A case series of caesarean myomectomy

Uterine fibroids are benign, monoclonal tumors of smooth muscle cells of the myometrium. Most fibroids do not increase in size during pregnancy and are not always removed when encountered during cesarean section. Objective was to see the outcome of patients undergoing cesarean myomectomy. The study design was observational study. All patients undergoing cesarean section with uterine fibroid of size more than 5 cm. In carefully selected patients and with use of intraoperative vasopressin, myomectomy may be safely accomplished at the time of caesarean section by experienced surgeons. cesarean myomectomy is safe and successful if patient selection is done carefully and does not add to any additional post-operative morbidity.

Download Full-text

TO THE QUESTION ON UTERINE FIBROIDS DURING PREGNANCY

Scientific digest of association of obstetricians and gynecologists of Ukraine ◽

10.35278/2664-0767.1(47).2021.242698 ◽

2021 ◽

pp. 54-59

Author(s):

T. F. TATARCHUK ◽

N. V. KOSEY ◽

S. I. REGEDA ◽

O. V. ZANKO ◽

K. D. PLAKSIIEVA

Keyword(s):

Statistical Analysis ◽

Cesarean Section ◽

Live Birth ◽

Uterine Fibroid ◽

Postpartum Period ◽

Uterine Fibroids ◽

Premature Delivery ◽

Pelvic Ultrasound ◽

Natural Childbirth ◽

Increased Risk

Uterine fibroids is an extremely common tumor of the female reproductive system, among whose manifestations are infertility, spontaneous abortions, incorrect fetal position, placenta previa, premature delivery, bleeding during and after delivery, and an increased risk of cesarean section. According to the literature, myomas are changing in size during pregnancy and in the postpartum period. Aim of the study. To assess the dynamics of uterine fibroid size change during pregnancy and the effect of an existing uterine fibroid on the course of pregnancy and labor. Materials and methods. Outpatient records of patients aged 24 to 45 years (mean age 33.36 ± 4.63 years) who were diagnosed with Pregnancy and uterine fibroids from 2016 to 2021 at Verum Medical Center were evaluated (n = 57). The size of the fibroids (volume and diameter) before, during (I or II prenatal screening) and after pregnancy (first pelvic ultrasound after delivery) was used for statistical analysis. Forty-one of the 57 patients had pelvic ultrasound before, during, and after pregnancy and were included in the statistical analysis of changes in uterine myoma size. Results. Among the patients included in the statistical analysis, uterine fibroids increased in volume by 194.38% ± 86.9 (40.98% ± 18.4 in diameter) during pregnancy, and decreased by 53.98% ± 14.93 in diameter and by 54.28% ± 29.62 of baseline in the postpartum period. A significant number of fibroids (39.47%) did undergo involutionary changes and were not visualized in the first postpartum ultrasound. The live birth rate was high at 90% (64% of deliveries were through natural childbirth and 26% through cesarean section). Conclusions. There was no effect of intramural, intramural-subserosal, and subserosal uterine fibroids with an average diameter of £20 mm on pregnancy and live birth in women. A great amount of uterine fibroids nearly triple in size during pregnancy, but after delivery they return to their original size and even halve in size. This can be regarded as a confirmation of the absence of a negative effect of pregnancy, or, possibly, a positive effect on uterine fibroid size, which requires further investigation.

Download Full-text

Evaluation of safety of caesarean myomectomy: A prospective study

Bangladesh Critical Care Journal ◽

10.3329/bccj.v7i1.40765 ◽

2019 ◽

Vol 7 (1) ◽

pp. 40-43

Author(s):

