scholarly journals Myomectomy during cesarean section

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.

scholarly journals Perinatal complications of pregnancies complicated by uterine fibroids

2021 ◽  
Vol 2 (1) ◽  
pp. 16-24
Author(s):  
Radmila Sparić ◽  
Đina Tomašević
Keyword(s):  
Cesarean Section ◽  
Placenta Previa ◽  
Perioperative Complications ◽  
Uterine Fibroids ◽  
Bed Rest ◽  
First Trimester ◽  
Reproductive Age ◽  
Perinatal Complications ◽  
Increased Risk ◽  
In Pregnancy

Fibroids (myomas) are the most common tumors of the female reproductive organs, consisting of smooth muscle cells, fibroblasts, and extracellular matrix. They develop from menarche to menopause. They are diagnosed in 10-20% women of reproductive age. Their size varies from barely visible nodules to large tumors. Change in the size of fibroids during pregnancy and after childbirth is the subject of numerous studies. Most studies indicate a significant increase in the size of fibroids during the first trimester, unchanged size during the second and the third trimester, and a decrease in their size after the delivery. The effect of fibroids on pregnancy depends on their number, location, and size. Myomas are associated with numerous perinatal complications: bleeding in pregnancy, miscarriages, pain due to red degeneration, preterm birth, placental abruption, placenta previa, intrauterine growth restriction, fetal malpresentation, prolonged labor, increased cesarean section rate, uterine atony, and postpartum hemorrhage. Treatment of fibroids in pregnancy includes bed rest and follow-up with symp-tomatic therapy in case of pain, as well as intensive monitoring of the fetus. Very rarely, myomectomy may be necessary during pregnancy. Myomectomy during cesarean section has been considered contraindicated for years. Recent research demonstrates that this procedure may not be associated with an increased risk of perioperative complications. Its advantages include performing two operations within one surgical procedure while avoiding the risks of repeated laparotomy and anesthesia. The most common postpartum complications of fibroids are bleeding and infection.

scholarly journals TO THE QUESTION ON UTERINE FIBROIDS DURING PREGNANCY

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.

Increased expression of neurogenic factors in uterine fibroids

2019 ◽  
Author(s):  
Alice Luddi ◽  
Camilla Marrocco ◽  
Laura Governini ◽  
Bianca Semplici ◽  
Valentina Pavone ◽  
...  
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Age ◽  
In Vivo Studies ◽  
Pcr Analysis ◽  
Benign Tumors ◽  
Endometrial Stromal Cells ◽  
Eutopic Endometrium ◽  
Qrt Pcr ◽  
Fertility Sparing

Abstract STUDY QUESTION Are selective markers for the neuronal differentiation such as microtubule-associated protein 2 (MAP-2) and synaptophysin (SYP) as well as the nerve growth factor (NGF) expressed by fibroids, myometrium and eutopic endometrium? SUMMARY ANSWER Neuronal markers NGF, MAP-2 and SYP are highly expressed in fibroids compared with matched myometrium, and this neurogenic pathway is upregulated by tumor necrosis factor (TNF) alpha in cultured smooth muscle cells (SMCs). WHAT IS KNOWN ALREADY Uterine fibroids or leiomyomas are the most common benign tumors, accounting for approximately one-third of hysterectomies. The present trend is to improve the medical treatment avoiding surgery, also for fertility sparing; hence, the pathogenic mechanisms are investigated, aiming to develop new therapeutic strategy. STUDY DESIGN, SIZE, DURATION This laboratory-based case–control study is focused on fibroids and myometrial specimens obtained between 2015 and 2017 from 15 women of reproductive age at the proliferative phase of the menstrual cycle. Leiomyomas, matched myometrium and endometrium from each woman were analyzed. Control endometrium was obtained from women undergoing surgery for ovarian cyst (n = 15). PARTICIPANTS/MATERIALS, SETTING, METHODS qRT-PCR, western blotting and immunostaining were applied to evaluate the expression of neurogenic markers; the effects of TNF on NGF, MAP-2 and SYP expression in cultured SMCs from leiomyomas and matched myometrium were analyzed. MAIN RESULTS AND THE ROLE OF CHANCE qRT-PCR analyses using tissues from clinical patients showed that the levels of NGF, MAP-2 and SYP mRNA were significantly higher in uterine leiomyomas compared with their matched myometrium (P < 0.05), whereas only NGF was significantly increased in eutopic endometrium compared with healthy endometrium. In primary SMCs, isolated from fibroids or from the adjacent myometrium, NGF, MAP-2 and SYP mRNA expression were significantly increased by TNF treatment (P < 0.05). Finally, human endometrial stromal cells prepared from the endometrium of patients affected by uterine fibroids display higher TNF expression (P < 0.001). LIMITATIONS, REASONS FOR CAUTION qRT-PCR analysis and immunofluorescence validation are robust methods demonstrating a clear upregulation of neurogenic factors in leiomyomas, even though additional studies are needed to establish a correlation between increased neuronal gene expression and degree of pain, as well as the involvement of inflammation mediators in the development of the neurogenic unhinge. Therefore, more in vivo studies are needed to confirm the results achieved from primary cultured SMCs. WIDER IMPLICATIONS OF THE FINDINGS The increased expression of neurogenic factors in uterine fibroids and endometrium may contribute to explain the painful stimuli. Accordingly, these neurogenic pathways may represent potential therapeutic avenues to treat the fibroid-related disorders. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by research grants from the University of Siena. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

