Emergency myomectomy during pregnancy: a case report

Nwagha, UI; Agu, Kenneth A.; Nwankwo, Theophilus Ogochukwu; Egbuji, Chuma C

doi:10.4314/tjog.v22i1.14549

Cited by 2 publications

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“…[2][3][4] malpresentations, preterm rupture of membranes and preterm labour during pregnancy, obstructed labour from a cervical or lower segment mass intrapartum and retained placenta, subinvolution of the uterus, postpartum endomyometritis, and postpartum haemorrhage in the immediatepostpartum period. 3,[9][10][11] Myomectomy at the time of caesarean delivery is controversial because of the risk of intractable hemorrhage and increased postoperative morbidity. But recent studies suggest that Caesarean myomectomy is safe to perform in selected patients and results in no significant post-operative morbidity.…”

Section: Introductionmentioning

confidence: 99%

A study on safety and feasibility of caesarean myomectomy: at a private institute

Rai¹,

Mishra²

2017

Int J Reprod Contracept Obstet Gynecol

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The incidence of myoma associated with pregnancy is reported at 0.3-5%, with a majority of myomas not requiring surgical intervention during pregnancy or delivery. [5][6][7][8] In the pregnant women with coexisting fibroids, there are increased incidences of first trimester losses, pressure symptoms, pain from red degeneration (necrobiosis), torsion of a pedunculated variant, ABSTRACT Background: Myomectomy at the time of caesarean delivery is controversial because of the risk of intractable hemorrhage and increased postoperative morbidity. The incidence of myoma associated with pregnancy is reported at 0.3-5%, with a majority of myomas not requiring surgical intervention during pregnancy or delivery. Recent studies consider it to be safe in selected patients and thus allow women to have a better obstetric outcome in future pregnancies, and to avoid hysterectomy. It relieves symptoms associated with fibroids and negates the need for later surgery or sonographic follow-ups for the fibroid after delivery. Methods: We performed a prospective cohort study of 15 patients with myomas who underwent myomectomy at the time of Caesarean section at MGM Hospital between January 2016 and December 2016. In a predesigned proforma, patient's details such as age, parity, antenatal course, gestational age at delivery, type of Caesarean section, size and location of the fibroids, blood loss, postoperative morbidity and perinatal outcome were noted. Results: The incidence of hemorrhage in the study group was 20%. There was no significant increase in the incidence of postpartum fever (6.6%), operating time (50 min), and length of postpartum stay (5.6 days). No patient required hysterectomy. Size of fibroid did not appear to affect the incidence of hemorrhage, although intramural myomas were more associated with hemorrhage. Conclusions: This study shows that myomectomy during caesarean section is a safe procedure and is not associated with major intraoperative and postoperative complications.

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Section: Introductionmentioning

confidence: 99%

A study on safety and feasibility of caesarean myomectomy: at a private institute

Rai¹,

Mishra²

2017

Int J Reprod Contracept Obstet Gynecol

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“…These tumours may be asymptomatic. In the pregnant women with coexisting fibroids, there are increased incidences of first trimester losses, pressure symptoms, pain from red degeneration (necrobiosis), torsion of a pedunculated variant, malpresentations, preterm rupture of membranes and preterm labour [ 3 , 5 ] during pregnancy , obstructed labour from a cervical or lower segment mass intrapartum and retained placenta, subinvolution of the uterus, postpartum endomyometritis, and postpartum haemorrhage in the immediate postpartum period [ 3 , 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Myomectomy during Caesarean Birth in Fibroid-Endemic, Low-Resource Settings

Awoleke

2013

Obstetrics and Gynecology International

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If myomectomy during caesarean delivery becomes a widespread practice, it could potentially eliminate multiple surgeries for both indications. However, many surgeons have been reluctant to adopt this policy without conclusive evidence demonstrating its safety. This study reviews the publications on caesarean myomectomy especially from the African Continent with respect to duration of surgery, blood loss, length of hospital stay, and blood transfusions. Judging from the lack of large studies on caesarean myomectomy, the proportion of surgeons who attempt the procedure is largely low because of concerns about its safety. However, most of the authors suggested that the complications and morbidity following caesarean myomectomy do not significantly differ from those occurring during caesarean section alone, while fertility is apparently not compromised by this treatment. With careful patient selection, adequate experience, and efficient haemostatic measures, the procedure does not appear as hazardous as was once thought. This piece of information is relevant for counseling women who request for the simultaneous removal of previously diagnosed fibroids during caesarean section. Staff and facilities for safe management of haemorrhage are a requisite for the procedure. Large randomized trials are needed to guide decisions as to the best clinical practice regarding myomectomy during caesarean delivery.

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Emergency myomectomy during pregnancy: a case report

Cited by 2 publications

References 0 publications

A study on safety and feasibility of caesarean myomectomy: at a private institute

A study on safety and feasibility of caesarean myomectomy: at a private institute

Myomectomy during Caesarean Birth in Fibroid-Endemic, Low-Resource Settings

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