Myomectomy during cesarean section: is it a redundant or a feasible procedure?

Abstract

Myomectomy during cesarean section: is it a redundant or a feasible procedure? H. Kiyak1, L. S. Turkgeldi1, C. Ozdemir1, S. Gunkaya1, K. Tolga2, A. Gedikbası1 1Department of Obstetric and Gynecology, Istanbul Health Sciences University, Istanbul Kanuni Sultan Suleyman Training and Research Hospital 2Department of Obstetric and Gynecology, Istanbul Health Sciences University Bagcilar Training and Research Hospital, Istanbul (Turkey) Summary Aim: The aim of this study was to evaluate the postoperative course of myomectomies performed during cesarean deliveries at a tertiary hospital and determine the safety of this procedure. Materials and Methods: The clinical characteristics and postoperative outcome of 64 patients who underwent cesarean myomectomy and 75 patients who underwent cesarean delivery only were compared retrospectively. The operative times and complete blood count (CBC) parameters obtained preoperatively and on the first and second postoperative days were recorded. The clinical course of each pregnancy and postoperative complications, such as bleeding necessitating blood transfusions, fever and uterine atony were recorded. Results: No difference was detected in the mean preoperative and postoperative days 1 and 2 CBC parameters between the two groups. The change between preoperative and postoperative day 1 mean CBC parameters was not significantly different between the two groups, however the mean change in the CBC parameters between preoperative day 1 and postoperative day 2 was statistically significantly higher in the myomectomy group (p = 0.034) when compared with the non-myomectomy group. The mean operative time in the cesarean myomectomy group was significantly longer than the non-myomectomy group (p = 0.004). Conclusions: A higher amount of blood loss is encountered in those who underwent cesarean myomectomy than those who underwent cesarean delivery only, however, because the incidence of severe hemorrhage is not significantly different between the two groups, hence the authors conclude that cesarean myomectomy is a safe and feasible procedure, for subserosal as well as for intramural ones. Key words: Myomectomy; Cesarean section; Fibroids; Operative bleeding.