Myomectomy at cesarean section can be performed without significant complications
Fibroidsare the most common benign tumors of the uterus. The complications due to theirpresence however depend on their size, number, and location. When present inlower uterine segment, they may obstruct the passage of the fetus, and in suchcases, cesarean delivery is indicated. Whether myomectomy should be combinedwith cesarean is still an unanswered question in modern obstetrics. Cesareanmyomectomy till recently was a dreaded surgery. It was believed that because ofincreased vascularity in a pregnant uterus, myomectomy at the time of cesareanwould lead to massive hemorrhage and increase in perioperative morbidity.However, with the advent of newer techniques of selective devascularization andadvances in the field of anesthesia, today many obstetricians are opting formyomectomy along with cesarean section (CS) to avoid a second surgery in thenear future with its accompanying set of complications and cost factor.
To assessthe intra- and post-operative complications of cesarean myomectomy, Ehigiegba,A.E., Ande, A.B. and Ojobo, S.I et carried out a descriptive study, and thesetting was the Department of Obstetrics and Gynaecology, University of Benin TeachingHospital and two private consultant units, all in Benin City. The subjects were25 pregnant women undergoing elective or emergency cesarean section at theseunits. The outcome measures were blood loss and need for blood transfusion,intra- and post-operative complications and duration of hospital stay.
Eighty-fourfibroids of various sizes (2–10 cm) were removed from the 25 women. Thefibroids were on the anterior uterine wall with most (94.8%) being sub-serousor intramural, and only few (five) sub-mucous. The mean blood loss was 876±312ml, range 400–1700 ml. Five patients (20%) had two units of whole bloodtransfusion. There was no case of severe hemorrhage necessitating hysterectomy.Eighteen patients (72%) had post-operative morbidities mainly of anemia [15(60%); hematocrit 26±2.9%). The average duration of post-operative hospitalstay was 7.4±2.2 days (range 3–12 days). Three (12%) patients have subsequentlybecome pregnant, two (66.7%) of whom had normal vaginal deliveries, while thethird had a repeat elective cesarean section.
Myomectomyduring CS is not always a hazardous procedure and can be performed withoutsignificant complications. Myomectomy should be performed after CS unlessdelivery of baby is not possible without removal of fibroid; then the fibroidmay have to be removed first.
Withadequate experience and the use of high dose oxytocin infusion (intra- andpost-operatively), myomectomy at cesarean section is not as hazardous as manynow believe.
Source: Ehigiegba, A.E., Ande, A.B. and Ojobo, S.I.(2001), Myomectomy during cesarean section. International Journal of Gynecology& Obstetrics, 75: 21-25. https://doi.org/10.1016/S0020-7292(01)00452-0
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