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Shi C, Chen J, Chen A. Clinical outcome analysis of intramural myoma greater than 8 cm in diameter removed during caesarean section: a retrospective study. BMC Womens Health 2023; 23:60. [PMID: 36774454 PMCID: PMC9921307 DOI: 10.1186/s12905-023-02210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVE To explore the safety and efficiency of endometrial myomectomy (EM) and Serosal myomectomy (SM) for the removal of intramural myoma greater than 8 cm in diameter during cesarean section. METHODS Retrospective analysis and follow-up were used, and 190 cases of pregnancy complicated with uterine myoma from Jan. 2017 to May 2022 in Ningbo Women's and Children's Hospital were collected, 130 cases of caesarean myomectomy as study group, 64 cases of EM as study group A, 66 cases of SM as study group B, 33 cases with uterine fibroids removed before suturing the uterine incision as study group B1, 33 cases with uterine incision sutured followed by removal of fibroids as study group B2, 60 cases of Caesarean section alone as control group. To compare perioperative conditions between and within groups. RESULTS ① Operation time, postoperative exhaust time, pre- and post-operative haemoglobin drop, intraoperative blood loss were all more than those of the control group in the study group (68.65 ± 11.87 vs 56.17 ± 9.18 min, 21.04 ± 4.98 vs 17.03 ± 1.3 h, 1.27 ± 0.59 vs 1.09 ± 0.43 g/dl, 613 ± 221 vs 532 ± 156 ml, P < 0.001, P < 0.001, P = 0.025, P = 0.011). ② For type III and V fibroids, the time of myoma removal, postoperative exhaust and pre- and post-operative haemoglobin drop and intraoperative blood loss in study group A were less than those in study group B (18.02 ± 3.89 vs 20.19 ± 5.32 min, 18.83 ± 2.57 vs 23.93 ± 6.84 h, 600 ± 194 vs 730 ± 277 ml, 1.20 ± 0.57 vs 1.59 ± 0.70 g/dl, P = 0.036, P < 0.001, P = 0.014, P = 0.008); For type IV uterine fibroids, only postoperative exhaust time was less in Study Group A than in Study Group B (19.27 ± 2.2 vs 21.35 ± 3.23 h, P = 0.016). ③ Time of myoma removed was less in study group B1 than in study group B2 (18.24 ± 4.53 vs 20.7 ± 4.59 min, P = 0.033). CONCLUSION It is safe and feasible to remove interstitial myomas larger than 8 cm in diameter during caesarean section. EM has the advantage of shorter operation time and less intraoperative bleeding, SM, in a way that the myoma is removed before suturing the uterine incision, can shorten the myomectomy time. It can benefit the patients more.
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Affiliation(s)
- Chunbo Shi
- Department of Obstetrics and Gynecology, Ningbo Women and Children’s Hospital, Ningbo, 315012 Zhejiang China
| | - Jinliang Chen
- Radiology Department, Ningbo Women and Children’s Hospital, Ningbo, 315012 Zhejiang China
| | - Aner Chen
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, 315012, Zhejiang, China.
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Dimassi K, Ami O, Merai R, Velemir L, Simon B, Fauck D, Triki A. Double-layered purse string uterine suture compared with single-layer continuous uterine suture: A randomized Controlled trial. J Gynecol Obstet Hum Reprod 2021; 51:102282. [PMID: 34933146 DOI: 10.1016/j.jogoh.2021.102282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND With the aim of preventing cesarean scar defects, we introduced a new technique involving a purse string uterine suture. To date, this uterine suture technique has not been formally evaluated. The objective of the study was to test the hypothesis that compared to single layer continuous uterine suture (SLCUS), a double layered purse string uterine suture (PSUS) significantly reduces cesarean scar defect (CSD) rates, without increasing the perioperative maternal morbidity. METHODS A prospective randomized study. Primary outcome was the rate of CSD. 100 patients were enrolled in 2 groups according to the uterine suture technique. A hysterosonography was performed by the same senior obstetrician blinded to the uterine suture technique 6 months after surgery .Operative time and calculated blood loss (CBL) were used for the short time analysis. Uterine and CSD measurements were used for the mid time analysis. RESULTS Despite a longer operative time with PSUS (7.17 ± 2.31 min Vs. 6.31 ± 3.04 min, p = 0.028; p <10‾³); there was no significant difference in terms of CBL (520 ± 58 with PSUS vs. 536 ± 50 ml, p = 0.724). There was a significant decrease in the rate of CSD with PSUS: 6.66% Vs.40% with SLUCS; p<0.001. Moreover, SLUCS was the leading risk factor for CSD: adjusted OR=6; 95% CI [0-1], p<10‾³). CONCLUSION Compared to single layer continuous suture, double layered purse stringuterine suture significantly reduces cesarean scar defect rates, without increasing the perioperative maternal morbidity.
