The proper management of uterine leiomyomas found during cesarean section remains uncertain. Some obstetricians believe that myomectomy is safe in carefully selected cases, but others continue to discourage the practice because of the risk of intractable bleeding. Uterine artery occlusion may provide an alternative. This prospective nonrandomized study evaluated ligation in 48 women with uterine leiomyomas, including at least one larger than 5 cm, who underwent cesarean section for obstetrical reasons. Approximately 60% of patients had multiple myomas. Twenty-six women (group I) had ligation of both uterine arteries immediately after closing the uterine incision, while 22 (group II) served as a control group. In study cases the uterine arteries were double-ligated with silks. Women in the study and control groups were similar with respect to age, parity, gestational age, myoma size, position of the dominant myoma, indications for cesarean delivery, and preoperative hemoglobin values. The average postoperative follow-up was 38.5 months.
Surgery was technically successful in all cases. Blood loss during surgery averaged 254 ml and 278 ml for groups I and II, respectively. One group II patient required blood transfusion because of hemorrhage. In group I women the decrease in myoma volume averaged 45%. In group II women, average myoma volume increased 34%. During follow-up, two group I women (8%) and nine group II women (41%) underwent myomectomy or hysterectomy. All three group II women who had repeat cesarean deliveries requested uterine artery ligation.
The investigators believe that uterine artery ligation may be a promising means of lessening postpartum bleeding in women found during cesarean section to have uterine leiomyomas. The procedure may reduce the need for future myomectomy or hysterectomy, and does not appear to compromise fertility.
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and Institute of Emergency Medicine and Critical Care, National Yang-Ming University School of Medicine, Taipei, Taiwan
Fertil Steril 2006;86:423–428