Cesarean Myomectomy: Experience at a Tertiary-Care Center

Abstract

Abstract

Objectives:

The aim of this study was to evaluate the outcomes and procedural safety of cesarean myomectomy (CM).

Materials and

Methods: In this retrospective cohort study 55 cases of CM—54 patients, with 1 who underwent CM twice—were analyzed at a tertiary care obstetric unit. The primary outcome measure was intraoperative blood loss during CM. Secondary objectives were drop in hemoglobulin (Hb) after surgery, duration of surgery, hospital stay, and any other complications. Outcome measures were compared between patients with ≤5-cm myomas (group A) and patients with >5-cm myomas (group B).

Results:

Mean myoma size was 9.6 ± 2.35 (3–25) cm and mean myoma weight was 805.22 ± 221.27 (190–3530) g. Nine patients had ≤5-cm myomas and 46 patients had >5-cm myomas. Eleven patients (20%) had undergone abdominal/laparoscopic myomectomy prior to the current pregnancy. Estimated blood loss was comparable between the 2 groups (555.56 ± 212.78 mL and 726.01 ± 290.16 mL; p = 0.10). Hb fall after surgery was also comparable (1.32 ± 1.31 g% and 1.94 ± 1.15 g%; p = 0.15) between the 2 groups. Duration of surgery was significantly longer in group B, compared to group A. The largest myoma removed in the series was 25 cm (3530 g). Three or more myomas were considered to be multiple myoma. The maximum number of myomas removed in one patient was 13. There was no difference in postoperative hospital stay and any other complications in the two groups. None of the patients required cesarean hysterectomy.

Conclusions:

CM may be considered safe and feasible for both small and large leiomyoma. Surgical expertise is the key factor and the advantage of two surgeries together should be offered to patients after counseling. (J GYNECOL SURG 34:203)