Safety of cesarean myomectomy with huge myoma compared with uncomplicated cesarean section in Indian scenario

Background: Myomectomy with cesarean section has traditionally been discouraged due to risk of intractable hemorrhage and increased post-operative morbidity. In recent years, many studies have demonstrated safety of performing myomectomy with cesarean section even for large fibroids. The aim of this study was to find out the safety and clinical outcome of cesarean myomectomy in case of large myoma to encourage routine combination of both procedures. Methods: 15 term women undergoing cesarean myomectomy constituted the study group and were compared with control group of 15 pregnant women matched on basis of gestational age and parity without myoma or any other high risk factor. Outcomes studied were duration of surgery, change in hemoglobin from pre-operative to post-operative period, need for blood transfusion, and duration of hospital stay, post-operative complications and follow up of patients up to 6 weeks postpartum. Results: Mean age was higher in study group than control group which could be attributed to increased incidence of fibroids with increasing age. Both the groups were comparable for pre-operative hemoglobin, post-operative hemoglobin, change in hemoglobin, neonatal outcome, post-operative complications, duration of hospital stay and follow up to 6 weeks postpartum. Duration of surgery was significantly increased in study group as compared to control group. Blood transfusion was required only in study group. Conclusions: Myomectomy may be done with cesarean section safely even for large fibroids by expert person in tertiary care setting.