Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?

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(1)DOI: 10.17772/gp/57833. Ginekol Pol. 2016, 87, 54-58.

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(3) po ł o ż n i c t wo. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure? Miomektomia podczas cięcia cesarskiego: czy jest bezpieczną procedurą?

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(10) Department of Obstetrics and Gynecology, Tepecik Research and Training Hospital, Izmir, Turkey. Abstract Objectives: Myomectomy during cesarean is still controversial. Our aim is to assess the safety and feasibility of myomectomy during cesarean section for solitary uterine fibroids in terms of intraoperative and postoperative risks. Material and methods Data from 306 patients with leiomyoma undergoing elective cesarean operations were reviewed retrospectively. Eighty-two patients who underwent myomectomy during cesarean section were compared to 224 patients diagnosed with myoma who did not undergo myomectomy. The patients were reviewed for pre- and post-operative hemoglobin values, duration of operation, amount of intraoperative hemorrhage, need for blood transfusion, and duration of hospital stay. Results: The decrease in hemoglobin values after operation was not significantly different between the groups (1.48±0.7 vs. 1.31±0.68 g/dL; p = 0.063). Both the hospital stay and operation durations were significantly longer in the myomectomy group (57.9±19.7 vs. 50.54±20.77 hours, p = 0.006; 39.94±12.5 vs. 35.27±9.1 minutes, p=0.001, respectively). The operation duration was significantly shorter in the group with myomas = 3 cm in size (35.41±9.33 vs. 45.58±16.57 vs. 47.05±10.61 minutes; p < 0.05). Conclusions: Cesarean myomectomy did not increase intrapartum or early postpartum morbidity. Thus, we suggest that myomectomy can be performed during cesarean section in selected patients to avoid repeat operations and additional cost.. Key words: complication / leiomyoma / cesarean / perioperative hemorrhage /. Autor do korespondencji: Emrah Töz 468 Gaziler Streat, Konak, Izmir, Turkey Postal code: 35120 Izmir Turkey Tel. +90 232 2494949; fax: +90 232 261 7351; e-mail: emrahtoz79@gmail.com. 54. Otrzymano: 03.02.2015 Zaakceptowano do druku: 09.03.2015. © Polskie Towarzystwo Ginekologiczne. Nr 1/2016.

(11) Ginekol Pol. 2016, 87, 54-58. P R A C E. DOI: 10.17772/gp/57833. O R Y G I N A L N E po ł o ż n i c t wo. Aykut Özcan et al. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?. Streszczenie Cel pracy: Miomektomia podczas cięcia cesarskiego jest wciąż kontrowersyjna. Celem naszego badania była ocena bezpieczeństwa i wykonalności miomektomii pojedynczego mięśniaka podczas cięcia cesarskiego pod względem ryzyka w trakcie operacji oraz po zabiegu. Materiał i metoda: Retrospektywnie dane zebrano od 306 pacjentek, które miały wykonane elektywne cięcie cesarskie. Porównano 82 pacjentki, które podczas cięcia cesarskiego miały wykonaną miomektomię z 224 pacjentkami również z rozpoznanym mięśniakiem, które nie miały miomektomii. Analizie poddano wyniki przed i pooperacyjne hemoglobiny, czasu trwania operacji, wielkości krwotoku śródoperacyjnego, potrzeby przetoczenia krwi i czasu hospitalizacji. Wyniki: Spadek poziomu hemoglobin po operacji nie różnił się istotnie pomiędzy grupami (1.48±0.7 vs. 1.31±0.68 g/dL; p = 0.063). Zarówno czas hospitalizacji jak i czas trwania operacji były istotnie dłuższe w grupie z miomektomią (57.9±19.7 vs. 50.54±20.77 godzin, p = 0.006; 39.94±12.5 vs. 35.27±9.1 minut, p=0.001, odpowiednio). Czas trwania operacji mięśniaków wielkości 3cm był istotnie krótszy (35.41±9.33 vs. 45.58±16.57 vs. 47.05±10.61 minut; p < 0.05). Wnioski: Miomektomia podczas cięcia cesarskiego nie zwiększa chorobowości podczas porodu i we wczesnym okresie poporodowym. Sugerujemy, że można wykonywać miomektomię w wyselekcjonowanej grupie pacjentek, tak aby uniknąć relaparotomii i dodatkowych kosztów.. Słowa kluczowe: /

