title: [Management of uterine myomas during pregnancy].
abstract: OBJECTIVE
  To assess the impact of myomas on pregnancy and discuss the role of myomectomy during cesarean section.
  
  
  METHODS
  Databases PubMed, Medline and Cochrane were searched until 30 June 2015.
  
  
  RESULTS
  The most commonly reported obstetric complications relative to fibroids are: increased rate of spontaneous miscarriage in women with submucosal or intramural fibroids, pain, placentation disorders and malpresentation. A higher cesarean section rate is found among pregnant women with fibroids. The most common postpartum complication is postpartum haemorrhage. For years, risk of haemorrhage led caregivers not to practice myomectomy during cesarean section. Current data are rather reassuring. No study shows significant hemorrhage differences between myomectomy during cesarean section and cesarean section alone or myomectomy alone. The long-term morbidity of myomectomy during cesarean section is not enough studied but does not appear higher than expected for fertility and complications during pregnancy. Therefore, myomectomy during cesarean section is not currently recommended by learned societies.
  
  
  CONCLUSIONS
  Women with fibroids is a common obstetric situation. Complications are rare. Myomectomy during cesarean section seems to be not associated with higher short-term maternal morbidity. But studies with a longer-term follow-up of patients are necessary.
authors.affiliation: Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France.
authors.forename: F
authors.initials: F
authors.lastname: Levast
authors.affiliation: Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre, France.
authors.forename: G
authors.initials: G
authors.lastname: Legendre
authors.affiliation: Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France.
authors.forename: P-E
authors.initials: PE
authors.lastname: Bouet
authors.affiliation: Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France. Electronic address: loicsentilhes@hotmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Sentilhes
mesh_terms: D002585:Cesarean Section; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000150:complications* / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D012307:Risk Factors; D063186:Uterine Myomectomy / Q000009:adverse effects; D014594:Uterine Neoplasms / Q000150:complications* / Q000601:surgery
keywords: Cesarean section; Césarienne; Fibroids; Fibromes; Grossesse; Leiomyomas; Léiomyomes; Myomas; Myomectomie; Myomectomy; Myomes; Pregnancy