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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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Petousis S, Chatzakis C, Westerway SC, Abramowicz JS, Dinas K, Dong Y, Dietrich CF, Sotiriadis A. World Federation for Ultrasound in Medicine Review Paper: Incidental Findings during Obstetrical Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:10-19. [PMID: 34702644 DOI: 10.1016/j.ultrasmedbio.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Although the prevalence of incidental findings revealed during an obstetric ultrasound examination is low, the findings may include adnexal and cervical masses, uterine or urinary congenital malformations, free fluid in the pouch of Douglas or tortuous vessels (varices). Adnexal masses are the most common finding and vary in imaging characteristics. They are mainly unilateral, cystic masses with a low risk of malignancy that are treated conservatively. The International Ovarian Tumor Analysis scoring models may be helpful in differentiating benign from malignant masses. For those masses >5 cm, follow-up is recommended, and resection could be considered to avoid risk of torsion, rupture and hemorrhage, which may compromise pregnancy outcome. Uterine masses such as fibroids are commonly diagnosed early in the first trimester and should be followed up during pregnancy to evaluate any changes. Transabdominal and transvaginal ultrasound is the first-line test for the diagnosis of such incidentalomas; however, magnetic resonance ultrasound may have a useful role in excluding malignancy potential. As a result of their low frequency and the lack of good evidence, there are no specific guidelines on the management of incidentalomas detected at obstetric scans. Their management should follow the related general guidelines for ovarian, cervical and uterine masses, with individualized management depending on the pregnancy status.
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Affiliation(s)
- Stamatios Petousis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Christos Chatzakis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | | | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
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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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Kwon JY, Byun JH, Shin I, Hong S, Kim R, Park IY. Risk factors for intraoperative hemorrhage during cesarean myomectomy. Taiwan J Obstet Gynecol 2021; 60:41-44. [PMID: 33495006 DOI: 10.1016/j.tjog.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We intended to identify the risk factors of intraoperative hemorrhage on occasions of a combined operation of myomectomy with cesarean section for patients with uterine leiomyoma. MATERIALS AND METHODS A retrospective cohort study was done of all patients who underwent cesarean myomectomy for intramural leiomyoma at a single university hospital. Cases identified with subserosal leiomyoma, placental disorder, and comorbid conditions related to coagulopathy were excluded. All the included cases were classified into intraoperative hemorrhage and non-hemorrhage group. Obstetric and demographic factors and parameters of leiomyoma were compared between two groups. RESULTS A total of 302 women underwent cesarean myomectomy during the study period. Among these women, 212 pregnant women met the inclusion criteria. Intraoperative hemorrhage occurred in 43 women (20.3%). There was no significant intergroup difference in the number of removed leiomyomas. Multiple logistic regression analysis demonstrated that lower segmental location (odds ratio [OR], 2.827; 95% confidence interval [CI], 1.033-7.734, P = 0.043) and the diameter (OR, 1.167; 95% CI, 1.044-1.305, P = 0.006) were significant independent risk factors for hemorrhage during cesarean myomectomy. The combination of ≥ 8 cm diameter or lower segmental position of the leiomyoma yielded a specificity of 79.3% for operative hemorrhage during cesarean myomectomy. The negative predictive value of this combination was 88.7% for operative hemorrhage with a prevalence of 20%. CONCLUSION The large size and lower segmental position of the leiomyoma are significantly risk factors for intraoperative hemorrhage during cesarean myomectomy. If the leiomyoma is located in the uterine fundus or body and its diameter is less than 8 cm, the removal of leiomyoma may be considered at the time of cesarean section.
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Affiliation(s)
- Ji Young Kwon
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hea Byun
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Inhye Shin
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Rayon Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea.
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Sakinci M, Turan G, Sanhal CY, Yildiz Y, Hamidova A, Guner FC, Buyuk A, Dogan NU, Olgan S. Analysis of Myomectomy during Cesarean Section: A Tertiary Center Experience. J INVEST SURG 2020; 35:23-29. [PMID: 32865048 DOI: 10.1080/08941939.2020.1810832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE This study analyzed the safety of myomectomy during the cesarean section (CS). METHODS Pregnant women who underwent myomectomy during CS in a tertiary center between January 2015 and November 2019 were included in the study in Group A, and pregnant women who did not have myoma and who underwent only CS were included in the study in Group B. The following information was obtained from patient files in hospital archives and was then recorded and compared: age, gravidity, parity, gestational week, characteristics of the myomas (i.e., location, size, number, and type), duration of surgery, perioperative complications, need for blood transfusion, preoperative and postoperative hemoglobin (Hb) values, duration of surgery, and hospital stay duration. RESULTS A total of 83 patients underwent CS plus myomectomy (Group A), and 80 patients (without myoma) underwent only CS (Group B).There were no statistically significant differences between the groups in terms of preoperative and postoperative Hb values or blood transfusion rates (p > 0.05). Hospitalization and surgery duration were significantly higher in the group that underwent CS myomectomy (p = 0.001 and p = 0.001, respectively). The mean myoma size was 8.3 ± 4.1 cm in Group A. There was a statistically significant and inverse correlation between the size of the myoma and the delivery week (p = 0.035). There was a statistically significant and positive correlation between the myoma size and hospital stay (p = 0.01). CONCLUSION Myomectomy during CS is safe and can be applied regardless of the location, size, type, and number of myomas. However, to make myomectomy routine during CS, multi-center studies that include more cases are needed.
