A cohort study of maternal and fetal outcomes for myomectomy at caesarean section in Aba, South Eastern Nigeria

Background: Fibroids in pregnancy are common in Nigeria but myomectomy during caesarean section is not popular due to concerns for severe hemorrhage. Previous studies did not directly compare outcome for routine Caesarean Section (CS) with Caesarean Myomectomy (CM). This prospective cohort study compares the maternal and fetal outcomes of caesarean myomectomy (exposed arm) with caesarean section (control arm); (n=64; CM=34; CS=30).Methods: Variables include maternal age, durations of surgery and hospitalization, Estimated Blood Loss (EBL), as well as pre and postoperative hematocrit. Fetal weight, number and weight of fibroids were also considered. Data was analyzed with SPSS using descriptive statistics and chi-square tests.Results: There was no significant difference in EBL, incidence of postoperative complications, fetal APGAR score at 5 minutes as well as duration of hospitalization between both groups. Number of fibroids (>10) was significantly associated with blood transfusion (X2=11.46, P <0.001), and was found to be strongly correlated with longer duration of surgery (r=0.79; P <0.001).Conclusions: Study suggests that caesarean myomectomy maybe a safe procedure, with good maternal and fetal outcomes, in well-selected patients, especially those with <10 fibroids in pregnancy. Caution should be applied in patients with >10 fibroids. We recommend use of total number of fibroids as an index of surgical risk, instead of dimension of fibroids, as correlates significantly with duration of surgery and estimated blood loss.