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(184) (n=82) (Mean ± SD). Control group (n=224) (Mean ± SD). p value. Maternal age (years). 32.6 ± 5.8. 29.9 ± 5.2. 0.001. Gravidity. 2.3 ± 1.3. 3.0 ± 1.1. 0.001. Parity. 1.3 ± 1.3. 1.5 ± 0.8. NS. Median gestational age, (weeks). 37.8 ± 2.51. 37.6 ± 2.17. NS. Diameter of myoma (cm). 3.8 ± 2.6. 3.4 ± 2.3. NS. NS, not significant.. Nr 1/2016. © Polskie Towarzystwo Ginekologiczne. 55.

(185) P R A C E O R Y G I N A L N E poł ożn i ct wo. DOI: 10.17772/gp/57833. Ginekol Pol. 2016, 87, 54-58. Aykut Özcan et al. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?. Table II. Features of myomas in two groups. Size. group (n=82) n (%). Control group (n=224) n (%). . 48 (58.6). 142 (63.4). >3 and <6 cm. 17 (20.7). 52 (23.2). . 17 (20.7). 30 (13.4). Pedunculated. 1 (1.2). 3 (1.4). Subserosal. 50 (61). 82 (36.6). Intramural. 29 (35.4). 125 (55.8). Submucosal. 2 (2.4). 14 (6.2). Fundal Corpus Anterior. 75 (91.5). 119(53.1). Posterior. 3 (3.7). 98 (43.8). Cervical. 2 (2.4). 6 (2.7). Intraligamenter. 2 (2.4). 1 (0.4). . . G

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(484) Ginekol Pol. 2016, 87, 54-58. P R A C E. DOI: 10.17772/gp/57833. O R Y G I N A L N E po ł o ż n i c t wo. Aykut Özcan et al. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?. Table III. Comparison of operation outcomes between two groups.

(485) (n=82) (Mean ± SD). Control group (n=224) (Mean ± SD). p-value. Preoperative Hb (g/dL). 12±0.88. 11.53±1.3. 0.002. Postoperative Hb (g/dL). 10.2±0.85. 9.97±1.1. 0.025. Mean change in Hb (g/dL). 1.48±0.7. 1.31±0.68. NS. Duration of operation (minutes). 39.94±12.5. 35.27±9.1. 0.001. Length of hospital stay (hours). 57.9±19.7. 50.54±20.77. 0.006. Birth weight (gram). 3073±754. 3115.54±522. NS. Frequency of blood transfusion (n-%). 2 (2.4). 3 (1.4). NS. Values for continuous variables are mean ± standard deviation. Values for categorical variables are number/total number of cases (%). Abbreviations: Hemoglobin – Hb; NS – not significant.. Table IV. Comparison of outcomes among myomectomy subgroups. (n=48) (Mean ± SD). (n=17) (Mean ± SD). (n=17) (Mean ± SD). p value. Mean change in Hb (g/dL). 1.47±0.68. 1.40±0.74. 1.60±0.78. NS. Preoperative Hb (g/dL). 12.09±0.77. 11.75±0.92. 12.1±1.09. NS. Mean postoperative Hb (g/dL). 10.35±0.77. 10.07±1.02. 10.27±0.89. NS. Duration of operation (minutes). 35.41±9.33. 45.58±16.57. 47.05±10.61. <0.001. Length of hospital stay (hours). 56.47±18.52. 64.82±24.13. 55±18.04. NS. Birth weight (gram). 3101.46±690.22. 3092.35±879.33. 2973.53±754.13. NS. NS – not significant..

