Our Summary

This research paper examines the safety of removing certain types of fibroids (non-cancerous growths in the uterus, known as intramural myomas) during a cesarean section in women carrying twins. The study looked at 145 cases in a Beijing hospital from 2013 to 2021.

The women were split into two groups: those who had the fibroids removed during their cesarean section (49 cases, the “myomectomy group”) and those who only had a cesarean section without fibroid removal (96 cases, the “non-myomectomy group”).

The researchers found that the operation took longer and the hospital stay was slightly longer for the group who had the fibroids removed. However, there were no significant differences in other factors such as blood loss, postpartum hemorrhage, blood transfusion, postoperative fever, and the babies’ health (measured by the Apgar score) between the two groups.

When specifically looking at smaller fibroids (less than 5 cm), there was no significant difference in outcomes between the two groups. For larger fibroids (5 cm or more), the operation and hospital stay were again slightly longer for the group that had the fibroids removed, but there were no significant differences in other outcomes.

The study concludes that it is safe for experienced doctors to remove these fibroids during a cesarean section in women carrying twins.

FAQs

  1. What is the impact of fibroid removal during a cesarean section on the operation duration and hospital stay?
  2. Are there any differences in the babies’ health between the group that had the fibroids removed and the group that didn’t?
  3. Is the removal of larger fibroids (5 cm or more) during a cesarean section safe for women carrying twins?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss the potential risks and benefits of the procedure, including the possibility of longer operation time and hospital stay. It is important for patients to understand that myomectomy can be safely performed during a cesarean section, especially in cases where the fibroids are causing symptoms or affecting fertility. Patients should also be informed about the specific outcomes and considerations based on the size of the fibroids.

Suitable For

Patients who are typically recommended myomectomy are those who have symptomatic fibroids (such as heavy menstrual bleeding, pelvic pain, or pressure symptoms) that are affecting their quality of life. Additionally, myomectomy may be recommended for patients who have fertility issues or recurrent miscarriages due to the presence of fibroids in the uterus. In some cases, myomectomy may also be recommended for patients with fibroids that are causing complications during pregnancy, such as placental abruption or fetal growth restriction.

Timeline

Before myomectomy:

  1. Patient consults with a gynecologist and discusses symptoms such as heavy menstrual bleeding, pelvic pain, and fertility issues.
  2. Gynecologist confirms the presence of fibroids through imaging tests such as ultrasound or MRI.
  3. Patient undergoes pre-operative testing to assess overall health and fitness for surgery.
  4. Patient discusses the risks and benefits of myomectomy with their healthcare provider and decides on the best course of action.

After myomectomy:

  1. Patient undergoes the myomectomy procedure, which can be performed through open surgery, laparoscopic surgery, or hysteroscopy.
  2. Patient may experience pain and discomfort following the surgery and will be prescribed pain medication.
  3. Patient stays in the hospital for a few days for monitoring and recovery.
  4. Patient follows post-operative instructions, including rest, avoiding heavy lifting, and attending follow-up appointments.
  5. Patient may experience improvements in symptoms such as decreased menstrual bleeding, relief from pelvic pain, and improved fertility outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What are the risks and benefits of having a myomectomy during a cesarean section?
  2. How experienced are you in performing myomectomies during cesarean sections?
  3. What is the likelihood of complications during and after the procedure?
  4. How will having a myomectomy during a cesarean section affect my recovery time?
  5. Will having a myomectomy during a cesarean section affect my ability to have future pregnancies?
  6. Are there any alternative treatment options for my fibroids that I should consider?
  7. How will the presence of fibroids during my pregnancy affect me and my babies?
  8. What is the likelihood of the fibroids causing complications during my pregnancy or delivery if they are not removed?
  9. What will be the follow-up care and monitoring needed after a myomectomy during a cesarean section?
  10. Can you provide me with more information or resources about myomectomy during cesarean section for women carrying twins?

Reference

Authors: Wang HM, Shen RG, Yang HJ, Tian YC, Zhang CL, Dai YM. Journal: Zhonghua Fu Chan Ke Za Zhi. 2022 Nov 25;57(11):843-849. doi: 10.3760/cma.j.cn112141-20220721-00472. PMID: 36456481