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Affiliation(s)
- Mehmet Sakinci
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Gokce Turan
- Department of Obstetrics and Gynecology, School of Medicine, Gazi University, Ankara, Turkey
| | - Cem Yasar Sanhal
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Aygun Hamidova
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Fatma Ceren Guner
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Alime Buyuk
- Department of Physiotherapy and Rehabilitation, Faculty of Health and Sciences, Akdeniz University, Antalya, Turkey
| | - Nasuh Utku Dogan
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Safak Olgan
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
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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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7
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Myomectomy During Cesarean Section: Why Do We Abstain From? J Obstet Gynaecol India 2020; 70:133-137. [PMID: 32255951 DOI: 10.1007/s13224-019-01303-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022] Open
Abstract
Objectives To assess the intra- and postoperative results of cesarean myomectomy. Methods A retrospective study was conducted to collect the results of cesarean myomectomy procedures performed in our tertiary center between June 2013 and December 2018. The subjects were 2219 pregnant women undergoing cesarean section at these units. Results A total of 2219 scheduled patients undergoing CS were included in the present study. Sixty-five patients have undergone intramural myomectomy during CS; 82 patients have had subserosal myomectomy during CS. No statistically significant differences were found between the three groups in changes of preoperative Hb, postoperative Hb, mean Hb and length of hospital stay. Operation times were significantly longer in both intramural and subserosal myomectomy groups (45.23 ± 8.498 vs. 39.02 ± 6.824 vs. 32.14 ± 5.423 min, p 0.01). Only in the intramural myomectomy group, two patients were subjected to blood transfusion (3%). Assessment of intramural myomectomy patients was carried out by taking 5 cm as the cutoff value. No statistical differences were found between the two groups in terms of mean Hb change, operation time, length of hospital stay. In the group with intramural myomectomy larger than 5 cm, two (15.38%) patients needed a blood transfusion. Conclusions Cesarean myomectomy operation performed by experienced surgeons has no adverse effects other than lengthening the duration of operation and can be safely implemented.
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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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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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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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Abstract
PURPOSE OF REVIEW The review analyzes how fibroids may influence pregnancy and how myomas may be modified by pregnancy. The most important clinical aspect concerns the impact of myoma on pregnancy and the possibility of a well tolerated surgical treatment for the mother and her fetus, preserving maternal reproductive capacity. RECENT FINDINGS Fibroids significantly increase in size during early pregnancy and then decrease in the third trimester. Although most women with uterine fibroids have a regular pregnancy, data from the literature suggest that they may have a higher risk of fertility problems and pregnancy complications. SUMMARY Myomectomy can increase the rate of pregnancy in women with infertility, attempting to restore a normal anatomy and reduce uterine contractility and local inflammation associated with the presence of fibroids, improving the blood supply. Current evidence does not suggest routine myomectomy during pregnancy or at the cesarean birth, as fibroids-related complications are rare and may be overcome by the risks of surgery. However, in selected cases, myomectomy is a feasible and safe technique and associated to a good outcome.The diagnosis of myomas in pregnancy may require attention for the adequate management to preserve maternal and fetal well-being.
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Akkurt MO, Yavuz A, Eris Yalcin S, Akkurt I, Turan OT, Yalcin Y, Sezik M. Can we consider cesarean myomectomy as a safe procedure without long-term outcome? J Matern Fetal Neonatal Med 2016; 30:1855-1860. [DOI: 10.1080/14767058.2016.1228057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mehmet Ozgur Akkurt
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
| | - And Yavuz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
| | - Serenat Eris Yalcin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
| | - Iltac Akkurt
- Isparta Maternity and Children’s Hospital, Department of Obstetrics and Gynecology, Isparta, Turkey, and
| | - Ozerk Turel Turan
- College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
| | - Yakup Yalcin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
| | - Mekin Sezik
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
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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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Is uterine myomectomy a safe option during cesarean section? Arch Gynecol Obstet 2014; 290:201-2. [PMID: 24728107 DOI: 10.1007/s00404-014-3239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
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