Myomectomy during cesarean section –pros and cons.Clinical case report and literature data
Medical Review (Med. pregled), 2024, 60(3), 55-60.
E. Ismail1,2, N. Tabakova2,3, J. Jekov2,3
1 Head of Health Care Department – Shumen, MU – Varna
2 SHOGAT ”Prof. D. Stamatov“ – Varna
3 Obstetrics and Gynecology Department, Faculty of Medicine, MU – Varna
Abstract. Uterine fibroids are the most common pelvic tumors in women. Uterine fibroids are common in women over the age of 30, and their growth is directly related to high levels of circulating estrogens. The frequency of leiomyomas in pregnant women ranges from 0.1% to 3.9%. The exact incidence of uterine fibroids during pregnancy is unknown, but they are known to be associated with multiple maternal and fetal complications. Complications during pregnancy and childbirth occur almost twice as often in women diagnosed with uterine fibroids than in those without. Myomectomy during cesarean section (CS) is not a life-threatening operation as it was believed in the past. This article presents a myomectomy during an emergency cesarean section of a 39-year-old patient in her first pregnancy in 28 g.w. The patient was hospitalized urgently due to signs of preterm labor. Attempts to stop the progression of labor were unsuccessful and an emergency operative delivery was performed. The finding during CS was multiple myomatosis of the uterus – intramural and subserous fibroids. Several pictures show the stages of myomectomy during CS. In cases of subserous myoma on a pedicle, myomectomy is relatively easy, especially if the pedicle is narrowly based. Removal of intramural fibroids is an inadvisable and contraindicated procedure during CS, according to some obstetrics textbooks. Data in the literature are conflicting regarding myomectomy during cesarean delivery. The surgeon must decide whether myomectomy is really indicated at the time of cesar-ean section or whether it can be delayed for several months after delivery.
Key words: myomectomy, complications, approaches, cesarean section
Address for correspondence: Assoc. Prof. E. Ismail, DMedSc, е-mail: Elis.ismail@mu-varna.bg, ORCID 0000-0002-8415-8424