scholarly journals Pregnancy with previous caesarean section: an overview of adverse fetomaternal sequelae

2018 ◽  
Vol 7 (5) ◽  
pp. 1817 ◽  
Author(s):  
Joyita Bhowmik ◽  
Amit Kyal ◽  
Indrani Das ◽  
Vidhika Berwal ◽  
Pijush Kanti Das ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Previous History ◽  
Successful Outcome ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Medical College ◽  
Increased Risk ◽  
Fetal Complications ◽  
History Of

Background: The Caesarean section epidemic is a reason for immediate concern and deserves serious international attention. The purpose of this study was to evaluate adverse maternal and fetal complications associated with pregnancies with history of previous caesarean section.Methods: A cross-sectional, observational study carried out over a period of 1 year from 1st June 2016 to 31st July 2017 in Medical College Kolkata. 200 antenatal patients with previous history of 1 or more caesarean sections were included. In all cases thorough history, complete physical and obstetrical examination, routine and case specific investigations were carried out and patients were followed till delivery and for 7 days thereafter. All adverse maternal and fetal complications were noted.Results: Out of 200 women, 30 candidates were tried for VBAC, of them 20 (66.66%) had successful outcome. Most common antenatal complication was APH (5.5%) due to placenta praevia followed by scar dehiscence. There were 12 cases (6.66%) of PPH and 6 cases (3.33%) of scar dehiscence in the study group. 3 cases required urgent hysterectomy due to placenta accreta. 42 out of 196 babies required management in SNCU immediately or later after birth.Conclusions: Women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counselling for trial of labor and proper antepartum and intrapartum monitoring of patients are key to reducing the cesarean section rates and maternal complications.

Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors

2005 ◽  
Vol 26 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Piret Mitt ◽  
Katrin Lang ◽  
Aira Peri ◽  
Matti Maimets
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Fetal Monitoring ◽  
University Hospital ◽  
Cross Sectional Survey ◽  
Increased Risk ◽  
Multi Method Approach ◽  
Method Approach

AbstractObjectives:To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.Design:Cross-sectional survey.Setting:Academic tertiary-care obstetric and gynecology center with 54 beds.Patients:All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.Methods:Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.Results:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).Conclusions:The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).

scholarly journals A case series of caesarean myomectomy

2021 ◽  
Vol 10 (9) ◽  
pp. 3580
Author(s):  
Shazia Parveen ◽  
Nasreen Noor ◽  
Iti Madan ◽  
Ummay Kulsoom
Keyword(s):  
Smooth Muscle ◽  
Caesarean Section ◽  
Observational Study ◽  
Cesarean Section ◽  
Patient Selection ◽  
Uterine Fibroid ◽  
Uterine Fibroids ◽  
Case Series ◽  
Operative Morbidity ◽  
Cesarean 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.

scholarly journals High levels of ca125 in a patient with large uterine fibroid.

2020 ◽  
Vol 19 (4) ◽  
pp. 167-170
Author(s):  
Konstantinos Zacharis ◽  
Konstantinos Dafopoulos
Keyword(s):  
Abdominal Mass ◽  
Female Genital Tract ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Caucasian Woman ◽  
Cancer Antigen 125 ◽  
Cancer Antigen ◽  
Present Case Report ◽  
Female Genital

Uterine leiomyomas, also known as uterine fibroids, are the most common benign tumors of the female genital tract and affect 60 to 80% of women at their reproductive age. Although elevated tumor markers may be measured in benign gynaecological diseases, the association of uterine fibroids with increased levels of serum cancer antigen 125 (CA125) has not been proven to date. In the present case report we present a rare case of a 21-year-old Caucasian woman attended to our outpatient department with hypermenorrhea and pelvic discomfort that was treated for an enlarged intra-abdominal mass with an abnormally high CA-12 (777.3 U/mL).