Nazlima Nargis ◽

Md Iqbal Karim ◽

Salma Loverine

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Prospective Study ◽

Reproductive Tract ◽

Female Reproductive Tract ◽

The Body ◽

College Hospital ◽

Average Value ◽

The Difference ◽

Cesarean Myomectomy

Background: Uterine myomas are the most common benign tumour of female reproductive tract and the prevalence of myomas in pregnancy has been reported to be 2%to 5% . Myomectomy during cesarean section has traditionally been discouraged due to risk of intractable haemorrhage and fear of hysterectomy. But recently large scaled studies indicated that cesarean myomectomy could be safely performed in majority of cases without any serious or life threatening complications. Materials and Methods: This prospective study was done at Ibn Sina Medical College Hospital, Dhaka, Bangladesh between January 2016 and December 2016. Fifty patients were recruited into the study, 25 patients had undergone myomectomy during cesarean section and 25 patients had undergone only cesarean section. Results: Average value of haemoglobin both pre and post-operatively was 12.31±1.22 g/dl and 10.64±1.51 g/dl for patients who had cesarean section with myomectomy and 11.61±1.3 g/dl and 10.3±1.7 g/dl in the other group in which cesarean section without myomectomy was performed. The difference in average haemoglobin for patients who had a cesarean section and myomectomy was 1.41 while those who had caesarean section alone was 1.32±1.12. This was not significant. The average duration of operation was longer in patient who had cesarean section and myomectomy (54.32±18.06 mins) than those who had caesarean section alone (38.54±8.42mins). The incidence of hemorrhage was5.45±1.23% and 5.23±1.03% respectively and the mean length of postoperative hospitalization was2.42±1.45and 2.17±0.70 days and no hysterectomy was needed in any group. Blood transfusion was given in 6 patients with 3 patients in each group. Sixty eight percent of the fibroids were subserous and in the body of the uterus. Conclusion: Cesarean myomectomy is a safe and effective procedure and does not increase the incidence of intraoperative and postoperative complications. Bangladesh Crit Care J March 2019; 7(1): 40-43

Download Full-text

Myomectomy during cesarean section

Serbian Journal of Anesthesia and Intensive Therapy ◽

10.5937/sjait2104073s ◽

2021 ◽

Vol 43 (3-4) ◽

pp. 73-80

Author(s):

Radmila Sparić ◽

Đina Tomašević ◽

Mladen Anđić ◽

Miljan Pupovac ◽

Aleksandra Pavić ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Perioperative Complications ◽

Uterine Fibroids ◽

Surgical Site Infections ◽

Reproductive Age ◽

Benign Tumors ◽

Uterine Torsion ◽

Perioperative Bleeding ◽

Increased Risk

Myomas (fibroids, leiomyomas) are the most common benign tumors of genital organs in women of reproductive age and represent a significant problem in women's health care. The frequency of cesarean section is higher in women with uterine fibroids. Absolute indications for myomectomy during caesarean section are: fibroids that prevent hysterotomy during caesarean section, impede uterine incision suture, hamper safe fetal extraction and cause uterine torsion. Relative indications for myomectomy during caesarean section are: subserous and pedunculated fibroids, anterior uterine wall fibroids, fibroids that can cause immediate perioperative, and puerperal complications, the patient's desire, fibroids that can cause complications in subsequent pregnancies, and fibroids that can be enucleated without additional hysterotomy. Myomectomy during caesarean section is a complex surgical procedure, associated with the possibility of considerable complications, and defining their actual frequency and risk factors for their occurrence requires further research. Myomectomy during caesarean section is associated with an increased risk of perioperative bleeding. Other perioperative complications of myomectomy during cesarean section are: disseminated intravascular coagulation, paralytic ileus, surgical site infections, sepsis, postoperative febrile morbidity, increased incidence of blood transfusions, and prolonged hospitalization.

Download Full-text

Anatomical locations of uterine fibroids in Sudanese women

Anatomy Journal of Africa ◽

10.4314/aja.v9i1.6 ◽

2020 ◽

Vol 9 (1) ◽

pp. 1701-1706

Author(s):

Mohammed A.A. Abdelmtalab ◽

O. Tahir ◽

K. Hussein ◽

Kamal Badawi

Keyword(s):

Smooth Muscle ◽

Uterine Fibroid ◽

Uterine Fibroids ◽

Maternity Hospital ◽

Benign Tumors ◽

Uterine Neoplasms ◽

Age Group ◽

Single Mass ◽

Posterior Position ◽

Anterior Posterior

Uterine fibroids are the commonest uterine neoplasms, they are benign tumors of smooth muscle origin. The study was done to look for the anatomical locations of uterine fibroids and their incidence in Sudanese women at Omdurman Maternity Hospital between 1st July 2014 to 5th October 2015. Their sociodemographic and ultrasound data were collected using a prepared questionnaire. The study included 138 confirmed cases of uterine fibroids out of 2968 investigated cases representing incidence rate of 4.6%. The highest incidence was found in the age group 36-40 years. Most dominant anatomical locations of uterine fibroids were intramural as a single mass (34.78%), followed by the intramural-subserosal in multiple masses (20.29%). The anatomical positions of uterine fibroids, posterior position was seen in (27.5%) which was the most dominant in single uterine fibroid mass, followed by the anterior-posterior position in multiple uterine one (18.1%). Intramural anatomical locations in single mass are the commonest uterine fibroids types which affect the Sudanese women. Key words: Anatomical locations; Uterine fibroid and leiomyomas