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Affiliation(s)
- Kaouther Dimassi
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia; University Tunis El Manar, Faculty of Medicine Tunis.
| | - Olivier Ami
- Ramsay Healthcare France, La Muette, Paris, France
| | - Rania Merai
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia; University Tunis El Manar, Faculty of Medicine Tunis
| | - Luka Velemir
- Lenval foundation Polyclinique Santa Maria, Nice, France
| | - Benedicte Simon
- Ramsay Healthcare France, Les Franciscaines, Versailles, France
| | - Denis Fauck
- Ramsay Healthcare France, Saint Lambert, La Garenne-Colombes, France
| | - Amel Triki
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia; University Tunis El Manar, Faculty of Medicine Tunis
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Dai Y, Xia L, Lin J, Xu R, You W. Study on the method of enucleation of anterior uterine fibroids by transverse incision of the lower uterine segment during cesarean section. BMC Pregnancy Childbirth 2021; 21:744. [PMID: 34732155 PMCID: PMC8564958 DOI: 10.1186/s12884-021-04226-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction A retrospective study was conducted to investigate the effectiveness and feasibility of fibroid enucleation in the anterior wall of the uterus by transverse uterine incision during cesarean section. Methods The medical history, surgical data, preoperative and postoperative changes in the blood system, and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section at the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively. Results No significant differences were noted in the leiomyoma number, pathological type, preoperative and postoperative hemoglobin level, perioperative bleeding incidence, blood transfusion frequency, postoperative fever incidence, and duration of lochia between the study and control groups. The proportion of large fibroids was slightly higher in the study group than in the control group (p < 0.05), and the operation time and average hospitalization time were slightly longer in the study group than in the control group (p < 0.05). The distribution of type III–V fibroids was slightly more in the study group than in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05). Conclusion Fibroid enucleation is safe and effective in the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. It has the potential to reduce the risk of pelvic and intrauterine adhesions in the future.
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Affiliation(s)
- Yan Dai
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China.
| | - Li Xia
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China.
| | - Jinxiao Lin
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China
| | - Rongli Xu
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China
| | - Wenqiang You
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China
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Dimassi K, Halouani A, Kammoun A, Ami O, Simon B, Velemir L, Fauck D, Triki A. The extraperitoneal French AmbUlatory cesarean section technique leads to improved pain scores and a faster maternal autonomy compared with the intraperitoneal Misgav Ladach technique: A prospective randomized controlled trial. PLoS One 2021; 16:e0245645. [PMID: 33481875 PMCID: PMC7822305 DOI: 10.1371/journal.pone.0245645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. Study design One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. Results Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04–2.41] vs. 2.93 [2.46–3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patients (p < 0.001). There were no differences in maternal surgical or neonatal complications between groups. Conclusions Our results indicate that FAUCS can reduce postoperative pain and accelerate recovery, suggesting that this technique might be superior to MLCS and should be more widely used. One potentially key difference between FAUCS and MLCS is that MLCS includes 100 mcg spinal morphine anesthesia in addition to the same anesthesia used by FAUCS. Any interpretation of apparent differences must take the presence/absence of morphine into account.
