The dilemma of cesarean myomectomy: Is it safe or not?

To evaluate the safety and effectiveness of myomectomy during cesarean section. The data of fifty-four pregnant who underwent cesarean myomectomy and twenty-six pregnant with uterine leiomyoma who had cesarean section without myomectomy between the years of 2017 and 2020 in our tertiary clinic were examined retrospectively. There was no significant difference in terms of maternal age, weeks of gestation, gravida, parity, use of additional uterotonics, type of leiomyoma, size of leiomyoma, cesarean indications, blood transfusion requirement, postoperative fever, preoperative hemoglobin (g/dl), change in hemoglobin (g/dl), preoperative hematocrit (%), change in hematocrit (%), length of hospital stay between the two groups (p˃0.05). While no significant difference was observed according to the location of the leiomyomas between the anterior, fundal and posterior location between the two groups, cervical leiomyomas were significantly higher in the CS group (p˂0.05). This study shows that cesarean myomectomy is a safe procedure in selected cases. It also offers the advantage of avoiding a second operation in patients.

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Outcome of Cesarean Myomectomy: Is it a Safe Procedure?

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0043-120918 ◽

2017 ◽

Vol 77 (11) ◽

pp. 1200-1206 ◽

Cited By ~ 6

Author(s):

Mehmet Senturk ◽

Mesut Polat ◽

Ozan Doğan ◽

Çiğdem Pulatoğlu ◽

Oğuz Yardımcı ◽

...

Keyword(s):

Retrospective Study ◽

Blood Transfusion ◽

Cesarean Section ◽

Pregnant Women ◽

Maternal Age ◽

Hemoglobin Level ◽

Safe Procedure ◽

The Mean ◽

Cesarean Myomectomy ◽

Duration Of Operation

Abstract Objective Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy. Method A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant. Results While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05). Conclusion This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.

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Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i06/04 ◽

2018 ◽

Vol 3 (06) ◽

Author(s):

Dr.Randa Mohammed AboBaker

Keyword(s):

Cesarean Section ◽

Hospital Stay ◽

Demographic Data ◽

Length Of Hospital Stay ◽

Chewing Gum ◽

Control Group ◽

Controlled Clinical Trial ◽

Bowel Motility ◽

Gum Chewing ◽

Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay. Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

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Enhanced recovery care versus traditional non- ERAS care following osteotomies in developmental dysplasia of the hip in children : a retrospective case-cohort study

10.21203/rs.2.21179/v2 ◽

2020 ◽

Author(s):

Jin Li ◽

Saroj Rai ◽

Renhao Ze ◽

Xin Tang ◽

Ruikang Liu ◽

...

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Perioperative Complications ◽

Length Of Hospital Stay ◽

Developmental Dysplasia ◽

Control Group ◽

Postoperative Fever ◽

Vas Score ◽

Significant Difference ◽

Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). The VAS score in 3-day was significantly lower in ERAS group (2.9±0.8) than traditional non-ERAS group (4.0±0.8) (P<0.001). However, there was no significant difference in the frequency of breakout pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

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Addition of azithromycin to cefazolin pre elective CS reduces post operative infections

QJM ◽

10.1093/qjmed/hcaa056.021 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M E Mohamed ◽

H A Allam ◽

M A Abdelgaber

Keyword(s):

