Our Summary

This research paper looks at the safety and feasibility of performing a myomectomy (surgery to remove fibroids from the uterus) during a cesarean section (C-section). The researchers reviewed a number of studies conducted between 2008 and 2019, looking at things like blood loss, operation time, need for blood transfusions, and length of hospital stay among patients.

The study included 6545 women, 4702 of whom had a myomectomy during their C-section while 1843 had a C-section alone. The results showed that women who had a myomectomy during their C-section had a slightly lower hemoglobin level (which could indicate blood loss), and a higher need for blood transfusions. However, these differences were not clinically significant, meaning they didn’t have a major impact on the patients’ health or recovery.

The researchers also found that the operation time and hospital stay were slightly longer for the women who had a myomectomy, but again, these differences were not clinically significant. There was no difference between the two groups in terms of the incidence of hemorrhage (heavy bleeding) or fever.

The researchers concluded that performing a myomectomy during a C-section is feasible and can be safely done, particularly by experienced surgeons in tertiary care centers. They suggest that this procedure should be preferred over a C-section alone, especially for women with multiple or large fibroids.

FAQs

  1. Is performing a myomectomy during a C-section safe?
  2. What were the main differences in recovery for women who had a myomectomy during their C-section vs. those who had a C-section alone?
  3. Who should consider having a myomectomy during their C-section?

Doctor’s Tip

A doctor might tell a patient considering a myomectomy that it is a safe and feasible procedure, especially when performed by experienced surgeons in specialized centers. They may also mention that while there may be slightly longer operation times and hospital stays compared to a regular C-section, the differences are not clinically significant and should not impact the patient’s overall health or recovery.

Suitable For

Overall, patients who are typically recommended for a myomectomy are those who have symptomatic fibroids that are causing issues such as heavy menstrual bleeding, pelvic pain, or pressure symptoms. Additionally, patients who are experiencing infertility or recurrent pregnancy loss due to fibroids may also be recommended for a myomectomy.

It is important for patients to discuss their individual situation with their healthcare provider to determine if a myomectomy is the best treatment option for them. Factors such as the size and location of the fibroids, the patient’s age, desire for future fertility, and overall health status will all be taken into consideration when making this decision.

Timeline

Before myomectomy:

  1. Patient experiences symptoms such as heavy menstrual bleeding, pelvic pain, and pressure.
  2. Patient undergoes a physical exam and imaging tests to diagnose fibroids.
  3. Patient discusses treatment options with their healthcare provider, including the possibility of a myomectomy.
  4. Patient undergoes pre-operative tests and preparations before the surgery.

After myomectomy:

  1. Patient undergoes the myomectomy procedure to remove fibroids from the uterus.
  2. Patient is monitored in the recovery room for any immediate complications.
  3. Patient may experience some pain and discomfort after the surgery.
  4. Patient is discharged from the hospital after a few days of recovery.
  5. Patient follows post-operative instructions, including pain management, activity restrictions, and follow-up appointments.
  6. Patient experiences relief from symptoms such as heavy bleeding and pelvic pain.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy during a C-section include:

  1. What are the potential risks and complications associated with having a myomectomy during a C-section?
  2. How experienced are you in performing myomectomies during C-sections?
  3. Are there any specific criteria that make me a good candidate for a myomectomy during my C-section?
  4. How will having a myomectomy during my C-section affect my recovery time and postoperative care?
  5. What are the expected outcomes and benefits of having a myomectomy during my C-section?
  6. Will I need any additional follow-up care or monitoring after having a myomectomy during my C-section?
  7. Are there any alternative treatment options for my fibroids that I should consider before deciding on a myomectomy during my C-section?
  8. How will having a myomectomy during my C-section impact future pregnancies and fertility?
  9. What is the likelihood of needing a blood transfusion during or after the procedure?
  10. Can you provide me with information about your previous experience and success rates with performing myomectomies during C-sections?

Reference

Authors: Goyal M, Dawood AS, Elbohoty SB, Abbas AM, Singh P, Melana N, Singh S. Journal: Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:145-157. doi: 10.1016/j.ejogrb.2020.11.008. Epub 2020 Nov 11. PMID: 33232889