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Affiliation(s)
- Kaouther Dimassi
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
- * E-mail:
| | - Ahmed Halouani
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Amine Kammoun
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
| | - Olivier Ami
- Ramsay Healthcare France, La Muette, Paris, France
| | - Benedicte Simon
- Ramsay Healthcare France, Les Franciscaines, Versailles, France
| | - Luka Velemir
- Lenval Foundation Polyclinique Santa Maria, Nice, France
| | - Denis Fauck
- Ramsay Healthcare France, Saint Lambert, La Garenne-Colombes, France
| | - Amel Triki
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
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HORTU İ, ALGÜL F, DURMAZ B, AKDEMİR A, ŞAHİN Ç, ERGENOĞLU AM, AKERCAN F. Sezaryen sırasında miyomektomi: Perioperatif sonuçların değerlendirilmesi. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.834155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Huang Y, Ming X, Li Z. Feasibility and safety of performing cesarean myomectomy: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 35:2619-2627. [PMID: 32674632 DOI: 10.1080/14767058.2020.1791816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine the feasibility and safety of performing cesarean myomectomy on pregnant women with myomas compared to cesarean section only. METHODS We retrieved English articles in the PubMed, Cochrane Library, Medline and EMBASE databases from inception to April 2020. Observational studies including the comparison of patients who underwent cesarean myomectomy and cesarean section, as well as those reporting perioperative outcomes were selected. Data extraction was conducted using RevMan 5.3. RESULTS Twenty-three studies comprising 8,016 women were included in the meta-analysis. Of these, 3,955 underwent cesarean myomectomy, while 4,061 underwent cesarean section only. Cesarean myomectomies were associated with a greater decline in mean hemoglobin (mean difference [MD] 0.20 g/dL, 95% confidence intervals [CI] 0.06, 0.35, p = .007), greater incidence of hemorrhage (odds ratio [OR] 1.46, 95% CI 1.06, 2.01, p = .02), greater volume of blood loss (MD 45.54 ml, 95% CI 2.68, 88.41, p = .04), higher transfusion rate (OR 1.47 95%CI 1.09, 1.99, p = .01), longer operation duration (MD 10.40 min, 95% CI 8.54, 12.25, p < .001), or longer postoperative hospitalization (MD 0.18 d, 95% CI 0.12, 0.24, p < .001), compared to those who underwent cesarean section only. There was no statistical difference in postoperative fever rates (OR 1.12, 95% CI 0.77, 1.62). CONCLUSION Hemorrhage represents a risk factor which should not be overlooked by surgeons performing cesarean myomectomy. Intramural myomas, myomas ≥7 cm in size, and multiple myomas are associated with more intraoperative hemorrhage and prolonged operation duration. We suggest that, with appropriate hemostatic techniques and when performed by experienced surgeons, cesarean myomectomy may be safe and feasible in selected patients with myomas, regardless of size and locations, except if they are located at the cornual or close to large vessels, and in the absence of uterine atony during surgery.
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Affiliation(s)
- Yue Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
| | - Xiu Ming
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
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7
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Parsons AD, Saunders RD, Katebi Kashi P, McMullen EN, Dengler KL. Incidental myomectomy at time of vaginal delivery contributing to postpartum hemorrhage: A case report and review of the literature. J Gynecol Obstet Hum Reprod 2020; 50:101776. [PMID: 32325269 DOI: 10.1016/j.jogoh.2020.101776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Uterine leiomyoma are implicated in certain adverse pregnancy related outcomes such as postpartum hemorrhage. Large submucosal leiomyoma defined as greater than 5 cm, may have higher complication rates; however, high quality data is limited. CASE A 44-year-old gravida 4 with history of two full-term vaginal deliveries presented at 40 and 2/7 weeks of gestation with premature rupture of membranes and delivered vaginally a viable female infant complicated by a postpartum hemorrhage due to uterine atony. During a manual uterine sweep for suspected retained products of conception, a submucosal leiomyoma was incidentally extracted. Uterine hemorrhage immediately ensued, requiring vasopressors, blood transfusion, and intensive care unit admission. Hemostasis was ultimately achieved with placement of a Bakri balloon. CONCLUSION This case reaffirms the association of large (greater than five centimeters) submucosal leiomyoma with severe postpartum hemorrhage. Caution should be taken with patients who have leiomyoma with these characteristics. The use of balloon tamponade in such situations may aid in hemostasis and avoidance of postpartum hysterectomy.
