Myomectomy as a Pregnancy-Preserving Option in the Carefully Selected Patient

Hasbargen, Uwe; Strauß, Alexander; Summerer-Moustaki, M; Baretton, G; Roth, Ulrike; Kimmig, Rainer; Hepp, H

doi:10.1159/000048017

Cited by 26 publications

(6 citation statements)

References 3 publications

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“…The risk of miscarriage, pPROM or preterm birth in women with fibroids undergoing amniocentesis is not increased compared with the general population, especially if antibiotic prophylaxis is used. The increased rate of fetal loss in patients with myoma is to attribute only to the fibroids themselves, and amniocentesis does not increase this risk …”

Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

Myoma and myomectomy: Poor evidence concern in pregnancy

Milazzo¹,

Catalano²,

Badia³

et al. 2017

J of Obstet and Gynaecol

110

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Aim: Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. Methods: Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. Results: Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. Conclusions: Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.

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Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

Myoma and myomectomy: Poor evidence concern in pregnancy

Milazzo¹,

Catalano²,

Badia³

et al. 2017

J of Obstet and Gynaecol

110

View full text Add to dashboard Cite

show abstract

“…Such complications include necrobiosis with pains, abortions, preterm premature rupture of the membranes, preterm deliveries, abnormal lies and presentations, increased caesarean delivery rates, postpartum haemorrhage and endomyometritis 1 .In order to prevent these complications some have performed antenatal myomectomies in selected cases 2 . Huge uterine myomas are not frequent encounters in Post Partum Haemorrhage.…”

Section: Introductionmentioning

confidence: 99%

A huge polypoid uterine myoma causing severe primary postpartum haemorrhage: A report of one case

Adaji

Shittu²,

Ageda³

2006

Nigerian Journal of Surgical Research

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Complications from uterine myomas in pregnancy could occur antenally, intrapartum or in the puerperium. One of such was diagnosed in a 36-year old para 2+0 who had successful gestation to term delivery in co-existence with a huge fibroid polyp and had spontaneous vaginal delivery of a life baby. She however developed severe primary postpartum haemorrhage prompting emergency postpartum digital vaginal myomectomy which was very helpful.

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“…This is caused by degeneration of the myoma due to reduced perfusion, which occurs frequently and may be associated with nausea, vomiting and fever [17]. If the pain is resistant to treatment, some authors consider that myoma enucleation is indicated in the pregnant uterus.…”

Section: Discussionmentioning

confidence: 99%

Myoma enucleation during cesarean section: elective procedure or incalculable risk?

et al. 2004

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Background: Myomas are often located in the area of the lower uterine segment. During cesarean section they can lead to problems in delivering the baby and can make it difficult or impossible to close the uterine incision. The goal of the study was to determine the relative risk of a myoma enucleation in combination with a cesarean section. Methods: The study included ten pregnant patients in whom a myomatous uterus was expected to present difficulty during birth underwent delivery by cesarean section between 1993 and 2003 at the university departments of gynecology and obstetrics in Frankfurt and Erlangen, Germany. A detailed questionnaire was sent to patients retrospectively. Results: Three patients with enucleation of the myoma during cesarean section had a hemoglobin value less than 6.5 g/dl postoperatively. In all three cases the anemia was explained by enucleation of the myoma. The diameter of each myoma was more than 8 cm. Conclusions: Depending on the size and location of the myomas, a detailed discussion should be carried out with the patient regarding the associated risks, such as hysterectomy due to hemorrhage and the possible need for blood transfusions.

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Myomectomy as a Pregnancy-Preserving Option in the Carefully Selected Patient

Cited by 26 publications

References 3 publications

Myoma and myomectomy: Poor evidence concern in pregnancy

Myoma and myomectomy: Poor evidence concern in pregnancy

A huge polypoid uterine myoma causing severe primary postpartum haemorrhage: A report of one case

Myoma enucleation during cesarean section: elective procedure or incalculable risk?

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