Myomectomy during cesarean section

Abstract

Obstetricians are often confronted with large fibroids while performing cesarean sections. Pedunculated fibroids can easily be removed and hemostasis secured at that time without endangering the life of the mother. Yet, myomectomy during cesarean section was practically absent from the obstetric literature until the last decade and the current teaching still is to deliver the baby and perform myomectomy later, perhaps before the next pregnancy. When the fibroids are located in the lower segment of the uterus, many obstetricians prefer to choose this classical route. To deliver the baby, however, they are sometimes faced with the emergency decision of either removing fibroids, or incising through them and leaving them behind for a later myomectomy.

In a prospective clinical trial conducted between April 2000 and January 2001 at the Korle Bu Teaching Hospital and Family Health Hospital in Accra, Ghana, a myomectomy performed during a cesarean section was compared with a cesarean section without myomectomy. Twelve patients with uterine fibroids who had a cesarean section for various indications formed the case group. Women who had a cesarean section immediately after one of the 12 selected patients served as a control group. In all, 24 women were enrolled in the study.

The average age of the case group was 34.5 years and the average age of the control group was 30.2 years. The average hemoglobin rates were 11.73 g/dl pre‐operatively and 9.90 g/dl post‐operatively for the case group, and 12.07 g/dl pre‐operatively and 10.34 g/dl post‐operatively for the control group. The average duration of the operation was 62.08 min for women who had cesarean section and myomectomy. Although it was longer than for the control group, for which it was 50.83 min, it was not significantly longer.

The removed fibroids, which were mainly intramural and located in the body of the uterus, were composed of 1–6 nodules. In one patient, they weighed a total of approximately 500 g. Uterine involution was normal in all women and there were no significant complications during the puerperium.