Most obstetricians avoid removing uterine fibroids during cesarean deliveries unless the fibroids are small and pedunculated, primarily because of the risk of uncontrollable hemorrhage. A few previous reports have indicated, however, that with careful case selection, myomectomy during cesarean section (CS) is safe and improves subsequent pregnancy outcomes. This retrospective case-control study assessed the effectiveness, safety, complications, and outcomes of myomectomy during CS among Chinese women diagnosed with uterine fibromyomas before pregnancy. Outcomes in 1242 pregnant women with fibromyomas who underwent myomectomy during CS (the study group) were compared with 3 control groups comprised of pregnant women undergoing CS: Group A contained 200 matched patients without fibromyomas; Group B was comprised of 145 patients with fibromyomas that were not removed; and Group C contained 51 patients who underwent CS followed immediately by hysterectomy. The primary study outcomes were the difference between pre- and postoperative hemoglobin levels, and the frequency of hemorrhage, blood transfusion, and postoperative fever, the duration of operation, and length of hospital stay.
There were no differences among the 4 groups with respect to median parity or gestational age. The maternal age of women in Group C was higher and the gestational age lower than the study group women, but the differences were not statistically significant. In comparison with the study group, the median number of fibromyomas in Group B was lower (P < 0.05) and the diameter of fibromyomas was smaller (P < 0.01). Simple fibromyoma occurred more frequently than multiple fibroids in Group B; the opposite was found in Group C. More uterine cornual fibromyomas were seen in Group B compared to the study group. No significant differences were noted between the groups in the mean hemoglobin change, the frequency of hemorrhage, or postoperative fever, and the length of hospital stay. These findings show that myomectomy during CS is an effective and safe procedure that is not associated with bleeding or other complications.
Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China
Acta Obstet Gynecol 2009;88:183-186