Outcome and risk factors of cesarean delivery with and without cesarean myomectomy in women with uterine myomatas

Dedes, Ioannis; Schäffer, Leonhard; Zimmermann, Roland; Burkhardt, Tilo; Haslinger, Christian

doi:10.1007/s00404-016-4177-8

Cited by 32 publications

(19 citation statements)

References 14 publications

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“…Our data showed that the presence of a large-sized leiomyoma ≥5cm and birth weight ≥4,000 g were the important risk factors, while myomectomy during cesarean and the location and type of fibroids have little effects. In line with our study, Dedes I et al reported that a larger size of fibroid (≥5 cm) and a maternal age more than 40 years are risk factors of increased blood loss in women with uterine fibroids during cesarean [22]. Sei K et al investigated 759 pregnant women and reported the presence of a uterine fibroid of 175 cm 3 , birth weight of 2,500 g, and primipara were predictors for massive intraoperative hemorrhage during cesarean delivery [23].…”

Section: Discussionsupporting

confidence: 92%

Outcomes of Myomectomy at the Time of Cesarean Section among Pregnant Women with Uterine Fibroids: A Retrospective Cohort Study

Zhao

Wang

Zou

et al. 2019

BioMed Research International

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Objective. A retrospective study was performed to evaluate the safety and feasibility of cesarean myomectomy among pregnant women with uterine fibroids (UFs). Methods. Upon data collection, the pregnant women with UF underwent cesarean section in the 39 hospital divided into two groups: cesarean myomectomy group, receiving cesarean section and myomectomy; cesarean group, receiving cesarean section only. Information about the type, location, and number of UFs was collected from the medical records or the prenatal ultrasound examinations. Results. In the cesarean myomectomy group, the proportion of subserous UFs was significantly higher than the cesarean group (65.6% versus 49.3%, P < 0.0001). The comparison of postpartum hemorrhage, neonatal weight, fetal distress, and neonatal asphyxia showed no statistical significance. Multivariate logistic regression analysis demonstrated that birth weight ≥4000 g (OR 3.1, 95% CI:1.6–6.0) and presence of diameter > 5 cm fibroids (OR 2.2, 95%CI:1.3–4.0) were high risk factors for PPH ≥1,000 ml. Conclusions. Myomectomy during cesarean section was a common procedure in mainland China. Myomectomy cesarean could be safe and feasible based on the estimation by experienced obstetricians. During the procedure, special attention should be paid to a large-sized leiomyoma ≥5cm and birth weight ≥4,000 g.

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Section: Discussionsupporting

confidence: 92%

Outcomes of Myomectomy at the Time of Cesarean Section among Pregnant Women with Uterine Fibroids: A Retrospective Cohort Study

Zhao

Wang

Zou

et al. 2019

BioMed Research International

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“…In a retrospective cohort study by Dedes et al, 48 women underwent CM out of 162 pregnant women with myomas and rest had cesarean only (CO). 17 Overall there was no adverse outcome like hysterectomy or blood transfusion CM group. There was no significant difference in estimated blood loss (p=0.78), change in hemoglobin (p=0.60), operating time (p=0.13) or use of uterotonics (p=0.51).…”

Section: Resultsmentioning

confidence: 83%

“…4 Premature labor can occur in women who experience intractable pain and inflammation due to "red degeneration". 12,14,17 Obstetric concerns are considerably raised when myomas are complicated with secondary changes like necrosis, red degeneration (necrobiosis), torsion, impaction and hemorrhage leading to unbearable pain. Approximately 5-21% of women are hospitalized during pregnancy for pain control.…”

Section: Management Controversy and Complications Of Myomasmentioning

confidence: 99%

Navigating through the maze of caesarean myomectomy: generating evidence

Khan

Itua

2019

Int J Reprod Contracept Obstet Gynecol

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Management of myomas during pregnancy and labor is a contested subject so far. Currently no recommended national or international guidelines are in place resulting in conflicted opinion and management variation across the globe. Many obstetricians still discourage its practice due to fear of uncontrolled haemorrhage which may lead to unwanted hysterectomy in a reproductive age. However, some researchers have challenged the conventional perspective and argue that caesarean myomectomy (CM) is a safe procedure. The aim of this study is to examine all aspects of CM with an evaluative lens and to weigh its risk-benefit ratio. For this purpose, we conducted a literature review of studies, including those from low-resource countries indexed in scientific databases like PubMed, Google Scholar and Scopus. Most recent articles that reported benefits, complications and different techniques to safely perform caesarean myomectomy with proven benefit for the patient were examined thoroughly so that solid evidence on pros and cons of caesarean myomectomy could be generated. There is a dire need to conduct large sample size studies or randomized controlled trials for the risk-benefit evaluation of CM and to produce evidence-based clinical conclusion.

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“…CM of multiple myomas, as well as those with pedunculated and subserosal myomas, was associated with both increased blood loss and surgical time compared to women with CS alone. There were no cases of hysterectomy or blood transfusions [11].…”

Section: Discussionmentioning

confidence: 94%

Cesarean Myomectomy: Necessity or Opportunity?

Chauhan¹

2018

J Obstet Gynecol India

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Fibroids in pregnancy are increasingly common, due to advanced maternal age, better diagnostic tools and use of assisted reproductive techniques. Cesarean section (CS) is the commonest mode of delivery in these patients. Cesarean myomectomy (CM) is the term used to describe the removal of fibroids at CS; it has always been a controversial topic, with two schools of thought. Some obstetricians advise against it due to the traditional fear of massive obstetric hemorrhage and its attendant complications. However, recent literature advocates elective or opportunistic myomectomy in well-selected cases during CS. This is especially valuable in low-resource settings where the patient may be spared a repeat surgery and problems of anesthesia and cost associated with it. This review examines the recent published data on CM, its indications, technique, safety and applicability in modern obstetrics.

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Outcome and risk factors of cesarean delivery with and without cesarean myomectomy in women with uterine myomatas

Cited by 32 publications

References 14 publications

Outcomes of Myomectomy at the Time of Cesarean Section among Pregnant Women with Uterine Fibroids: A Retrospective Cohort Study

Outcomes of Myomectomy at the Time of Cesarean Section among Pregnant Women with Uterine Fibroids: A Retrospective Cohort Study

Navigating through the maze of caesarean myomectomy: generating evidence

Cesarean Myomectomy: Necessity or Opportunity?

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