Myomectomy during cesarean section

Objectives: To assess the infra- and post-operative complications of cesarean myomectomy. Methods: The study design was descriptive, and the setting was the Department of Obstetrics and Gynaecology, University of Benin Teaching hospital and two private consultant units, all in Benin City. The subjects were 25 pregnant women undergoing elective or emergency cesarean section at these units. The outcome measures were blood loss and need for blood transfusion, infra- and post-operative complications and duration of hospital stay. Results: Eighty-four fibroids of various sizes (2-10 cm) were removed from the 25 women. The fibroids were on the anterior uterine wall with most (94.8%) being sub-serous or intramural, and only few (five) sub-mucous. The mean blood loss was 876 +/- 312 ml, range 400-1700 ml. Five patients (20%) had two units of whole blood transfusion. There was no case of severe hemorrhage necessitating hysterectomy. Eighteen patients (72%) had post-operative morbidities mainly of anemia [15 (60%); hematocrit 26 +/- 2.9%). The average duration of post-operative hospital stay was 7.4 +/- 2.2 days (range 3-12 days). Three (12%) patients have subsequently become pregnant, two (66.7%) of whom had normal vaginal deliveries, while the third had a repeat elective cesarean section. Conclusions: With adequate experience and the use of high dose oxytocin infusion (intra- and post-operatively), myomectomy at cesarean section is not as hazardous as many now believe. (C) 2001 International Federation of Gynecology and Obstetrics. All rights reserved.