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Zhu-Ge L, Bei Q, Pan W, Ni X. Spontaneous regression of a giant uterine leiomyoma after delivery: a case report and literature review. BMC Pregnancy Childbirth 2024; 24:123. [PMID: 38341545 PMCID: PMC10858580 DOI: 10.1186/s12884-024-06324-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Uterine leiomyomas are hormone-dependent benign tumors and often begin to shrink after menopause due to the reduction in ovarian steroids. The influence of pregnancy on uterine leiomyomas size remains unclear. Here, we present a case of spontaneous regression of a giant uterine leiomyoma after delivery. CASE PRESENTATION A 40-year-old woman presented with multiple uterine leiomyomas, one of which is a giant uterine leiomyomas (approximately 8 cm in diameter) that gradually shrinked after delivery. At over two months postpartum, the large myometrial leiomyoma had transformed into a submucosal leiomyoma, and over 3 years postpartum, both the submucosal leiomyoma and multiple intramural leiomyomas completely regressed. CONCLUSION Spontaneous regression of a giant uterine leiomyom is rare after delivery. Considering uterine leiomyoma regression until over 3 year postpartum,we need to observe the regression of uterine fibroid for a longer time postpartum in the absence of fibroid related complications. In addition, it will provide new insights for treatment options of uterine leiomyomas in the future.
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Affiliation(s)
- Lifang Zhu-Ge
- Department of Gynaecology, Beilun District People's Hospotal, 1288 Lusan East Road, Ningbo, Zhejiang Province, 315800, China
| | - Qiaoli Bei
- Department of Gynaecology, Beilun District People's Hospotal, 1288 Lusan East Road, Ningbo, Zhejiang Province, 315800, China
| | - Weiping Pan
- Department of Gynaecology, Beilun District People's Hospotal, 1288 Lusan East Road, Ningbo, Zhejiang Province, 315800, China.
| | - Xiaojun Ni
- Department of Gynaecology and Obstetric, The Second Affiliated Hospital of Zhejiang University School of Medicine, Lanxi Hospital, Jinhua, China
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Lee YE, Park S, Lee KY, Song JE. Risk factors based on myoma characteristics for predicting postoperative complications following cesarean myomectomy. PLoS One 2023; 18:e0280953. [PMID: 36893190 PMCID: PMC9997914 DOI: 10.1371/journal.pone.0280953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/12/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES To evaluate the influence of myoma characteristics on cesarean myomectomy and to demonstrate its additional advantages. METHODS Retrospective data were collected from 292 women with myomas who had undergone cesarean section at Kangnam Sacred Heart Hospital between 2007 and 2019. We performed subgroup analysis according to the type, weight, number, and size of myomas. Preoperative and postoperative hemoglobin levels, operative time, estimated blood loss, length of hospital stay, incidence of transfusion, uterine artery embolization, ligation, hysterectomy, and postoperative complications were compared among subgroups. RESULTS There were 119 patients who had cesarean myomectomy and 173 who had cesarean section only. An increase in postoperative hospitalization and operation time was observed in the cesarean myomectomy group compared to that in the caesarean section only group (mean difference, 0.7 days, p = 0.01, 13.5 minutes, p <0.001). Estimated blood loss, hemoglobin differences, and transfusion rates were higher in the cesarean myomectomy than in the cesarean section only group. There were no differences in postoperative complications (fever, bladder injury, and ileus) between the two groups. No hysterectomy cases were reported in the cesarean myomectomy group. In subgroup analysis, the larger and heavier the myoma, the higher the risk of bleeding that led to transfusion. Estimated blood loss, differences in hemoglobin, and transfusion rate increased depending on myoma size and weight. A significant increase in postoperative hospitalization was observed in women with larger and heavier myomas. However, there was no statistical difference among the three types of myomas. CONCLUSION In cesarean myomectomy, larger (≥ 10 cm), and heavier myomas (≥ 500 g), were associated with postoperative outcomes, but not the number or type of myoma. The safety of cesarean myomectomy is not inferior to that of caesarean section only, considering its positive effects such as gynecological symptom relief and avoidance of the next surgery.
