Cesarean myomectomy in modern obstetrics: More light and fewer shadows

Abstract

The study aim was to evaluate management of myomas during cesarean section, the pro and cons and the outcomes of cesarean myomectomy. Moreover, we tried to investigate the long-term outcomes of cesarean myomectomy. The authors conducted a literature review using scientific databases, focusing on the benefits and outcomes of cesarean myomectomy and the recent trends regarding this topic, and identified relevant articles, related references and other papers citing them. Despite the demonstrated advantages of cesarean myomectomy, postponed myomectomy after cesarean section was recommended in some instances. Apart from recent reports on the safety and feasibility of cesarean myomectomy, the current literature also describes serious complications of cesarean myomectomy, including even maternal death. This poses a question about the reported rate of complications: whether it is underestimated in common practice. Although some studies strongly suggest the safety of cesarean myomectomy, data on the long-term outcomes of cesarean myomectomy in women are lacking. The risk-benefit ratio of cesarean myomectomy should be re-evaluated in the new century, given the increasing patient age, incidence of myoma in pregnancy, and the wide use of assisted reproductive techniques.

Myomectomy during cesarean section: is it a safe procedure?

“…Moreover, the possible risks of re-operation are prevented, while at the same time the cost is also reduced. [19] As a matter of fact, in their study, Liu et al reported that 40% of the myoma cases where myomectomy was not performed during C/S, were re-operated on within 6 to 38 months postoperatively. [20] Some factors to consider for myomectomy during C/S include the number, size and localization of the myomas, the possible effects on uterine contractility, the experience of the surgeon and the facilities at the health institution where the operation is performed.…”

Navigating through the maze of caesarean myomectomy: generating evidence

“…10,12 Adverse obstetric complications are reported in 10%-40% of cases like spontaneous miscarriage, labor dystocia, intrauterine growth restriction, preterm labor, placental abruption, Placenta Previa, fetal malpresentation and postpartum haemorrhage. 4,[8][9][10]12,14…”

“…Risk of complications is also increased with submucosal, retro placental, large and multiple fibroids. 4,12 In early pregnancy, chances of spontaneous miscarriage are 8% with single fibroid and 23.6% with multiple fibroids. Early miscarriage and abdominal pain are common when fibroid is located in the body than in lower segment and with intramural or submucosal fibroid.…”

“…In about 10% of cases they can present with various symptoms like pelvic pressure, pelvic pain, heavy menstruation, dysmenorrhea, increased urinary frequency and impaired fertility in 1-3% of women. [1][2][3][4][5] The intensity of these symptoms varies according to the location, size and number of fibroids. At times these symptoms can be severe enough to adversely affect the quality of life (QOL) causing substantial morbidity and significant economic and social impact.…”

Pros and Cons of Myomectomy during Cesarean Section

“…Another important advantage of cesarean myomectomy is the improved quality of life in affected women. However, they concluded that the risk benefit of cesarean myomectomy should be re-evaluated and further research is necessary [28]. Song et al reviewed myomectomy during cesarean section through the database search and among 2500 studies they found nine studies eligible for their review and concluded that cesarean myomectomy may be a reasonable option in some leiomyoma patients but data driven from the meta-analysis were low quality, and definitive conclusion on this issue cannot be drawn [29].…”