Caesarean Myomectomy Feasibility and safety
Journal Title: Sultan Qaboos University Medical Journal - Year 2012, Vol 12, Issue 2
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 8 cases from Sultan Qaboos University Hospital, Oman, where myomectomy was performed during Caesarean section for large lower segment fbroids. Seven were anterior lower segment fbroids, while one was a posterior lower uterine fbroid which interfered with closure of the uterine incision. Te antenatal course, perioperative management, and postoperative morbidity are discussed. Results: Te average age of the women was 28.7 years and mean gestational age at delivery was 36.75 weeks. Regarding intra-operative blood loss, 1 patient lost 900 ml, 5 patients lost 1–1.5 litres, 2 lost 1.5–2 L, and 1 patient with a 10 x 12 cm fbroid lost 3.2 L. Despite the majority being large myomas (7 of the 8 patients had myomas >5 cm in size) and 50% being intramural, no hysterectomy was required. Stepwise devascularisation was necessary in one case and preoperative placement of uterine balloon catheters was necessary in another. Te size of the fbroids was confrmed by histopathology. Myomectomy added 15 minutes to the operating time and 1 day to the hospital stay, but there was no signifcant 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.
Authors and Affiliations
Lovina SM Machado| Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman, Vaidyanathan Gowri| Department of Obstetrics & Gynaecology , College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman, Nihal Al-Riyami| Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman, Lamya Al-Kharusi| Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman
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