Caesarean myomectomy feasibility and safety

Caesarean myomectomy has traditionally been discouraged due to fears of intractable haemorrhage and increased postoperative morbidity. However, a number of authors have recently shown that myomectomy during Caesarean section does not increase the risk of haemorrhage or postoperative morbidity. We present a series of 8 cases from Sultan Qaboos University Hospital, Oman, where myomectomy was performed during Caesarean section for large lower segment fibroids. Seven were anterior lower segment fibroids, while one was a posterior lower uterine fibroid which interfered with closure of the uterine incision. The antenatal course, perioperative management, and postoperative morbidity are discussed. The average age of the women was 28.7 years and mean gestational age at delivery was 36.75 weeks. Regarding intra-operative blood loss, 1 patient lost 900 ml, 5 patients lost 1-1.5 litres, 2 lost 1.5-2 L, and 1 patient with a 10 x 12 cm fibroid lost 3.2 L. Despite the majority being large myomas [7 of the 8 patients had myomas >5 cm in size] and 50% being intramural, no hysterectomy was required. Stepwise devascularisation was necessary in one case and preoperative placement of uterine balloon catheters was necessary in another. The size of the fibroids was confirmed by histopathology. Myomectomy added 15 minutes to the operating time and 1 day to the hospital stay, but there was no significant postoperative morbidity. Neonatal outcome was good in all patients. In selected patients, myomectomy during Caesarean section is a safe and effective procedure at tertiary centres with experienced surgeons

Submyomatous cornual pregnancy managed surgically after failed medical management

Cornual pregnancy constitutes an emergency while its diagnosis and management remain a challenge. Anatomical abnormalities in the uterus, such as fibroids in the cornual region, make the management even more difficult. A nulliparous patient presented with an ectopic pregnancy at the right cornua under a huge fibroid. Despite multiple doses of methotrexate for a cornual ectopic gestation, the serum beta human chorionic gonadotropin [beta-hcG] levels doubled on the fifth day and a viable fetus was demonstrated on imaging. Thus surgical intervention in the form of laparoscopy followed by laparotomy, myomectomy of a large cornual fibroid and cornuostomy was performed. The serum beta human chorionic gonadotropin result was negative three weeks later. Surgical intervention in the form of myomectomy and cornuostomy was necessary to preserve fertility in this unusual presentation of cornual ectopic pregnancy

early history of modern medicine in Oman

The introduction of modern medicine to oman began well over 100 years ago but clinics and hospitals took a long time to establish. European and American doctors played a most important role in providing a sound medical service despite the difficulties of obtaining supplies and coping with the relentless heat of the oman summers. The American mission established the first enduring taste of modern medicine with their hospital in muttrah built in 1933. the rapid growth of the health services after 1970 is outlined together with its achievements in providing the much needed hospital buildings and medical personnel as well as the provision of mobile health services, health education and preventive medicine. The author has been privileged with the opportunity of interviewing three of the pioneers who were involved both before and after the formation of the ministry of health in 1970