Myoma praevia and pregnancy

Uterine Fibroids and Pregnancy: A Review of the Challenges from a Romanian Tertiary Level Institution

Background and Objectives. Uterine fibroids are relatively common in reproductive-age women and are directly linked to pregnancy. There are many debates about performing a myomectomy at the same time as a caesarian section (CS) in such cases due to the risk of a hemorrhage. Our study aims to investigate fibroid features and their evolution in pregnancy, complications of a myomectomy during CS and maternal and fetal obstetric outcomes of pregnancies with fibroids. Materials and methods. We realize a prospective study that includes 57 patients with fibroids in pregnancy diagnosed in January 2017–June 2019. We analyze the number, the location and the growth of fibroids during pregnancy and the maternal and fetal outcome. We appreciate the bleeding in patients with a myomectomy and without a myomectomy during CS, using hemoglobin values before and after birth. Results. Most of the patients present single fibroids that are 30–160 mm in size, located on the anterior uterine wall. Vaginal delivery is used in 7% of women, whereas 85.96% deliver by CS. In addition, 68% of fibroids are diagnosed in the first trimester. In most cases, the fibroid has maximum growth in the second trimester of pregnancy. The myomectomy rate for fibroids during CS is 24.48. Hemoglobin values showed no statistically significant difference between the two groups with and without myomectomy. The operating time is double for the group with a myomectomy associated with a CS. The results of the obstetric outcomes are abortion in 7% of all patients, whereas premature delivery and births at term are 9.43% and 90.57%, respectively. Conclusions. The decision of performing a myomectomy during pregnancy can be a challenge and must be performed for selected cases. This procedure may have several benefits, such as avoiding another operation to remove fibroids.

Application of Single-Port Laparoscopic Surgery in Myomectomy

Research Question

The use of a power morcellator in laparoscopic myomectomy is a controversial topic. The application of single-port laparoscopy solves this problem, but its safety, efficacy and prognosis are also challenges. The purpose of this study was to compare the clinical application of single-port laparoscopy and traditional three-port laparoscopy in myomectomy.

Design

This is a retrospective review of a total of 120 patients who underwent single-port laparoscopic myomectomy (n=60) or traditional three-port laparoscopic myomectomy (n=60), performed between January 2019 to December 2020. The operation time, intraoperative blood loss, specimen removal time, hemoglobin change after operation, postoperative ambulation time, first exhaust time after surgery, the length of hospital stay, pain score on the day, the first day after operation and the satisfaction of abdominal wall scar were evaluated for the surgical outcomes.

Results

Compared with the traditional three-port laparoscopic group, the specimen removal time, postoperative ambulation time, first exhaust time after surgery, the length of hospital stay were all shorter, the satisfaction of abdominal wall scar were higher in single-port laparoscopic group. The duration of surgery was longer in single-port laparoscopic group significantly. The differences were statistically significant (P<0.05). The intraoperative blood loss, hemoglobin change after operation, pain score on the day of operation and the first day after operation of the two groups had no differences (P>0.05).

Conclusions

The clinical effect of single-port laparoscopic myomectomy is satisfactory and can be popularized in clinic.