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Affiliation(s)
- Arlene D Parsons
- Department of Obstetrics and Gynecology, Blanchfield Army Community Hospital, Fort Campbell, KY, United States
| | - Rhiana D Saunders
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Payam Katebi Kashi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Inova Fairfax Women's Hospital, Falls Church, VA, United States
| | - Erin N McMullen
- Obstetrics & Gynecology, MultiCare Women's Center, Tacoma, WA, United States
| | - Katherine L Dengler
- Department of Obstetrics and Gynecology, Division of Urogynecology, Walter Reed National Military Medical Center, Bethesda, MD, United States.
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8
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Hatırnaz Ş, Güler O, Başbuğ A, Çetinkaya MB, Kanat-Pektaş M, Bakay K, Çelik S, Şentürk Ş, Soyer-Çalışkan C, Gürçağlar A, Şahin B, Kalkan Ü, Çelik H, Kalyoncu Ş, Bıyık İ, Yassa M, Erol O, Akarsu S, Turhan U, Ulubaşoğlu H, Sparic R, Tinelli A. A Comparative Multicentric Study on Serosal and Endometrial Myomectomy During Cesarean Section: Surgical Outcomes. J INVEST SURG 2020; 34:687-694. [DOI: 10.1080/08941939.2020.1725188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Şafak Hatırnaz
- Medicana Samsun International Hospital, IVF Center, Sansun, Turkey
| | - Oğuz Güler
- Department of Obstetrics and Gynecology, Bilge Hastanesi, Istanbul, Turkey
| | - Alper Başbuğ
- Department of Obstetrics and Gynecology, School of Medicine, Duzce University, Duzce, Turkey
| | - Mehmet Bilge Çetinkaya
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Mine Kanat-Pektaş
- Department of Obstetrics and Gynecology, School of Medicine, Kocatepe University, Afyon, Turkey
| | - Kadir Bakay
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Samettin Çelik
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Şenol Şentürk
- Department of Obstetrics and Gynecology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | - Aysemin Gürçağlar
- Department of Obstetrics and Gynecology, School of Medicine, Amasya University, Amasya, Turkey
| | - Banuhan Şahin
- Department of Obstetrics and Gynecology, School of Medicine, Amasya University, Amasya, Turkey
| | - Üzeyir Kalkan
- Department of Obstetrics and Gynecology, Özel Egemed Hospital Söke, Aydın, Turkey
| | - Handan Çelik
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Şenol Kalyoncu
- Department of Obstetrics and Gynecology, Private Office, Ankara, Turkey
| | - İsmail Bıyık
- Department of Obstetrics and Gynecology, Kütahya Sağlık Bilimleri Üniversitesi, Kütahya, Turkey
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Şişli Etfal Hastanesi, İstanbul, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Antalya Eğitimve Araştırma Hastanesi, Antalya, Turkey
| | | | - Uğur Turhan
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Hasan Ulubaşoğlu
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Radmila Sparic
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Višegradska, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Lecce, Italy
- Laboratory of Human Physiology, PhystechBioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia
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9
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Liu D, Han M, Huang P, Li C, Li X. Use of the base purse-string suture approach to remove giant uterine fibroids during cesarean section. J Int Med Res 2019; 48:300060519893868. [PMID: 31889467 PMCID: PMC7783271 DOI: 10.1177/0300060519893868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to investigate the optimal strategy for myomectomy for
removing giant uterine fibroids when necessary in women undergoing cesarean
section. Methods This study was retrospective in design, and assessed outcomes in 26 patients
who underwent myomectomy using a “base purse-string suture” during cesarean
section. The operative duration, blood loss, uterine involution, and
duration of postpartum lochia were analyzed. Results This suture was associated with a mean operative duration of 11.17 ± 5.36
minutes and the mean estimated blood loss was 11.15 ± 6.05 mL. The mean
postpartum duration of lochia was 34.92 ± 7.55 days and there were no cases
of postpartum hemorrhage. Uterine size returned to normal within 6 weeks of
delivery, without any apparent defects or abnormalities in the uterine wall
as shown by an ultrasonic examination. Conclusion This novel implementation of a base purse-string suture during cesarean
myomectomy for removal of giant fibroids is a simple, safe, and effective
intervention that should be considered for implementation in appropriate
patients.