Download Full-text

Effects of Herbal formulations in management of Uterine Fibroid (Sul’ah-E-Rehm) – A Case Report

International Journal of AYUSH Case Reports ◽

10.52482/ijacare.v5i2.221 ◽

2021 ◽

Vol 5 (2) ◽

pp. 91-97

Author(s):

Mohammad Shamim Khan ◽

Shaikh Imran ◽

Mobashshera Khan

Keyword(s):

Smooth Muscle ◽

Case Report ◽

Connective Tissue ◽

Oral Administration ◽

Uterine Fibroid ◽

Uterine Fibroids ◽

Fibrous Connective Tissue ◽

Indian Women ◽

Reproductive Life ◽

Herbal Formulations

Uterine fibroid is the commonest benign and solid tumor in female during reproductive life. Approximately 15-25 million of Indian women have affected from fibroid uterus. Histologically itis composed of smooth muscle and fibrous connective tissue of varying proportional. It is considered as Sul’ah (tumor) in Unani classic litretures, as Ali Ibn-e-Abbas Majusi (930-994 AD) defined it under the topic of Warm-e-Balghami; as it is a swelling filled with viscid phlegm (Balgham-e-Ghaleez).Present paper deals with a reports of a 30 years old female having uterine fibroids measuring 2.6 cm× 3.1 cm, 2.6 cm× 3.6 cm, with left ovarian cyst of 3.1 cm × 4 cm. Patient was treated with herbal formulations; Majun Dabeedul Ward ( 5 gm paste), Kanchanar Guggul (2 tablet) and Niswani (10 ml syrup) twice a day for 8 consecutive weeks as oral administration. The patient was clinically assessed fortnightly, and radiologically just after treatment. Patient has shown encouraging result in post treatment investigation of Ultrasonography and finally patients got free from uterine fibroids without operation. The drugs were found to be safe and effective in this case.

Download Full-text

Outcomes of Myomectomy at the Time of Cesarean Section among Pregnant Women with Uterine Fibroids: A Retrospective Cohort Study

BioMed Research International ◽

10.1155/2019/7576934 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Rong Zhao ◽

Xin Wang ◽

Liying Zou ◽

Weiyuan Zhang

Keyword(s):

Birth Weight ◽

Cesarean Section ◽

Pregnant Women ◽

Statistical Significance ◽

Mainland China ◽

Uterine Fibroids ◽

Multivariate Logistic Regression Analysis ◽

Fetal Distress ◽

Common Procedure ◽

Cesarean Myomectomy

Objective. A retrospective study was performed to evaluate the safety and feasibility of cesarean myomectomy among pregnant women with uterine fibroids (UFs). Methods. Upon data collection, the pregnant women with UF underwent cesarean section in the 39 hospital divided into two groups: cesarean myomectomy group, receiving cesarean section and myomectomy; cesarean group, receiving cesarean section only. Information about the type, location, and number of UFs was collected from the medical records or the prenatal ultrasound examinations. Results. In the cesarean myomectomy group, the proportion of subserous UFs was significantly higher than the cesarean group (65.6% versus 49.3%, P < 0.0001). The comparison of postpartum hemorrhage, neonatal weight, fetal distress, and neonatal asphyxia showed no statistical significance. Multivariate logistic regression analysis demonstrated that birth weight ≥4000 g (OR 3.1, 95% CI:1.6–6.0) and presence of diameter > 5 cm fibroids (OR 2.2, 95%CI:1.3–4.0) were high risk factors for PPH ≥1,000 ml. Conclusions. Myomectomy during cesarean section was a common procedure in mainland China. Myomectomy cesarean could be safe and feasible based on the estimation by experienced obstetricians. During the procedure, special attention should be paid to a large-sized leiomyoma ≥5cm and birth weight ≥4,000 g.

