Myomectomy during cesarean delivery

Background: The optimal management of leiomyomas during cesarean delivery is unclear. Objectives: To assess the safety of myomectomy performed during cesarean delivery. Search strategy: PubMed, MEDLINE, EMBASE, and Cochrane Library were searched to identify potentially relevant studies published prior to June 30, 2012. Selection criteria: Case-control study comparing myomectomy with no myomectomy in patients undergoing cesarean delivery. Data collection and analysis: The quality of the studies was assessed and data were extracted independently by 2 authors. Main results: Nine studies, including 1 082 women with leiomyomas, met the inclusion criteria; 443 (41.0%) women underwent cesarean myomectomy and 639 (59.1%) underwent cesarean delivery alone. The drop in hemoglobin after surgery was 0.30 g/dL greater in the cesarean myomectomy group than in the control group, but the difference was not significant. The operative time was 4.94 minutes longer in the cesarean myomectomy group, but again the difference was not significant. The overall incidence of fever was comparable in the 2 groups. No hysterectomies were performed in any of the included studies. Conclusions: Cesarean myomectomy may be a reasonable option for some women with leiomyoma. However, no definite conclusion can be drawn because the data included in the meta-analysis were of low quality. (C) 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.