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(710) .. References 1. Day Baird D, Dunson DB, Hill MC, [et al.]. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003, 188 (1),100-107. 2. Rosati P, Exacoustòs C, Mancuso S. Longitudinal evaluation of uterine myoma growth during pregnancy. A sonographic study. J Ultrasound Med. 1992, 11 (10), 511-515. 3. Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010, 3 (1), 20-27. 4. Turan V, Ergenoglu M, Yeniel O, [et al.]. Assessment of pregnancy outcomes with uterine leiomyomas larger than 10 cm; antepartum and postpartum complications. J Pediatr Adolesc Gynecol. 2010, 23 (1), 57-58. 5. Song D, Zhang W, Chames MC, [et al.]. Myomectomy during cesarean delivery. International Journal of Gynecology and Obstetrics. 2013, 121 (3), 208-213. 6. Kaymak O, Ustunyurt E, Okyay RE, [et al.]. Myomectomy during cesarean section. Int J Gynecol Obstet. 2005, 89 (2), 90-93. 7. Roman AS, Tabsh KM. Myomectomy at time of cesarean delivery: a retrospective cohort study. BMC Pregnancy Childbirth. 2004, 4 (1), 14. 8. Hasan F, Arumugam K, Sivanesaratnam V. Uterine leiomyomata in pregnancy. Int J Gynaecol Obstet. 1991, 34 (1), 45-48. 9. Exacoustòs C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol. 1993, 82 (1), 97-101. 10. Tian J, Hu W. Cervical leiomyomas in pregnancy: Report of 17 cases. Aust N Z J Obstet. Gynaecol. 2012, 52 (3), 258-261. 11. Incebiyik A, Hilali NG, Camuzcuoglu A, [et al.]. Myomectomy during caesarean: a retrospective evaluation of 16 cases. Arch. Gynecol. Obstet. 2014, 289 (3), 569-573. 12. Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int. J. Gynecol. Obstet. 2001, 75 (1), 21-25.. Conclusions. 13. Kwawukume EY. Cesarean myomectomy. Afr J Reprod Health. 2002, 6 (3), 38-43.. B(

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(727) .. 14. Sapmaz E, Celik H, Altungul A. Bilateral ascending uterine artery ligation vs. tourniquet use for hemostasis in cesarean myomectomy. A comparison. J Reprod Med. 2003, 48 (12), 950-954. 15. Cobellis L, Florio P, Stradella L, [et al.]. Electro-cautery of myomas during caesarean section-two case reports. Eur J Obstet Gynecol Reprod Biol. 2002, 10, 102 (1), 98-99.. Authors’ contribution: 1. Aykut Özcan – concept, study design, article draft, corresponding author. 2. Aycan Kopuz – acquistion of data, analysis and interpretation of data. 3. Volkan Turan – assumptions, study design. 4. Cagdas Sahin – revised article critically, article draft. 5. Emrah Töz – revised article critically. 6. Selin Aksoy – acquistion of data. 7. Mehmet Ozeren – analysis and interpretation of data. Authors’ statement ³ >RS] S] ^Y MO\^SPc ^RK^ ^RO Z_LVSMK^SYX aSVV XY^ `SYVKÔ ^RO MYZc\SQR^] YP K. third party, as understood according to the Act in the matter of copyright and related rights of 14 February 1994, Official Journal 2006, No. 90, Clause 63, with respect to the text, data, tables and illustrations (graphs, figures, photographs); ³ ^RO\O S] XY mMYX»SM^ YP SXÔ\O]^]p aRSMR YMM_\] aROX ^RO K_^RY\ \OWKSX] SX. a financial or personal relationship which unjustly affects his/her actions associated with the publication of the manuscript; ³ KXc ZY]]SLVO \OVK^SYX]RSZ] YP ^RO K_^RY\] aS^R ^RO ZK\^cZK\^SO]. interested in the publication of the manuscript are revealed in the text of the article; ³ ^RO WKX_]M\SZ^ RK] XY^ LOOX Z_LVS]RON SX Y\ ]_LWS^ÔN ^Y KXc Y^RO\. journal. ³ =Y_\MO YP ºXKXMSXQ$ 8YXO. 58. © Polskie Towarzystwo Ginekologiczne. Nr 1/2016.

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