RESUMO
Management of myomas during pregnancy and labor is a contested subject so far. Currently no recommended national or international guidelines are in place resulting in conflicted opinion and management variation across the globe. Many obstetricians still discourage its practice due to fear of uncontrolled haemorrhage which may lead to unwanted hysterectomy in a reproductive age. However, some researchers have challenged the conventional perspective and argue that caesarean myomectomy (CM) is a safe procedure. The aim of this study is to examine all aspects of CM with an evaluative lens and to weigh its risk-benefit ratio. For this purpose, we conducted a literature review of studies, including those from low-resource countries indexed in scientific databases like PubMed, Google Scholar and Scopus. Most recent articles that reported benefits, complications and different techniques to safely perform caesarean myomectomy with proven benefit for the patient were examined thoroughly so that solid evidence on pros and cons of caesarean myomectomy could be generated. There is a dire need to conduct large sample size studies or randomized controlled trials for the risk-benefit evaluation of CM and to produce evidence-based clinical conclusion.
RESUMO
Introduction: Contrary to previous belief many studies published now have shown that myomectomy during cesarean section (CS) is a safe procedure with no significant increased risk of intra and postoperative complications. Methods: This prospective study was carried out in antennal mothers from May09 to Sep 10 in a tertiary care hospital of Uttar Pradesh after taking institutional ethical committee approval. Diagnosis of myoma was confirmed by ultrsonography. Only those mothers were included in the study who gave the informed consent to participate in study. Cesarean myomectomy was planned in all mothers having myoma. Operative time, intraoperative haemorrhage and length of hospital stay of mothers having myoma were compared to matched pregnant women with CS alone (28cases). Data were collected on a questionnaire and analyzed by appropriate test of significance. Results: Out of 966 antenatal mothers registered during the study period myoma was detected in 14(1.18%) cases. Mean age mothers of having myoma were 27.08 years and 61.54% were primigravida and only 23.08 % were third gravida. In 61.54% mother’s parity was zero and only 15.39 % mothers were having parity two. Mean haemoglobin was 10.56 gm%. In all cases presentation of foetus was vertex. In 92.3% mothers location of myoma was at anterior wall and subserous and in 7.7% cases it was fundal . Size of myoma was less than 3.0 Cm in 38.50 cases , 3.1 Cm to 5.0 Cm in 23.1% cases and more than 5.1 Cm in 38.4% cases. There was no significant difference in operative time, intraoperative haemorrhage and length of hospital stay in comparison to matched pregnant women with CS alone. Postnatal period was uneventful and complication like PPH was nil in all in cesarean myomectomy cases. Conclusion: caesarean myomectomy can be safely performed in majority of patients with myomas without any serious or life threatening complication.