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Affiliation(s)
- Young-Eun Lee
- Department of Obstetrics and Gynecology, University of Hallym College of Medicine, Hallym Sacred Heart Hospital, Anyang, Korea
| | - Suyeon Park
- Department of Obstetrics and Gynecology, University of Hallym College of Medicine, Hallym Sacred Heart Hospital, Anyang, Korea
| | - Keun-Young Lee
- Department of Obstetrics and Gynecology, University of Hallym College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ji-Eun Song
- Department of Obstetrics and Gynecology, University of Hallym College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
- * E-mail:
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Singh S. Few concerns about evidence - feasibility and safety of performing cesarean myomectomy: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2021; 35:7513. [PMID: 34470121 DOI: 10.1080/14767058.2021.1951210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Surjit Singh
- Department of Pharmacology, AIIMS Jodhpur, Jodhpur, Rajasthan, India
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Goyal M, Dawood AS, Elbohoty SB, Abbas AM, Singh P, Melana N, Singh S. Cesarean myomectomy in the last ten years; A true shift from contraindication to indication: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 256:145-157. [PMID: 33232889 DOI: 10.1016/j.ejogrb.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/17/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND A lot of debate is present about Cesarean myomectomy (CM) in women with uterine myoma whether to consider it a feasible and safe procedure or an absolute contraindication. OBJECTIVE To assess the safety and feasibility of myomectomy during cesarean section in women with uterine myoma. SEARCH STRATEGY Electronic search was made on MEDLINE, EMBASE, Cochrane Library, ISI web of knowledge and Scopus from January 1, 2008 to December 31, 2019 using terms "Caesarean section", "Myomectomy", "Fibroid", "Caesarean myomectomy". SELECTION CRITERIA All full length studies either prospective or retrospective that address caesarean myomectomy were included. DATA COLLECTION AND ANALYSIS The outcomes studied were haemorrhage, mean change in haemoglobin, operative time, need for blood transfusion, febrile morbidity and duration of hospital stay. RESULTS Total 249 studies were assessed for eligibility and 17 studies included in analysis with 6545 women. There were 4702 (71.85 %) women in caesarean myomectomy (CM) group and 1843 (28.15 %) women in cesarean section (CS) group. There was statistically significant but clinically insignificant decrease in hemoglobin [MD = 0.27, 95 %CI = 0.08-0.45, p = 0.005; very low quality], significant higher need for blood transfusion [RR = 1.45, 95 %CI = 1.05-1.99, p = 0.02; high quality] in CM group versus CS alone. The mean operative time (minutes) [MD = 14.77, 95 %CI = 6.91-22.64, p = 0.0002; moderate quality] and mean hospital stay (days) [MD = 0.36, 95 %CI = 0.19-0.53, p < 0.00001; high quality] was significantly less in CM group, though of not any clinical significance. No difference in incidence of haemorrhage [RR = 1.16, 95 %CI = 0.86-1.56, p = 0.32; moderate quality evidence] and fever [RR = 1.17, 95 %CI = 0.83-1.65), p = 0.36; moderate quality] in two groups. CONCLUSIONS The meta-analysis suggests CM is associated with clinical insignificant increase in operative time, blood loss and hospital stay, especially with multiple and large size myomas. CM should be preferred over CS alone especially by experienced surgeons with appropriate haemostatic techniques and tertiary care centres.
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Affiliation(s)
- Manu Goyal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India.
| | - Ayman Shehata Dawood
- Assistant professor of Obstetrics and Gynecology, Tanta University, Tanta, Egypt
| | - Shereen B Elbohoty
- Assistant professor of Obstetrics and Gynecology, Tanta University, Tanta, Egypt
| | - Ahmed M Abbas
- Assistant Professor of Obstetrics and Gynecology, Assuit University, Assuit, Egypt
| | - Pratibha Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Nitesh Melana
- Consultant Paediatrician, SN Medical College, Jodhpur, India.
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, 342005, India
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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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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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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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Outcomes of Myomectomy at the Time of Cesarean Section among Pregnant Women with Uterine Fibroids: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7576934. [PMID: 30956984 PMCID: PMC6431434 DOI: 10.1155/2019/7576934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/21/2019] [Indexed: 11/18/2022]
Abstract
Objective A retrospective study was performed to evaluate the safety and feasibility of cesarean myomectomy among pregnant women with uterine fibroids (UFs). Methods Upon data collection, the pregnant women with UF underwent cesarean section in the 39 hospital divided into two groups: cesarean myomectomy group, receiving cesarean section and myomectomy; cesarean group, receiving cesarean section only. Information about the type, location, and number of UFs was collected from the medical records or the prenatal ultrasound examinations. Results In the cesarean myomectomy group, the proportion of subserous UFs was significantly higher than the cesarean group (65.6% versus 49.3%, P < 0.0001). The comparison of postpartum hemorrhage, neonatal weight, fetal distress, and neonatal asphyxia showed no statistical significance. Multivariate logistic regression analysis demonstrated that birth weight ≥4000 g (OR 3.1, 95% CI:1.6–6.0) and presence of diameter > 5 cm fibroids (OR 2.2, 95%CI:1.3–4.0) were high risk factors for PPH ≥1,000 ml. Conclusions Myomectomy during cesarean section was a common procedure in mainland China. Myomectomy cesarean could be safe and feasible based on the estimation by experienced obstetricians. During the procedure, special attention should be paid to a large-sized leiomyoma ≥5cm and birth weight ≥4,000 g.
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