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Affiliation(s)
- Dan Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Min Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pu Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chunfang Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuelan Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Ramya T, Sabnis SS, Chitra TV, Panicker S. Cesarean Myomectomy: An Experience from a Tertiary Care Teaching Hospital. J Obstet Gynaecol India 2019; 69:426-430. [PMID: 31598045 DOI: 10.1007/s13224-019-01239-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 05/09/2019] [Indexed: 11/27/2022] Open
Abstract
Background Recent literature supports the removal of myomas during cesarean section, which traditionally was considered a relative contraindication, given a higher complication rate. This study is to share our experience of cesarean myomectomy in the last decade. Methods This study is a retrospective review of our prospectively maintained database, from January 2008 to December 2017, at a tertiary care level teaching institution. All patients who underwent myomectomy during cesarean section were included. There were no exclusions. Results A total of twenty patients underwent myoma removal along with the cesarean operation during this period with a mean age of 30 years. Majority of patients were nulliparous (70%). Common comorbidities were diabetes mellitus (40%) and hypothyroidism (20%). Mean size of myomas were 5.33 cm (± 2.08), and the number varied from one to three. The most common location was the posterior surface of the uterus with the commonest variety being subserous. Most patients were discharged on the fifth postoperative day. Conclusion This study demonstrates that cesarean myomectomy to be a safe and feasible procedure in experienced hands. It offers the advantage of avoiding a second surgery in selected patients.
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Affiliation(s)
- T Ramya
- Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences and Research (PSGIMSR), Coimbatore, Tamil Nadu 641004 India
| | - Shraddha S Sabnis
- Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences and Research (PSGIMSR), Coimbatore, Tamil Nadu 641004 India
| | - T V Chitra
- Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences and Research (PSGIMSR), Coimbatore, Tamil Nadu 641004 India
| | - Seetha Panicker
- Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences and Research (PSGIMSR), Coimbatore, Tamil Nadu 641004 India
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11
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Senturk MB, Polat M, Doğan O, Pulatoğlu Ç, Yardımcı OD, Karakuş R, Tayyar AT. Outcome of Cesarean Myomectomy: Is it a Safe Procedure? Geburtshilfe Frauenheilkd 2017; 77:1200-1206. [PMID: 29200476 PMCID: PMC5703655 DOI: 10.1055/s-0043-120918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/09/2017] [Accepted: 10/09/2017] [Indexed: 11/05/2022] Open
Abstract
Objective
Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy.
Method
A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant.
Results
While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05).
Conclusion
This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.
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Affiliation(s)
- Mehmet Baki Senturk
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Mesut Polat
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Çiğdem Pulatoğlu
- Department of Obstetrics and Gynecology, Bayburt Government Hospital, Bayburt, Turkey
| | - Oğuz Devrim Yardımcı
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Resul Karakuş
- Departments of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Ahter Tanay Tayyar
- Departments of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
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Huang SY, Shaw SW, Su SY, Li WF, Peng HH, Cheng PJ. The impact of a novel transendometrial approach for caesarean myomectomy on obstetric outcomes of subsequent pregnancy: a longitudinal panel study. BJOG 2017. [DOI: 10.1111/1471-0528.14798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- SY Huang
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - SW Shaw
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - SY Su
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - WF Li
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - HH Peng
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - PJ Cheng
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
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13
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Sparić R, Kadija S, Stefanović A, Spremović Radjenović S, Likić Ladjević I, Popović J, Tinelli A. Cesarean myomectomy in modern obstetrics: More light and fewer shadows. J Obstet Gynaecol Res 2017; 43:798-804. [DOI: 10.1111/jog.13294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Radmila Sparić
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Saša Kadija
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Aleksandar Stefanović
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Svetlana Spremović Radjenović
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Ivana Likić Ladjević
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Jela Popović
- Higher Education School of Professional Health Studies; Belgrade Serbia
| | - Andrea Tinelli
- International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics, Moscow Institute of Physics and Technology; Moscow State University; Dolgoprudny Moscow Russia
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology; Vito Fazzi Hospital; Piazzetta Muratore Lecce Italy
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14
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Akbas M, Mihmanli V, Bulut B, Temel Yuksel I, Karahisar G, Demirayak G. Myomectomy for intramural fibroids during caesarean section: A therapeutic dilemma. J OBSTET GYNAECOL 2016; 37:141-145. [DOI: 10.1080/01443615.2016.1229272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Murat Akbas
