Myomectomy during Caesarean Section in Ambedkarnagar District: Case series

Abstract

Objectives: Caesarean myomectomy has traditionally been discouraged due to fears of intractable haemorrhage and increased postoperative morbidity. However, a number of authors have recently shown that myomectomy during Caesarean section does not increase the risk of haemorrhage or postoperative morbidity. Methods: We present a series of 14 cases from MRA medical college,Ambedkar nagar, where myomectomy was performed during Caesarean section for large fibroids. Eight were anterior lower segment fibroids, while five was upper anterior segment uterine fibroid one was post segment. The antenatal course, perioperative management, and postoperative morbidity are discussed. Results: The average age of the women was 28.7 years and mean gestational age at delivery was 37.6weeks. Regarding intra-operative blood loss, 4 patients lost 900 ml, 9 patients lost 1–1.5 litres, and 1 patient with a 14x 16 cm fibroid lost 2 L. Despite the majority being large myomas (12 of the 14 patients had myomas >5 cm in size) and 36% being intramural, no hysterectomy was required. Stepwise devascularization was necessary in one case. The size of the fibroids was confirmed by histopathology. Myomectomy added 15-30 minutes to the operating time and 6-14 day to the hospital stay, but there was no significant postoperative morbidity. Neonatal outcome was good in all patients. Conclusion: In selected patients, myomectomy during Caesarean section is a safe and effective procedure at tertiary centres with experienced surgeons.