Cesarean Section ◽

Antibiotic Prophylaxis ◽

Postoperative Infection ◽

Elective Cesarean Section ◽

Control Group ◽

Postoperative Fever ◽

Post Surgery ◽

Percentage Points ◽

Absolute Reduction ◽

Significant Difference

Abstract Introduction The results of the Cesarean Section Optimal Antibiotic Prophylaxis(C/SOAP) trial describe an absolute reduction of 5.9 percentage points in the rate of the primary composite outcome of endometritis, wound infection,or other infection occurring within 6 weeks after non elective cesarean section with the use of adjuvant azithromycin prophylaxis. The absolute reduction in maternal postpartum use of antibiotics was 4.3 percentage points. The study drug was administered after the first incision in 12.4%of the patients who received azithromycin and in12.3% of those who received placebo. The authors did not indicate when the standard prophylaxis(mainly cefazolin) was delivered. Objective The aim of our study is to evaluate the efficacy of addition of azithromycin to cefazolin pre-operative in reducing the risk of postoperative infection after elective CS. Methods Four hundred patients were randomized to two groups. Control Group included 200 women undergoing elective CS. Patients received standard antibiotic prophylaxis cefazolin (at a dose of 1 gm) and azithromycin (at a dose of 1 gm) 2 hours preoperatively. Study Group included 200 women undergoing elective CS. Patients received only standard prophylaxis antibiotic (cefazolin). Results Our study showed that majority of the mothers were housewives (70% in cefazolin-azithromycin group and 85.5% in cefazolin group), with a statistically high significant difference between the two groups regarding occupation (p < 0.001). But, there was no statistically significant difference regarding residence (p > 0.05) between both studied groups. Regarding demographic characteristics, majority of the mothers had similar mean age/years; 25.5 years in cefazolin-azithromycin group and 24.7 years in cefazolin group, with no statistically significant difference between both studied groups (p > 0.05) but body mass index illustrated statistically a significant difference (p < 0.05). On the other hand, preoperative hemoglobin showed no statistically significant difference between both studied groups (p > 0.05). Regarding obstetric history, there were statistically significnat differences between both studied groups regarding parity and previous cesarean sections (p < 0.05) and a high significant difference regarding previous abortions (p < 0.001). Conclusion At the end of this study, we observed that, with regards to postoperative fever, wound healing duration, infection post-surgery and per-vaginal discharge, addition of azithromycin to cefazolin (Zinol) is effective than cefazolin only in reducing the risk of postoperative infection after elective CS and maternal use of healthcare resources.

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Myomectomy at the time of Cesarean Section: A Prospective Multicentre Study

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v6i1.40778 ◽

2019 ◽

Vol 6 (1) ◽

pp. 18-22

Author(s):

Nargis Akther ◽

Shereen Yousuf ◽

Rashida Khatun ◽

Nargis Fatema ◽

Khairun Nahar

Keyword(s):

Cesarean Section ◽

Post Partum ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Uterine Wall ◽

Multi Centre Study ◽

Prospective Multicentre Study ◽

Increased Risk ◽

Cesarean Myomectomy ◽

Hospital Study

Background: Myomectomy can be performed during cesarean section. Objective: The purpose of the present study was to assess the safety and efficacy of myomectomy during cesarean section. Methodology: The study design was a prospective multi-centre study done in three tertiary care hospitals Dhaka Medical Collage, BSMMU & private Hospital in Dhaka City. The subject were 65 pregnant women elective or emergency myomectomy during cesarean section. All cesarean section myomectomy were performed by consultants. Intra-operative and post-operative complications such as change in haematocrit, length of operation, blood loss were estimated. Length of hospital stay was also recorded. Results: 79 Fibroid of various sizes (2 to 6cm) were removed from 65 women. Fibroid were on the anterior uterine wall with most being sub serous and intra mural. Four patients had one unit of whole blood transfusion in post-operative period. No hysterectomy was done at the time of cesarean section. There was no significant change of haematocrit: incidence of post-operative fever and duration of operation. The mean duration of post-operative hospital study was 7.3±1.2 days, 5 patients subsequently became pregnant, were also underwent repeated cesarean section in the study period. Conclusion: In selected cases myomectomy during cesarean section does not appear to result in an increased risk of intrapartum or short-term post-partum morbidity if performed by an experienced practitioner. Cesarean myomectomy is a safe surgical options with no significant complications. Journal of Current and Advance Medical Research 2019;6(1):18-22

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Is ultrasonography-guided drainage a safe and effective alternative to incision and drainage for deep neck space abscesses?

The Journal of Laryngology & Otology ◽

10.1017/s002221511700007x ◽

2017 ◽

Vol 131 (3) ◽

pp. 259-263 ◽

Cited By ~ 5

Author(s):

P Dabirmoghaddam ◽

A Mohseni ◽

Z Navvabi ◽

A Sharifi ◽

S Bastaninezhad ◽

...

