Pros and Cons of Cesarean Myomectomy: A Retrospective Study

Abstract

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)