Risk factors for intraoperative hemorrhage during cesarean myomectomy

Kwon, Ji Young; Byun, Ji Hea; Shin, Inhye; Hong, Subeen; Kim, Rayon; Park, In Yang

doi:10.1016/j.tjog.2020.11.007

Cited by 14 publications

(10 citation statements)

References 16 publications

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“…According to a study by Zhao et al [ 16 ], the presence of a leiomyoma > 5 cm and birth weight > 4,000 g were important risk factors for postpartum hemorrhage ≥ 1,000 mL in pregnant women with leiomyomas during CS, whereas the location and type of leiomyoma had little effect. Kwon et al reported that a large size (> 8 cm) and lower segmental position of the leiomyoma were significant risk factors for intraoperative hemorrhage during CM [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

The trend in cesarean myomectomies and the risk of obstetrical complications in Korea

Kim

Lee

Park

et al. 2022

BMC Pregnancy Childbirth

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Background To evaluate pregnancy outcomes and the risk of adverse obstetrical outcomes of cesarean myomectomy (CM) compared with cesarean section (CS) only, and to investigate the trend of surgeons in choosing CM. Methods A retrospective cohort study was performed on all patients who underwent CS complicated by leiomyoma at two university hospitals between January 2010 and May 2020. All patients were categorized into the CM (341 women) or CS-only (438 women) group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups. Results Women who underwent CS only were significantly more likely to have a previous myomectomy and multiple leiomyoma history than women who underwent CM. The gestational age at delivery and pregnancy complications were significantly higher in the CS-only group. The mean size of the leiomyomas was larger in the CM group than in the CS-only group (5.8 ± 3.2 cm vs. 5.2 ± 3.1 cm, P = 0.005). The operation time and history of previous CS and preterm labor were higher in the CM group. The leiomyoma types differed between the two groups. The subserosal type was the most common in the CM group (48.7%), and the intramural type was the most common in the CS-only group. Patients in the CM group had fewer than three leiomyomas than those in the CS-only group. Preterm labor and abnormal presentation were relatively higher in the CM group than in the CS-only group, concerning leiomyoma presence. There were no significant differences in the preoperative and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07–1.25; P < 0.001) and operation time > 60 min (OR = 2.461; 95% CI: 1.45–4.15) were significant independent predictors of adverse outcomes after CM. Conclusions CM should be considered a reliable and safe approach to prevent the need for another surgery for remnant leiomyoma. Herein, surgeons performed CM when uterine leiomyomas were large, of the subserosal type, or few. Standardized treatment guidelines for myomectomy during CSs in pregnant women with uterine fibroids should be established.

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Section: Discussionmentioning

confidence: 99%

The trend in cesarean myomectomies and the risk of obstetrical complications in Korea

Kim

Lee

Park

et al. 2022

BMC Pregnancy Childbirth

Self Cite

View full text Add to dashboard Cite

show abstract

“…According to a study by Zhao et al [14], the presence of a leiomyoma larger than 5 cm and birth weight of more than 4,000 g were the important risk factors for postpartum hemorrhage of ≥ 1,000 ml in pregnant women with leiomyomas during CS, whereas the location and type of leiomyoma had little effect. Kwon et al reported that large size exceeding 8 cm and lower segmental position of the leiomyoma were signi cant risk factors for intraoperative hemorrhage during CM [17].…”

Section: Discussionmentioning

confidence: 99%

The Trend in Cesarean Myomectomies and The Risk of Obstetrical Complications in Korea

Kim

Lee

Park

et al. 2021

Preprint

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Background To evaluate the pregnancy outcomes and the risk of adverse obstetrical outcomes from cesarean myomectomy (CM) compared to cesarean section (CS)-only and to investigate the trend of surgeons in choosing CM. Methods A retrospective cohort study was done of all patients who underwent CS that was complicated with leiomyoma at two university hospitals from January 2010 to May 2020. All patients were categorized into the CM group or the CS-only group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups. Results A total of 438 women in the CS-only group and 341 women in the CM group were included. Women who underwent CS-only had significantly more history of a previous myomectomy and multiple leiomyomas compared to women who underwent CM. The gestational days at delivery and the pregnancy complications were significantly higher in the CS group. The mean size of the leiomyomas was larger in the CM group than in the CS only group (5.8 ± 3.2 cm vs 5.2 ± 3.1 cm, P = 0.005). Operation time and history of previous CS and preterm labor were higher in the CM group. It seems that preterm labor and abnormal presentation were relatively higher in the CM group than in the CS group due to the presence of leiomyoma. There were no significant differences in the pre and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07 – 1.25; P < 0.001) and operation time > 60 minutes (OR = 2.461; 95% CI: 1.45 – 4.15) were significant independent predictors of adverse outcomes after CM. Conclusions Cesarean myomectomy is a reliable and safe approach to prevent the need for another operation for remnant leiomyoma. In this study, surgeons seemed to perform CM when uterine leiomyomas were large, the subserosal type, or few in number. Standardized treatment guidelines for myomectomy during cesarean section in pregnant women with uterine fibroids should be established.

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“…Specifically, a systematic review proposes an association between the number of myomas greater than five and an increased length of stay (LOS) in the hospital and estimated blood loss (EBL) [12][13]. The maximal diameter of the largest measured myoma greater than 9 cm has also been consistently associated with increased operative time, LOS, EBL, and the need for blood transfusions [14][15][16][17]. Myoma volume greater than 400 g in one study has also been proposed to incur increased perioperative complications [14].…”

Section: Minimally Invasive Gynecologic Surgery For Leiomyomatous Uterimentioning

confidence: 99%

The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult

Shu

Sosa

Pineda

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewMinimally invasive gynecologic surgery (MIGS) is a subspecialty focus of obstetrics and gynecology with focused expertise on complex benign gynecologic disorders. To date, no formal recommendations have been made in defining a referral system for MIGS. This article reviews the evidence regarding common disorders and procedures and their outcomes, and posits a basis for MIGS referral. Recent findingsIn instances where intraoperative and perioperative features may pose clinical challenges to the surgeon and ultimately the patient, the literature suggests the following scenarios may have adverse outcomes, and therefore, benefit from the skills of MIGS subspecialists: fibroids --at least five myomas, myoma size at least 9 cm, and suspected myoma weight at least 500 g; endometriosis --presence of endometrioma(s), suspected stage III/IV endometriosis, and requirement for advanced adjunct procedures; hysterectomy -uteri at least 250 g or 12 weeks estimated size, at least three prior laparotomies, obesity, and complex surgical history with suspected adhesive disease. SummaryA referral system for MIGS subspecialists has proven benefits for both the gynecologic surgical community as well as the patients and their outcomes. This article provides evidence for collaboration with MIGS especially as it relates to leiomyomatous uteri, endometriosis, and complex hysterectomies.

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Risk factors for intraoperative hemorrhage during cesarean myomectomy

Cited by 14 publications

References 16 publications

The trend in cesarean myomectomies and the risk of obstetrical complications in Korea

The trend in cesarean myomectomies and the risk of obstetrical complications in Korea

The Trend in Cesarean Myomectomies and The Risk of Obstetrical Complications in Korea

The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult

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