Cesarean Myomectomy: Transforming Outlook

Objective: To describe the clinical characteristics, obstetric parameters, intraoperative findings and postoperative issues among patients with fibroid in pregnancy who were considered for cesarean myomectomy.Materials and methods: A prospective observational study conducted in a private maternity home under one senior consultant for a period of 4 years.After taking consent, pregnant with fibroid uterus that underwent a cesarean section (CS) were taken as study population.Women with miscarriages who did not reach viability and viable pregnancies who delivered vaginally were excluded from the study.Demographic details, obstetric parameters, intraoperative findings and postoperative issues were studied.Results: A total of 12 cases were recruited for the study.However, cesarean myomectomy was successful in 10 cases.About two cases were deferred on table due to inaccessible nature and highly tortuous vascularity.The average age of the study population was 34.1 years.Out of 10 only 1 had previous living issue.Out of the 10 cases, elective C-section was performed in all except for two, who underwent a vaginal trial.Diabetes and hypothyroidism were the comorbidities noted.About 8 had upper segment fibroid while 2 had lower segment location.A low transverse incision was taken for cesarean in all the cases.And 9 patients presented with longitudinal lie where as 1 patient presented with transverse lie.About 60% of the patients presented with multiple fibroids while 40% of them presented with solitary fibroid.Five cases presented with pure intramural location of fibroid, 3 cases with a mix of intramural + subserosal, 2 cases with purely subserosal variety.Breech extraction in 2 cases, instrumental delivery in 2 cases and atonic postpartum hemorrhage (PPH) in 1 case were the complications observed.Liberal blood and blood products were transfused as per demand.None of the patients required an ICU admission.Only baby required NICU care for preterm birth.Postoperative stay was prolonged in two cases for a couple of more days. Conclusion:From the patient's perspective of avoiding separate operative procedures for fibroid uterus, the CS can be used as an opportunity to perform myomectomy when a small risk of blood transfusion is acceptable.