title: Outcome and risk factors of cesarean delivery with and without cesarean myomectomy in women with uterine myomatas.
abstract: OBJECTIVE
  To evaluate the outcome of a cesarean myomectomy (CM) versus a cesarean delivery (CD) alone in women with uterine myomas and the risk factors for adverse outcomes.
  
  
  METHODS
  A retrospective cohort study of all women undergoing CDs with uterine leiomyomatas and singleton pregnancies was performed. Patients with known risk factors for hemorrhage were excluded. Measured adverse outcome parameters included estimated blood loss, drop in hemoglobin levels (pre/postoperatively), operation time, and the use of additional uterotonics. Outcome parameters of women with CM were compared to women with CD alone. Possible risk factors for adverse outcomes were analyzed in a multivariate regression analysis. Evaluated risk factors for CM were according to localization and type of myomatas, the myoma size, BMI ≥30 kg/m2, age ≥40 years, fetal weight ≥4 kg, repeat CD, and unplanned CD in the first stage of labor. The influence of localization and myoma type were further analyzed in a subgroup analysis.
  
  
  RESULTS
  Of the 162 women with uterine myomatas during CD, 48 underwent CM and were analyzed. Overall, CM was not associated with adverse outcomes. Independent of a concomitant myomectomy, a large myoma size of ≥5 cm was associated with an increased blood loss of ≥500 ml (adj. OR 2.7 CI 95 % 1.2-6.2, p = 0.02), and women ≥40 years of age had a significant postoperative drop in hemoglobin (adj. OR 2.4 CI 95 % 1.0-5.4, p = 0.04). In the univariate subgroup analysis, CM of multiple myomatas was associated with an increased blood loss and an increased operation time compared to women with multiple myomatas and CD alone. Prolonged operation times were also observed in women with pedunculated and subserosal myomatas with concomitant myomectomy. There were no cases of hysterectomy or blood transfusions.
  
  
  CONCLUSIONS
  CM performed by an experienced obstetrician can be safe in selected patients who are without additional preexisting risk factors. Risk factors that are associated with increased blood loss in women with uterine leiomyomatas include a larger size of the leiomyoma (≥5 cm) and a maternal age of ≥40 years.
authors.affiliation: Division of Obstetrics, University Hospital of Zurich, 8091, Zurich, Switzerland. ioannis.dedes@usz.ch.
authors.forename: I
authors.identifier: http://orcid.org/0000-0001-7265-4765
authors.initials: I
authors.lastname: Dedes
authors.affiliation: Division of Obstetrics, Cantonal Hospital of Baden, Baden, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Schäffer
authors.affiliation: Division of Obstetrics, University Hospital of Zurich, 8091, Zurich, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Zimmermann
authors.affiliation: Division of Obstetrics, University Hospital of Zurich, 8091, Zurich, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Burkhardt
authors.affiliation: Division of Obstetrics, University Hospital of Zurich, 8091, Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Haslinger
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000009:adverse effects*; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Blood loss in cesarean delivery; Cesarean delivery; Cesarean myomectomy; Uterine fibroids; Uterine myomatas