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Veli Mihmanli
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Berk Bulut
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Ilkbal Temel Yuksel
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Gulsen Karahisar
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Demirayak
- Obstetrics and Gynaecology Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
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15
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Sparić R, Malvasi A, Kadija S, Babović I, Nejković L, Tinelli A. Cesarean myomectomy trends and controversies: an appraisal. J Matern Fetal Neonatal Med 2016; 30:1114-1123. [PMID: 27328626 DOI: 10.1080/14767058.2016.1205024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Although the first report on cesarean myomectomy (CM) was a century ago, the management of a myomectomy during a cesarean section (CS) remains controversial. The objective of this study is to provide the latest data on this topic regarding the techniques and complications of CM. METHODS The authors consulted the most important scientific databases investigating the indications and contraindications for CM, the operational techniques, benefits and complications. RESULTS CM provides the benefits of two surgeries in one laparotomy, avoiding the risks of repeated anesthesia and relaparotomy. Nevertheless, in some patients, CM may be associated with increased morbidity and, in such cases, an interval myomectomy might be a safer option. Myomas compromising fetal extraction and uterine incision and/or suturing should be preferably enucleated during CS. CM is generally considered relatively safe in cases of anterior wall myomas, subserous and pedunculated myomas, particularly if a myomectomy is feasible without additional hysterotomy. Multiple myomas, deep intramural, fundal and cornual myomas and posterior uterine wall myomas are associated with more surgical complications during CM. CONCLUSIONS With increasing reports in favor of CM, the risk-benefit ratio should be still evaluated with randomized controlled trials, in order to achieve more data on CM.
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Affiliation(s)
- Radmila Sparić
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Antonio Malvasi
- c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.,d Department of Obstetrics & Gynecology , Santa Maria Hospital, GVM Care & Research , Bari , Italy
| | - Saša Kadija
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Ivana Babović
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Lazar Nejković
- e Clinic of Gynecology and Obstetrics "Narodni Front" , Belgrade , Serbia , and
| | - Andrea Tinelli
- c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.,f Division of Experimental Endoscopic Surgery , Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology Vito Fazzi Hospital , Lecce , Italy
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16
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Turan C, Büyükbayrak EE, Onan Yilmaz A, Karageyim Karsidag Y, Pirimoglu M. Purse-string double-layer closure: A novel technique for repairing the uterine incision during cesarean section. J Obstet Gynaecol Res 2014; 41:565-74. [DOI: 10.1111/jog.12593] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 08/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Cem Turan
- Department of Obstetrics and Gynecology; Dr Lutfi Kirdar Kartal Education and Research Hospital; Istanbul Turkey
| | - Esra Esim Büyükbayrak
- Department of Obstetrics and Gynecology; Dr Lutfi Kirdar Kartal Education and Research Hospital; Istanbul Turkey
| | - Aylin Onan Yilmaz
- Department of Obstetrics and Gynecology; Dr Lutfi Kirdar Kartal Education and Research Hospital; Istanbul Turkey
| | - Yasemin Karageyim Karsidag
- Department of Obstetrics and Gynecology; Dr Lutfi Kirdar Kartal Education and Research Hospital; Istanbul Turkey
| | - Meltem Pirimoglu
- Department of Obstetrics and Gynecology; Dr Lutfi Kirdar Kartal Education and Research Hospital; Istanbul Turkey
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The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Sci 2014; 57:367-72. [PMID: 25264526 PMCID: PMC4175596 DOI: 10.5468/ogs.2014.57.5.367] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 03/25/2014] [Accepted: 04/28/2014] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the safety of cesarean myomectomy in large myomas sized >5 cm. Methods One hundred sixty-five pregnant women with myomas who delivered via cesarean section were identified. Ninety-six women had cesarean section without myomectomy, and 65 women underwent cesarean myomectomy. We compared the maternal characteristics, neonatal weight, myoma types, and operative outcomes between two groups. We further analyzed cesarean myomectomy group according to myoma size. The large myoma was defined as myoma >5 cm in size. The maternal characteristics, neonatal weight, and myoma types were compared between two groups. We also compared the operative outcomes such as preoperative and postoperative hemoglobin, operative time, and hospitalized days between two groups. Results There were no significant differences in the maternal characteristics, myoma types, neonatal weight and operative outcomes between cesarean section without myomectomy and cesarean myomectomy. The subgroup analysis according to myoma size (>5 cm or not) in cesarean myomectomy group revealed that there were no significant differences in the mean hemoglobin change (1.2 vs. 1.3 mg/dL, P=0.6), operative time (90.5 vs. 93.1 minutes, P=0.46), and the length of hospital stay (4.7 vs. 5.2 days, P=0.15) between two groups. The comparison of maternal characteristics, neonatal weight, and myoma types between two groups also showed no statistical significance. Conclusion Cesarean myomectomy in patients with large myomas is a safe and effective procedure.