Download Full-text

Anesthesia for cesarean section and SARS Cov-2: Observational study in Peru

Colombian Journal of Anesthesiology ◽

10.5554/22562087.e998 ◽

2021 ◽

Vol 49 (4) ◽

Author(s):

Marleny Elizabeth Huayanay Bernabé ◽

Marjorie Lisseth Calderón Lozano ◽

Álvaro Renato Moreno Gonzáles ◽

José Gunther Vásquez Rojas

Keyword(s):

Observational Study ◽

Cesarean Section ◽

Pregnant Women ◽

Perioperative Management ◽

Case Reports ◽

Case Series ◽

Anesthetic Technique ◽

Combined Spinal Epidural ◽

Clinical Records ◽

Spinal Epidural

Introduction: Information regarding the clinical behavior and the anesthetic and perioperative management in pregnant patients with SARS-CoV-2 is starting to appear in the literature in the form of case reports or case series. However, strong evidence and recommendations are still limited. Objective: To describe the clinical characteristics, the results of anesthetic and perioperative management, and complications in seroprevalent pregnant women for SARS-CoV-2 infection, delivered by cesarean section. Methodology: Observational study in which 107 clinical records of pregnant women who were seroprevalent for SARS-CoV-2 infection were reviewed and analyzed between April and June, 2020. Demographic, clinical and serological data were collected, as well as data on the anesthetic technique and intraoperative and postoperative complications. Results: Of the 107 pregnant women with SARS-CoV-2 infection, 99 (92.52%) were asymptomatic and 8 (7.48%) had mild symptoms. The most frequent reasons for cesarean section were cephalo-pelvic disproportion in 20 (18.68%), previous cesarean section in 20 (18.68%) and non-reassuring fetal status in 14 (13.08%). Anesthesia technique was neuraxial in all cases, with spinal used in 100 (93.5%), combined spinal-epidural in 4 (3.7%) and epidural catheter in 3 (2.8%) patients. No deaths had occurred until the third postoperative day of follow-up. Conclusions: The majority of pregnant women with SARS-CoV-2 infection are asymptomatic. In this work, spinal, combined spinal-epidural and epidural neuroxial anesthesia techniques were shown to be effective and safe for these patients and their newborn babies.

Download Full-text

Frequency of caesarean section in diabetic vs. non diabetic females undergoing induction of labour at term

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v25i1.1524 ◽

2021 ◽

Vol 25 (1) ◽

pp. 97-101

Author(s):

Fozia Umber Quraishi ◽

Saima Jabeen ◽

Anum Yousaf ◽

Rukhsana Gulzar

Keyword(s):

Caesarean Section ◽

Gestational Diabetes ◽

Cesarean Section ◽

Sample Size ◽

Case Series ◽

Sampling Technique ◽

Induction Of Labour ◽

Intrauterine Fetal Death ◽

Obstetrics And Gynecology ◽

Normal Delivery

Introduction: Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance recognized during pregnancy. Gestational diabetes is associated with adverse maternal and fetal outcome. Majority of patients with diabetes had induction of labour at term (≥37weeks) to prevent maternal and fetal morbidity especially shoulder dystocia, macrosomia and intrauterine fetal death at term Objectives: To find frequency of gestational diabetes (GDM) in patients undergoing induction of labour. To compare the frequency of caesarean section in diabetic (GDM) and non-diabetic females undergoing induction of labour Methodology: Study Type; It was a descriptive case series conducted at the department of Obstetrics and Gynecology, Shalamar Hospital Lahore. Duration of study was six months after approval from IRB. Sample size; Sample size of 214 cases undergoing induction of labour at term during study period; calculated with 95%confidence level and 3.4% margin of error and taking expected percentage of GDM is 6.9%. Sampling Technique; purposive sampling Methodology: 214 females who will fulfill the inclusion criteria were enrolled in the study from labour room of Department of Obstetrics and Gynecology, Shalamar Hospital Lahore. Induction of labour done with tab prostin 3mg single dose and patients having gestational diabetes were identified and frequency of caesarean section in Diabetic and non-diabetic calculated. Results: In current study, mean age of the patients was 27.8±4.4 years. Mean gestational age was 37.1±3.8 weeks and mean BMI was 28.6±4.1 kg/m2. Primigravida were 88 (41.1%) and multigravidas were 126 (58.9%). Gestational diabetes was found to be in 36 patients (16.8%). Caesarean section was performed in 77 patients (36%). Comparison of frequency of cesarean section in diabetic (GDM) and non-diabetic females undergoing induction of labour revealed majority of the caesarean sections performed in GDM patients (p=0.007). Conclusion In conclusion, our study found a higher incidence of cesarean section than normal delivery in pregnant women with gestational diabetes. Major factors for operational delivery in GDM population included: advanced maternal age and high BMI value.

