Cesarean section and concurrent myomectomy

In carefully selected women, myomectomy may be safely accomplished at the time of cesarean section. One series reported 25 women who had removal of 84 fibroids, of 2–10 cm, at the time of cesarean section with a mean estimated blood loss (EBL) of 876 mL (range, 400–1,700 mL) (58). Five women required blood transfusion, but none required a cesarean hysterectomy.

A retrospective study compared 111 women who had myomectomy at the time of cesarean section with 257 with documented fibroids who had cesarean section but not myomectomy (59). Only 1 (0.9%) woman in the myomectomy group required transfusion, and none required hysterectomy or uterine artery embolization, and there were no differences between the two groups in mean operative times, incidence of fever, or length of hospital stay. Preoperative pain, an obstructed lower uterine segment, or an unusual appearance of the fibroid at the time of surgery led to myomectomy in 14% of the women, but in 86% of the women, myomectomy was incidental, and cases were probably carefully selected. However, the investigators concluded that in experienced hands, myomectomy may be safely performed in selected women during cesarean section.

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