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Kosmidis C, Efthimiadis C, Anthimidis G, Vasiliadou K, Kotsifa C, Stefanatos A, Stavrakis T, Basdanis G. Laparoscopic Cholecystectomy During Cesarean Section: A Case Series. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | - Georgios Anthimidis
- Department of Surgery, Interbalkan Medical Center, Pilea, Thessaloniki, Greece
| | - Kalliopi Vasiliadou
- Department of Surgery, Interbalkan Medical Center, Pilea, Thessaloniki, Greece
| | - Chrysavgi Kotsifa
- Department of Obstetrics–Gynecology, Interbalkan Medical Center, Pilea, Thessaloniki, Greece
| | - Alexandros Stefanatos
- Department of Obstetrics–Gynecology, Interbalkan Medical Center, Pilea, Thessaloniki, Greece
| | - Thomas Stavrakis
- Department of Obstetrics–Gynecology, Interbalkan Medical Center, Pilea, Thessaloniki, Greece
| | - Georgios Basdanis
- Department of Surgery, Interbalkan Medical Center, Pilea, Thessaloniki, Greece
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Tinelli A, Malvasi A, Mynbaev OA, Barbera A, Perrone E, Guido M, Kosmas I, Stark M. The surgical outcome of intracapsular cesarean myomectomy. A match control study. J Matern Fetal Neonatal Med 2013; 27:66-71. [DOI: 10.3109/14767058.2013.804052] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND We evaluated the data of patients who had applied myomectomy during cesarean section operation in our clinic between April, 2008 and December, 2010. OBJECTIVE I0 n this period, 3689 cesarean sections were done in our clinic, we analyzed their data retrospectively and determined 27 myomectomy cases during cesarean section operation. The age of the patients, the numbers of pregnancy, parities, the rates of abortus, indications of cesarean, pregnancy weeks, residential areas of myoms detected during the cesarean and their size, were recorded. Furthermore, pre-operative and post-operative hemoglobin (Hb) values, differences between hemoglobin values, whether there was bleeding or not, the need of blood transfusion if it occurred, the duration of operation and hospitaization and the pathological diagnoses of myomectomy materials, were examined. MATERIALS AND METHODS Retrospective study of myomectomies. RESULTS The mean age of patients was 29.6±5.9 (19-42) and mean gestational age was 39.2±1.0(37-42) weeks. The mean size of the fibroids was 5.94±6.29 cm(3) (0.96-26.50 cm3). Subserous myoms were the most frequently seen ones (24 of 27 patients=89%) with fundal, corporal localizations in most of the instances. T0 he pre-operative and post-operative values of Hb were 11.8±1.52 (8.6-10.5) and 10.3±2.6 (6.9-13.3) g/dl respectively and the difference was statistically significant (P<0.001). Blood transfusion was not necessary in any patient. The mean duration of the operation was found to be 40.7±13.9 (13-60) minutes. CONCLUSION Myomectomies can be performed safely during cesarean section by experienced obstetricians and gynecologists, and myomectomy performed for fibroids in appropriate localizations does not increase post-operative bleeding or maternal morbidity or mortality.
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Affiliation(s)
- Kadı Celal
- Obstetrics and Gynecology Clinic, Alanya State Hospital, Antalya, Turkey
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