The safety of cesarean myomectomy in women with large myomas

Abstract

ObjectiveTo evaluate the safety of cesarean myomectomy in large myomas sized >5 cm.MethodsOne hundred sixty-five pregnant women with myomas who delivered via cesarean section were identified. Ninety-six women had cesarean section without myomectomy, and 65 women underwent cesarean myomectomy. We compared the maternal characteristics, neonatal weight, myoma types, and operative outcomes between two groups. We further analyzed cesarean myomectomy group according to myoma size. The large myoma was defined as myoma >5 cm in size. The maternal characteristics, neonatal weight, and myoma types were compared between two groups. We also compared the operative outcomes such as preoperative and postoperative hemoglobin, operative time, and hospitalized days between two groups.ResultsThere were no significant differences in the maternal characteristics, myoma types, neonatal weight and operative outcomes between cesarean section without myomectomy and cesarean myomectomy. The subgroup analysis according to myoma size (>5 cm or not) in cesarean myomectomy group revealed that there were no significant differences in the mean hemoglobin change (1.2 vs. 1.3 mg/dL, P=0.6), operative time (90.5 vs. 93.1 minutes, P=0.46), and the length of hospital stay (4.7 vs. 5.2 days, P=0.15) between two groups. The comparison of maternal characteristics, neonatal weight, and myoma types between two groups also showed no statistical significance.ConclusionCesarean myomectomy in patients with large myomas is a safe and effective procedure.

Retrospective study of 53 cases of caesarean myomectomy regarding its safety and feasibility

“…Studies by Li Hui, et al, Dam hye kwon, et al, Roman et al showed no increase in intraoperative blood loss in types of smaller 3-6cm subserosal and intramural fibroids. [5][6][7] In our study the mean Hb change is not statistically significant in different types of fibroids and we had only one 8cm submucous fibroid which needed an unit of PRBC transfusion. In other studies also, submucous fibroids were encountered in very less numbers (2-13%) and blood loss was not significant compared to other types except the risk of entering the cavity which becomes a risk factor in future pregnancies.…”

“…About the prophylactic measures, 75% of the women had either vasopressin usage (30) or other Devasularisation methods like Uterine artery ligation, Cornuotubal ligation, uterine artery embolisation, application of tourniquet. 1,2,6 But there is no difference in blood loss between the users and nonusers. In the study by Li Hui, et al, for larger myomas, tourniquet had been used and Adesiyun, et al routinely used Foleys tourniquet around broad ligament and ovarian arteries, Alexander, et al also used tourniquet around the base of broad ligament avoiding the tubes.…”

Is Caesarean Myomectomy a Safe Procedure? A Comparative Study

“…The present study could not obtain data on the length of operation, but experience shows that the length of operation will be longer in caesarean myomectomy. Kwon et al 17 conducted a study to compare caesarean myomectomy patients with myomas >5 cm to those with myomas ≤5 cm in terms of preoperative and postoperative haemoglobin changes, length of hospital stay, postoperative fever and length of operation and found no significant difference between the groups. Park et al 5 compared 97 pregnant women who underwent caesarean myomectomy and 60 pregnant women with myomas that had undergone C-section only and identified no complications that were independent from the location of the myoma.…”

Safety of cesarean myomectomy with huge myoma compared with uncomplicated cesarean section in Indian scenario

“…8 This study included 15 term pregnant women with fibroid who had undergone cesarean myomectomy and compared them with control group including 15 pregnant women without fibroid and any other high risk factor matched on basis of gestational age and parity undergoing cesarean section. The outcomes compared were operative time, change in haemoglobin level from pre-operative to postoperative period, post-operative complications, and duration of hospital stay and follow up of patients up to 6 weeks postpartum.…”