The utility of caesarean myomectomy as a safe procedure: a retrospective analysis of 21 cases with review of literature.
BACKGROUND
Myomectomy at the time of caesarean delivery has been discouraged because of the risk of intractable haemorrhage and increased postoperative morbidity. The aim of this study is to determine the safety and feasibility of caesarean myomectomy.


METHODS
A retrospective case control study done between June 2012 to May 2013 in a tertiary care teaching hospital in Karnataka, India which included 21 pregnant women with uterine fibroids who underwent myomectomy during caesarean section and were compared with 42 matched controls without uterine fibroids who had caesarean section alone during the same period. Primary outcome measures studied were incidence of haemorrhage and need for blood transfusion. Secondary outcome measures were duration of operation, length of hospital stay, postpartum fever and wound infection. Statistical analysis is done using IBMSPSS 20.0 software and students t-test. For calculation of incidence of haemorrhage Fisher's exact test is used.


RESULTS
Mean age of the 21 cases was 31.81yrs and 47.62% were primigravida. Total 37 fibroids were removed. Subserosal were 30 cases(81.08%) while 1(2.07%) was submucous. 21(56.76%)fibroids were situated in fundal region and 3(8.11%) were in lower segment. Mean change in the haemoglobin from preoperative to postoperative period in the cases was 1.3gm/dl(±1.155mg/dl) and control was 1.05% (±.854mg/dl). Two of the cases(9.52%) required blood transfusion compared to none in control. None in either group required hysterectomy. Mean duration of surgery was 68.57min (±15.012min)and 51.55min (±9.595min) for controls which is statistically significant.


CONCLUSIONS
This study shows that myomectomy during caesarean section is a safe procedure and is not associated with major intraoperative and postoperative complications.
Associate Professor, Department of Obstetrics and Gynecology, SDM College of Medical Science and Hospital Sattur, Dharwad, Karnataka, India .
Ramesh
R
Kumar R
Assistant Professor, Department of Obstetrics and Gynecology, SDM College of Medical Science and Hospital Sattur, Dharwad, Karnataka, India .
Manjula
M
Patil
Resident, Department of Obstetrics and Gynecology, SDM College of Medical Science and Hospital Sattur, Dharwad, Karnataka, India .
Shruthi
S
Sa
Caesarean section; Haemorrhage; Myoma; Myomectomy