Download Full-text

Mode of Delivery in Pregnant Females with Fibroid Uterus Presenting in Spontaneous Labour

Esculapio ◽

10.51273/esc20.2516416 ◽

2021 ◽

Vol 16 (4 (oct 2020 - dec 2020)) ◽

Author(s):

Uzma Aziz ◽

Madiha Afzal ◽

Hadia Shabbir

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Uterine Fibroids ◽

Emergency Caesarean Section ◽

Pregnant Females ◽

Fibroid Uterus ◽

Emergency Caesarean ◽

Spontaneous Labour

Objectives: To determine the mode of delivery of obstetric population with uterine fibroids presenting in spontaneous labor. Methods: It was a Descriptive cross sectional study done at Obstetric unit of Arif Memorial teaching Hospital, from June 2019 to May 2020. 50 pregnant patients with uterine fibroids in spontaneous labor were included in the study with 95% confidence level and 5 % margin of error. Results: In our study, 62 % (n=31) patients were between 20-30 years of age with 38 % (n=19) between 31-40 years with Mean age and SD 25.63 ±2.89 years. 68% (n=32) patients were between 34-36 weeks of gestation whereas 32% (n=18) were between 37-39 weeks with Mean gestational age and SD 29.66 ±1.59. 66 % (n=33) patients were Primigravida to Gravida 3 and 34% (n=17) were Gravida4 to Gravida 5. The frequency of emergency caesarean section in patients with uterine fibroids was 58% (n=29) whereas 42 % (n=21) cases with uterine fibroids had normal vaginal delivery. The most frequent indication for emergency cesarean section was labor dystocia i.e. (41.37%). Conclusion: The frequency of emergency caesarean section amongst patients with uterine fibroids presenting in spontaneous labor is high particularly due to labor arrest. The number of fibroids has an impact on mode of delivery in these patients. Therefore each obstetric patient with uterine fibroids, must be evaluated thoroughly for the appropriate mode of delivery in prenatal period. Key Words: Pregnancy, uterine fibroids, mode of delivery, cesarean section, spontaneous vaginal delivery How to Cite: Aziz U, Afzal M, Shabbir H. Mode of delivery in pregnant females with fibroid uterus presenting in spontaneous labour. Esculapio.2020;16(04):74-78.

Download Full-text

Use of the base purse-string suture approach to remove giant uterine fibroids during cesarean section

Journal of International Medical Research ◽

10.1177/0300060519893868 ◽

2019 ◽

Vol 48 (4) ◽

pp. 030006051989386

Author(s):

Dan Liu ◽

Min Han ◽

Pu Huang ◽

Chunfang Li ◽

Xuelan Li

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Uterine Fibroids ◽

Uterine Wall ◽

Purse String Suture ◽

Purse String ◽

Operative Duration ◽

Estimated Blood Loss ◽

The Mean ◽

Cesarean Myomectomy

Objective This study aimed to investigate the optimal strategy for myomectomy for removing giant uterine fibroids when necessary in women undergoing cesarean section. Methods This study was retrospective in design, and assessed outcomes in 26 patients who underwent myomectomy using a “base purse-string suture” during cesarean section. The operative duration, blood loss, uterine involution, and duration of postpartum lochia were analyzed. Results This suture was associated with a mean operative duration of 11.17 ± 5.36 minutes and the mean estimated blood loss was 11.15 ± 6.05 mL. The mean postpartum duration of lochia was 34.92 ± 7.55 days and there were no cases of postpartum hemorrhage. Uterine size returned to normal within 6 weeks of delivery, without any apparent defects or abnormalities in the uterine wall as shown by an ultrasonic examination. Conclusion This novel implementation of a base purse-string suture during cesarean myomectomy for removal of giant fibroids is a simple, safe, and effective intervention that should be considered for implementation in appropriate patients.

Download Full-text