Question: Is myomectomy during cesarean section recommended?
Answer: A retrospective case-control study including 1,242 pregnant women with fibromyomas who underwent myomectomy during caesarean section (CS) and three control groups of 200 matched pregnant women without fibromyomas who underwent CS deliveries (Group A), 145 patients with fibromyomas who underwent CS deliveries without removal of fibromyomas (Group B) and 51 patients with fibromyomas who had a hysterectomy during CS (1) found no differences in the mean hemoglobin change, the incidence of postoperative fever and the length of hospital stay among groups.
Other smaller case-control studies have also reported caesarean myomectomy to be safe and effective. (2-6) (Evidence level IIa)
A prospective non-randomised study including 29 women found that future fertility and or subsequent pregnancy outcome was unaffected by caesarean myomectomy (7) (Evidence level III)
References:
- Li H. Du J. Jin L. Shi Z. Liu M. Myomectomy during cesarean section. Acta Obstetricia et Gynecologica Scandinavica. 88(2):183-6, 2009. Abstract
- Hassiakos D. Christopoulos P. Vitoratos N. Xarchoulakou E. Vaggos G. Papadias K. Myomectomy during cesarean section: a safe procedure? Annals of the New York Academy of Sciences. 1092:408-13, 2006 Dec. Abstract
- Kaymak O. Ustunyurt E. Okyay RE. Kalyoncu S. Mollamahmutoglu L. Myomectomy during cesarean section. International Journal of Gynaecology & Obstetrics. 89(2):90-3, 2005 May. Abstract
- Kwawukume EY. Caesarean myomectomy. African Journal of Reproductive Health. 6(3):38-43, 2002 Dec. Abstract
- Dimitrov A. Nikolov A. Stamenov G. [Myomectomy during cesarean section]. [Bulgarian] Akusherstvo i Ginekologiia. 38(2):7-9, 1999. Abstract
- Brown D. Fletcher HM. Myrie MO. Reid M. Caesarean myomectomy--a safe procedure. A retrospective case controlled study. Journal of Obstetrics & Gynaecology. 19(2):139-41, 1999 Mar. Abstract
- Adesiyun AG. Ojabo A. Durosinlorun-Mohammed A. Fertility and obstetric outcome after caesarean myomectomy. Journal of Obstetrics & Gynaecology. 28(7):710-2, 2008 Oct. Abstract
Search date: May 2009
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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