Skip to main content
SpringerLink
Log in

Cesarean Myomectomy: Necessity or Opportunity?

  • Invited Mini Review
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Fibroids in pregnancy are increasingly common, due to advanced maternal age, better diagnostic tools and use of assisted reproductive techniques. Cesarean section (CS) is the commonest mode of delivery in these patients. Cesarean myomectomy (CM) is the term used to describe the removal of fibroids at CS; it has always been a controversial topic, with two schools of thought. Some obstetricians advise against it due to the traditional fear of massive obstetric hemorrhage and its attendant complications. However, recent literature advocates elective or opportunistic myomectomy in well-selected cases during CS. This is especially valuable in low-resource settings where the patient may be spared a repeat surgery and problems of anesthesia and cost associated with it. This review examines the recent published data on CM, its indications, technique, safety and applicability in modern obstetrics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jhalta P, Negi SG, Sharma V. Successful myomectomy in early pregnancy for a large asymptomatic uterine myoma: case report. Pan African Medical J. 2016;24:228. https://doi.org/10.11604/pamj.2016.24.228.9890.

    Article  Google Scholar 

  2. Jauniaux E, Khan KS. Caesarean myomectomy: Victor Bonney reports the first case in 1913. BJOG. 2014;121(2):193.

    Article  Google Scholar 

  3. Sparić R, Malvasi A, Kadija S, et al. Safety of cesarean myomectomy in women with single anterior wall and lower uterine segment myomas. J Matern Fetal Neonatal Med. 2017. https://doi.org/10.1080/14767058.2017.1333096. [Epub ahead of print].

    Article  Google Scholar 

  4. Kwon DH, Song JE, Yoon KR, Lee KY. The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Sci. 2014;57(5):367–72.

    Article  Google Scholar 

  5. Song D, Zhang W, Chames MC, Guo J. Myomectomy during cesarean delivery. Int J Gynaecol Obstet. 2013;121:208–13.

    Article  Google Scholar 

  6. Tinelli A, Malvasi A, Mynbaev OA, et al. The surgical outcome of intracapsular cesarean myomectomy: a match control study. J Matern Fetal Neonatal Med. 2014;27:66–71.

    Article  Google Scholar 

  7. Hatırnaz Ş, Güler O, Başaranoğlu S, et al. Endometrial myomectomy: a novel surgical method during cesarean section. J Matern Fetal Neonatal Med. 2018;31(4):433–8. https://doi.org/10.1080/14767058.2017.1286320 Epub 2017 Feb 9.

    Article  PubMed  Google Scholar 

  8. Huang SY, Shaw SW, Su SY, et al. The impact of a novel transendometrial approach for caesarean myomectomy on obstetric outcomes of subsequent pregnancy: a longitudinal panel study. BJOG. 2017. https://doi.org/10.1111/1471-0528.14798. [Epub ahead of print].

    Article  Google Scholar 

  9. Sparic R, Malvasi A, Tinelli A. Analysis of clinical, biological and obstetric factors influencing the decision to perform cesarean myomectomy. Ginekol Pol. 2015;86:40–4.

    Article  Google Scholar 

  10. Topçu HO, İskender CT, Timur H, et al. Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas. Int J Gynaecol Obstet. 2015;130(3):244–6. https://doi.org/10.1016/j.ijgo.2015.03.035 Epub 2015 May 17.

    Article  PubMed  Google Scholar 

  11. Dedes I, Schäffer L, Zimmermann R, et al. Outcome and risk factors of cesarean delivery with and without cesarean myomectomy in women with uterine myomatas. Arch Gynecol Obstet. 2017;295(1):27–32. https://doi.org/10.1007/s00404-016-4177-8 Epub 2016 Aug 24.

    Article  CAS  PubMed  Google Scholar 

  12. Akbas M, Mihmanli V, Bulut B, et al. Myomectomy for intramural fibroids during caesarean section: a therapeutic dilemma. J Obstet Gynaecol. 2017;37(2):141–5. https://doi.org/10.1080/01443615.2016.1229272 Epub 2016 Dec 7.

    Article  PubMed  Google Scholar 

  13. Turgal M, Ozgu-Erdinc AS, Beksac K, et al. Myomectomy during cesarean section and adhesion formation as a long-term postoperative complication. Ginekol Pol. 2015;86(6):457–60.

    Article  Google Scholar 

  14. Doğan S, Özyüncü Ö, Atak Z. Fibroids during pregnancy: effects on pregnancy and neonatal outcomes. J Reprod Med. 2016;61(1–2):52–7.

    PubMed  Google Scholar 

  15. Awoleke JO. Myomectomy during caesarean birth in fibroid-endemic, low-resource settings. Hindawi Publishing Corporation. Obstet Gynecol Int. Volume 2013, Article ID 520834, 6 pages. http://dx.doi.org/10.1155/2013/520834.

  16. Kumar RR, Patil M, Sa S. The utility of caesarean myomectomy as a safe procedure: a retrospective analysis of 21 cases with review of literature. J Clin Diagn Res. 2014;8(9):OC05–8. https://doi.org/10.7860/jcdr/2014/8630.4795 Epub 2014 Sep 20.

    Article  Google Scholar 

  17. Kanthi JM, Sumathy S, Sreedhar S, et al. Comparative study of cesarean myomectomy with abdominal myomectomy in terms of blood loss in single fibroid. J Obstet Gynaecol India. 2016;66(4):287–91. https://doi.org/10.1007/s13224-015-0685-x Epub 2015 Mar 15.

    Article  PubMed  Google Scholar 

  18. Sparić R, Kadija S, Stefanović A, et al. Cesarean myomectomy in modern obstetrics: more light and fewer shadows. J Obstet Gynaecol Res. 2017;43(5):798–804. https://doi.org/10.1111/jog.13294 Epub 2017 Feb 7.

    Article  PubMed  Google Scholar 

  19. Akkurt MO, Yavuz A, Eris Yalcin S, et al. Can we consider cesarean myomectomy as a safe procedure without long-term outcome? J Matern Fetal Neonatal Med. 2017;30(15):1855–60. https://doi.org/10.1080/14767058.2016.1228057 Epub 2016 Sep 9.

    Article  PubMed  Google Scholar 

  20. Pergialiotis V, Sinanidis I, Louloudis IE, et al. Perioperative complications of cesarean delivery myomectomy: a meta-analysis. Obstet Gynecol. 2017. https://doi.org/10.1097/aog.0000000000002342. [Epub ahead of print].

    Article  Google Scholar 

  21. Sparić R, Malvasi A, Kadija S, et al. Cesarean myomectomy trends and controversies: an appraisal. J Matern Fetal Neonatal Med. 2017;30(9):1114–23. https://doi.org/10.1080/14767058.2016.1205024 Epub 2016 Jul 17.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India

    Anahita R. Chauhan

Authors
  1. Anahita R. Chauhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anahita R. Chauhan.

Ethics declarations

Conflicts of interest

Dr Anahita Chauhan declares that she has no conflict of interest.

Ethical Approval

All procedures followed were in accordance with the ethical standards of the Institutional Ethics Committee and with the 1975 Declaration of Helsinki, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Anahita R. Chauhan is Former Professor and Head of Unit, Department of Obstetrics and Gynecology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chauhan, A.R. Cesarean Myomectomy: Necessity or Opportunity?. J Obstet Gynecol India 68, 432–436 (2018). https://doi.org/10.1007/s13224-018-1114-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-018-1114-8

Keywords

Search

Navigation