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Neck Surgery ◽

Safe Procedure ◽

Inclusion Criteria ◽

Ultrasound Guided ◽

Suitable Alternative ◽

Surgical Incision ◽

Incision And Drainage ◽

Significant Difference

AbstractBackground:Deep neck space abscesses are common head and neck surgery emergencies. Traditionally, surgical incision and drainage has been the main treatment for deep neck abscesses. Recently, it has been suggested that ultrasound-guided drainage of neck abscesses can be an effective and less invasive alternative to incision and drainage.Methods:Patients with deep neck space abscesses referred to the emergency department of Amiralam Hospital were assessed and enrolled to the study if they met the inclusion criteria. Patients were randomly assigned to incision and drainage or ultrasound-guided drainage groups using sealed envelopes.Results:Sixty patients were evaluated, with 30 patients in each group. There was a significant difference (p < 0.001) in mean length of hospital stay between patients who underwent ultrasound-guided drainage (5.47 days) and those who underwent incision and drainage (9.70 days).Conclusion:Ultrasound-guided drainage is an effective and safe procedure, leading to shorter hospital stay, and thus may be a suitable alternative to incision and drainage of deep neck abscesses.

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Current status of cesarean section myomectomy-prospective ongoing study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193533 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3189

Author(s):

Ripan Bala ◽

Preet Kamal ◽

Madhu Nagpal ◽

Sheena Singh

Keyword(s):

Cesarean Section ◽

Tertiary Care ◽

Anterior Wall ◽

Current Status ◽

Blood Component ◽

Emergency Cesarean ◽

Significant Difference ◽

Duration Of Surgery ◽

Cesarean Myomectomy ◽

Mean Time

Background: The aim of the study was to assess the feasibility, safety and efficacy of performing myomectomy during cesarean section.Methods: It was prospective study conducted in Sri Guru Ram Das University of Health and sciences which is a tertiary care referral centre. Myomectomy was conducted in 34 pregnant women during elective or emergency cesarean section. Analysis was done with reference to age, parity, character of myomas, intraoperative and post-operative morbidity, duration of surgery and duration of stay in hospital.Results: In this study 34-58 fibroid of various size (2-14 cm) were removed in 34 patients during cesarean section. Majority of fibroids were located in body of uterus (65.5%) and in anterior wall (55.2%) and all them were sub serosal. No significant difference was found in mean preoperative hemoglobin (11.8±0.7) and postoperative hemoglobin (10.9±0.8). No patient had postpartum hemorrhage requiring cesarean hysterectomy. Only two patient needed blood transfusion postoperatively. Mean time taken for surgery was 58.4±8.94 minute and average duration of hospital stay was 6.7±1.6.Conclusions: With the advent of better anesthesia, easy availability of blood and blood component, cesarean myomectomy is safe surgical procedure when performed by experienced obstetrician in carefully selected patients.

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Study on the Method of Enucleation of Anterior Uterine Fibroids by Transverse Incision of Lower Uterine Segment During Cesarean Section

10.21203/rs.3.rs-692369/v1 ◽

2021 ◽

Author(s):

Li Xia ◽

Jinxiao Lin ◽

Rongli Xu ◽

Wenqiang You ◽

Yan Dai

Keyword(s):

Cesarean Section ◽

Operation Time ◽

Anterior Wall ◽

Control Group ◽

Study Group ◽

Transverse Incision ◽

Postoperative Fever ◽

Perioperative Bleeding ◽

Significant Difference ◽

Surgical Data

Abstract Introduction: A retrospective study was conducted to investigate the effectiveness and feasibility of enucleation fibroids of the anterior wall of the uterus by transverse incision of the uterus at the same time during cesarean section. Methods The medical history, surgical data, preoperative and postoperative blood system changes and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section in the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively. Results There was no significant difference in the number of leiomyoma, pathological type, preoperative and postoperative hemoglobin, incidence of perioperative bleeding, frequency of blood transfusion, incidence of postoperative fever, uterine involution and lochia between the study group and the control group. The proportion of large fibroids in the study group was slightly higher than that in the control group (p < 0.05), and the operation time and average hospitalization time in the study group were slightly longer than that in the control group (p < 0.05).The distribution of type III-V fibroids in the study group was slightly more than that in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05). Conclusion It is safe and effective to enucleate the fibroids of the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. Potential to reduce the risk of pelvic adhesion and intrauterine adhesion in the future, so that some patients avoid the risk of reoperation.

