancy complications such us preterm delivery, short cervix, premature rupture of membrane, postpartum bleeding when compared with small or no myomas (18). If safely performed, the procedure is cost-effective and can prevent morbidities associated with potential future surgeries.…”

Section: Discussionmentioning

confidence: 99%