Inevitable caesarean myomectomy

Igwegbe, AO; Nwosu, B.O.; Ugboaja, JO; Monago, EN

doi:10.4314/njm.v18i3.51212

Cited by 6 publications

(3 citation statements)

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“…These include the application of a tourniquet to encompass and compress both uterine arteries at the base of the broad ligament and the vessels in the infundibulopelvic ligament after lifting away the Fallopian tubes, thus creating a relatively bloodless operating field [1, 23], bilateral uterine artery ligation [23], electrocautery [24], high-dose oxytocin infusion during (i.e., after the delivery of the baby and placenta) and after the surgery [22, 25, 26], and a combination of uterine tourniquet and high-dose oxytocin infusion [21]. …”

Section: Resultsmentioning

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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Section: Resultsmentioning

confidence: 99%

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

Awoleke

2013

Obstetrics and Gynecology International

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“…Kim et al concluded that cesarean myomectomy can be performed only in selected cases, because some patients may have significant complications such as ileus and postoperative atonic bleeding. 32 Leanza et al 33 and Igwegbe et al 34 have also reported large myomas removed during cesarean sections and suggested that the correct handling (high-dose oxytocin infusion and skillful surgery) ensures minimal intra-and postoperative blood losses.…”

Section: Safety Of Cesarean Myomectomymentioning

confidence: 94%

Pros and Cons of Cesarean Myomectomy: A Retrospective Study

PallaViktoria-Varvara

Karaolanis

IoannisKatafigiotis

et al. 2014

Journal of Gynecologic Surgery

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Background: Myoma incidence during pregnancy is estimated to be 0.5%-5%, with 1 in 10 of these women having myoma-related complications. In recent years, the percentage of these ocurrences appears to be higher, as more myomas have been noted in older pregnant women. Myomectomy during cesarean section is controversial because of the risks of uncontrollable hemorrhage and obliteration of the fibromyoma cavity. Yet, the medical literature has reported an increasing rate of myomectomies during cesarean sections during the past decade. Objective: The aim of this study was to investigate if removal of myomas during cesarean section aggravates the postoperative period. Materials and Methods: During 2006-2013, the outcomes of myomectomy during cesarean section were evaluated retrospectively. The study included 130 patients undergoing cesarean myomectomy and 346 women with known myomas undergoing only cesarean section. The patients' demographic characteristics, gestational age at delivery, myoma characteristics, mean change in hemoglobin values (g/dL), postoperative complications, surgery duration, and days of hospital stay were all recorded and analyzed. Results: There was no statistically significant difference in the patients' characteristics between the groups. The mean change in hemoglobin values was similar in the groups, and no patients needed blood transfusion. Frequency of postoperative fever and other postoperative complications were the same in the groups. Myomectomy added a mean time of 13 minutes to the operative procedure and increased the length of hospital stay by an average of 0.7 days, which were considered to be statistically significant differences. No cesarean hysterectomy or other repeated surgery was required for the patients in the myomectomy group. The postdischarge period was uncomplicated for all of the patients. Conclusions: Cesarean myomectomy is recommended in selected cases and should be done by experienced surgeons. ( J GYNECOL SURG 30:338)

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“…22 Leanza et al and Igwegbe et al have also reported large myomas removed at Caesarean section. [23][24] In our series of 8 patients, 5 lost less than 1.5 L of blood and there was no significant postoperative morbidity. The patient with a blood loss of 3,200 ml had the largest myoma in this series (10 x 12 cm) which showed evidence of degeneration and also had atonicity of the uterus necessitating a higher dose of oxytocin, carboprost, and a blood transfusion.…”

Section: 10-21mentioning

confidence: 99%

Caesarean Myomectomy : Feasibility and Safety = عملية إستئصال ورم الرحم العضلي أثناء إجراء العملية القيصرية : إمكانية إجراء العملية و السلامة

Machado¹,

Gowri²,

Al-Riyami³

et al. 2012

SQUMJ

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abstract:Objectives: Caesarean myomectomy has traditionally been discouraged due to fears of intractable haemorrhage and increased postoperative morbidity. However, a number of authors have recently shown that myomectomy during Caesarean section does not increase the risk of haemorrhage or postoperative morbidity. Methods: We present a series of 8 cases from Sultan Qaboos University Hospital, Oman, where myomectomy was performed during Caesarean section for large lower segment fibroids. Seven were anterior lower segment fibroids, while one was a posterior lower uterine fibroid which interfered with closure of the uterine incision. The antenatal course, perioperative management, and postoperative morbidity are discussed. Results: The average age of the women was 28.7 years and mean gestational age at delivery was 36.75 weeks. Regarding intra-operative blood loss, 1 patient lost 900 ml, 5 patients lost 1-1.5 litres, 2 lost 1.5-2 L, and 1 patient with a 10 x 12 cm fibroid lost 3.2 L. Despite the majority being large myomas (7 of the 8 patients had myomas >5 cm in size) and 50% being intramural, no hysterectomy was required. Stepwise devascularisation was necessary in one case and preoperative placement of uterine balloon catheters was necessary in another. The size of the fibroids was confirmed by histopathology. Myomectomy added 15 minutes to the operating time and 1 day to the hospital stay, but there was no significant postoperative morbidity. Neonatal outcome was good in all patients. Conclusion: In selected patients, myomectomy during Caesarean section is a safe and effective procedure at tertiary centres with experienced surgeons.Keywords: Caesarean section; Myomectomy; Fibroids; Pregnancy; Haemorrhage; Oman. Caesarean MyomectomyFeasibility and safety

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Inevitable caesarean myomectomy

Cited by 6 publications

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

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

Pros and Cons of Cesarean Myomectomy: A Retrospective Study

Caesarean Myomectomy : Feasibility and Safety = عملية إستئصال ورم الرحم العضلي أثناء إجراء العملية القيصرية : إمكانية إجراء العملية و السلامة

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