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Evaluation of Safety in Cesarean Myomectomy

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1403 ◽

2016 ◽

Vol 8 (2) ◽

pp. 136-139

Author(s):

Sabnam S Nambiar ◽

S Ajith ◽

Vidya Prabhu ◽

Beena George

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Intraoperative Complications ◽

Psychological Trauma ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Additional Surgery ◽

Significant Difference ◽

Cesarean Myomectomy

ABSTRACT Objectives Cesarean myomectomy (removal of fibroids during cesarean section) prevents an additional surgery, the cost, associated complications, and the physical and psychological trauma. However, there is risk of increased bleeding. Nevertheless, many centers practice it taking optimum precautions. The aim of our study was to compare cesarean myomectomy patients in those women who underwent cesarean section without fibroid removal for (a) blood loss, fall in hemoglobin, blood transfusion requirement; (b) intraoperative and postoperative complications; and (c) duration of hospitalization. Materials and methods We retrospectively studied medical records of cesarean sections done in our institution for women within the past 5 years. A total of 76 patients had documented fibroids, of whom 37 underwent concurrent myomectomy and 39 did not. Data were analyzed using Pearson's Chi-square test for categorical variables and student t test for continuous variables with threshold of significance p < 0.05. Results No significant difference was found in blood loss and intraoperative complications. A small increase was seen in febrile morbidity in myomectomy group, however, with no resultant increase in hospitalization. Conclusion Cesarean myomectomy does not cause increased morbidity. Moreover, it saves the mother an additional surgery of interval myomectomy provided proper selection of cases, adequate preoperative and intraoperative preparedness, and caution are taken into consideration. How to cite this article Nambiar SS, Ajith S, Prabhu V, George B. Evaluation of Safety in Cesarean Myomectomy. J South Asian Feder Obst Gynae 2016;8(2):136-139.

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The Outcome Of Preoperative Transfusion Guideline On Sickle Cell Disease Patients At King Fahd Hospital-Jeddah (Ksa)

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.243 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S111-S111

Author(s):

S M Felemban

Keyword(s):

Postoperative Complications ◽

Sickle Cell Disease ◽

Hospital Stay ◽

Sickle Cell ◽

Exchange Transfusion ◽

Length Of Hospital Stay ◽

Acute Chest Syndrome ◽

Cell Disease ◽

Postoperative Fever ◽

Significant Difference

Abstract Introduction/Objective We have developed a local hospital transfusion guidelines to reduce and prevent the perioperative and the postoperative complications. This study was conducted to evaluate the outcome of practice for preoperative transfusion therapy in SCD patients in our institution. Methods A retrospective review of SCD patients undergoing surgery at King Fahd Hospital, Jeddah, Saudi Arabia was conducted between April 2005 and May 2010. The medical records were reviewed to define the perioperative risks and the postoperative complications in relation to the type of transfusion modality selected. Results The medical record of 75 sickle cell disease patients in whom the hematologists were consulted for their preoperative assessment. Preoperatively, 25.3 % had complete exchange transfusion (CETX), 17.3 % had partial exchange transfusion (PETX), 26.7 % had simple top up transfusion (STX) and 30.7 % had no transfusion (NTX). The postoperative complications were 20% vaso-occlusive crises (VOC), 2.7% acute chest syndrome (ACS), and 16% had fever. The mean duration for the hospital stay was 7.36 with SD of 5.83. There was no significant difference in the outcome between all types of transfusion modalities, the P value was (p 0.245), (p 0.282), (p 0.133), (p 0.220) for postoperative fever, VOC, ACS, and the length of hospital stay, respectively. However, The correlation was highly significant between the post-transfusion haemoglobin (Hb) level and the occurrence of postoperative fever (p 0.01) and VOC (p 0.03). Interestingly, SCD patients who received hydroxyurea were observed to have less postoperative complication like fever, and the result was highly significant (P<0.01), while those who received prophylactic heparin in the postoperative period were found to have a reduced length of hospital stay (p<0.01) and vaso-occlusive crises (p <0.01). Conclusion The guidelines for preoperative transfusion in SCD patients was effective in reducing the postoperative morbidity and mortality. However, the selection of the optimum regimen for different surgical types in sickle cell disease patients and the surgical situations where preoperative transfusion is needed were all established in this guidelines.

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