Outcomes of cesarean myomectomy in Singleton compared with twin pregnancies: a 10-year retrospective cohort study

Background: To evaluate and compare the pregnancy outcomes after cesarean myomectomy in singleton and twin pregnancies. Methods: We retrospectively reviewed 100 pregnant women diagnosed with myoma who underwent cesarean myomectomy at Chungnam National University Hospital between January 2012 and July 2022. Of them, 77 were singleton pregnancies and 23 were twin pregnancies. Maternal characteristics, largest myoma size, number of myomas, and surgical outcomes were compared between two groups. Myomas were further categorized based on their size; large myomas were defined as lesions measuring ≥ 5 cm in diameter. Maternal characteristics, preoperative and postoperative hemoglobin levels, operative time, and length of hospital stay were compared between the two subgroups. Continuous variables were compared using the Mann–Whitney U test, and categorical variables were assessed using the chi-square test. Results: No significant differences were observed in the maternal characteristics, largest myoma size, number of myomas, or surgical outcomes between singleton and twin pregnancies. However, subgroup analysis based on the largest myoma size (≥ 5 vs. <5 cm) revealed significant differences in operative time (95.5 vs. 122.0 min, p < 0.001) and the need for transfusion (15.6% vs. 36.1%, p = 0.026). Otherwise, no significant differences were noted in the preoperative and postoperative hemoglobin levels or the need for massive transfusion (p > 0.999). No patient required interventions, such as the insertion of an intrauterine Foley balloon, uterine artery embolization, or hysterectomy. Conclusions: Cesarean myomectomy is safe and effective in both singleton and twin pregnancies, even in patients with large myomas. © The Author(s) 2025.