THE ADVERSE IMPACT OF MATERNAL OBESITY ON MATERNALAND PERINATAL OUTCOME

2021 ◽  
pp. 83-86
Author(s):  
Jayshree Chimrani ◽  
Uma Jain ◽  
Richa Bittharia
Keyword(s):  
Cesarean Section ◽  
Postpartum Hemorrhage ◽  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Perineal Trauma ◽  
Reproductive Age ◽  
Age Group ◽  
Apgar Scores ◽  
Increased Risk ◽  
Reproductive Age Group

Introduction: Rapidly increased global prevalence of overweight and obesity has also affected women of reproductive age group. Pregnant women who are obese at booking have an increased risk for complications, both for themselves and their babies during pregnancy and childbirth. Women who are obese are at risk for gestational diabetes, miscarriage, preeclampsia, increased incidence of cesarean section, anesthetic complication, postpartum hemorrhage, thromboembolism, perineal trauma, and wound infection. There is an increased risk of stillbirth, congenital anomalies, prematurity, macrosomia, poor APGAR scores, and neonatal death in babies of obese mothers. This study investigated the effect of Maternal BMI on the mode of delivery and perinatal outcome. Methods: This is a prospective cohort study of 100 primigravidas of the reproductive age group done at Shivpuri District Hospital over a period of a year. We categorized them on the basis of their BMI at booking and studied the mode of delivery and perinatal outcome. Results: Elective cesarean and emergency cesarean were more common with obese women whereas most of the normal weighted and underweight women underwent spontaneous labor and induced labor. Maternal and fetal complications were more pronounced in the overweight and obese groups. Babies also had an increased risk of poor APGAR scores with the increasing BMI of the mother. Conclusion: Input of skilled birth attendants is essential to improve intrapartum outcomes. Obstetricians need to be acutely aware that obese patients form a high-risk population with an increased incidence of cesarean section, postpartum hemorrhage, and perineal trauma.

Risk Factors for Surgical-Site Infections Following Cesarean Section

2001 ◽  
Vol 22 (10) ◽  
pp. 613-617 ◽  
Author(s):  
Carol A. Killian ◽  
Eileen M. Graffunder ◽  
Timothy J. Vinciguerra ◽  
Richard A. Venezia
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Multiple Logistic Regression Analysis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Cesarean Sections ◽  
Increased Risk ◽  
Active Labor ◽  
Prenatal Visits

AbstractObjective:To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections.Design:Prospective cohort study.Setting:High-risk obstetrics and neonatal tertiary-care center in upstate New York.Patients:Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998.Methods:Prospective surgical-site surveillance was conducted using methodology of the National Nosocomial Infections Surveillance System. Infections were identified during admission, within 30 days following the cesarean section, by read-mission to the hospital or by a postdischarge survey.Results:Multiple logistic-regression analysis identified four factors independently associated with an increased risk of SSI following cesarean section: absence of antibiotic prophylaxis (odds ratio [OR], 2.63; 95% confidence interval [CI95], 1.50-4.6; P=.008); surgery time (OR, 1.01; CI95, 1.00-1.02; P=.04); <7 prenatal visits (OR, 3.99; CI95, 1.74-9.15; P=.001); and hours of ruptured membranes (OR, 1.02; CI95,1.01-1.03; P=.04).Patients given antibiotic prophylaxis had significantly lower infection rates than patients who did not receive antibiotic prophylaxis (F=02), whether or not active labor or ruptured membranes were present.Conclusion:Among the variables identified as risk factors for SSI, only two have the possibility to be changed through interventions. Antibiotic prophylaxis would benefit all cesarean patients regardless of active labor or ruptured membranes and would decrease morbidity and length of stay. Women's healthcare professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including postoperative infection.

Pregnancy management in patients with uterine fibroids. Case report

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. 448-453
Author(s):  
Iuliia E. Dobrokhotova ◽  
Sonia Zh. Danelian ◽  
Ekaterina I. Borovkova ◽  
Elena A. Nagaitseva ◽  
Dzhamilia Kh. Sarakhova ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Uterine Fibroids ◽  
Uterine Cavity ◽  
Pain Syndrome ◽  
First Trimester ◽  
Reproductive Age ◽  
Node Degree ◽  
Birth Canal ◽  
Large Size ◽  
Natural Birth

Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, red degeneration of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

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