Our Summary

This research paper is about a study conducted to assess the management of myomas (a type of non-cancerous growth that develops in or around the uterus) during cesarean sections. The authors reviewed existing literature to understand the benefits, outcomes, and recent trends in cesarean myomectomy, which is the surgical removal of myomas during a cesarean section.

While some advantages of this procedure were identified, it was also suggested that myomectomy might be better postponed until after a cesarean section in certain cases. This is due to reports of serious complications, including maternal death, associated with cesarean myomectomy.

The authors question whether these complications are underestimated in regular medical practice. Despite some studies indicating that cesarean myomectomy is safe, there is a lack of data on the long-term effects on women.

Given the increasing age of patients, the higher occurrence of myomas during pregnancy, and the increased use of fertility treatments, the authors suggest that the risk and benefit balance of cesarean myomectomy should be re-evaluated.

FAQs

  1. What is cesarean myomectomy?
  2. What are the potential complications of cesarean myomectomy?
  3. Why do the authors suggest that the risk and benefit balance of cesarean myomectomy should be re-evaluated?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to carefully consider the potential risks and benefits of the procedure, especially in the context of pregnancy. It is important to have a thorough discussion with your healthcare provider to weigh the potential benefits of myomectomy against the risks, and to consider whether it may be safer to postpone the procedure until after giving birth. Additionally, it is important to ensure that the procedure is performed by a skilled and experienced surgeon to minimize the risk of complications.

Suitable For

Patients who are typically recommended for myomectomy include those with symptomatic myomas that are causing heavy menstrual bleeding, pelvic pain, pressure symptoms, infertility, or recurrent pregnancy loss. Additionally, patients who have rapidly growing myomas, those with large myomas that are distorting the shape of the uterus, and those who have failed conservative management options may also be recommended for myomectomy.

In the context of cesarean myomectomy, patients who have myomas that are located in a position that may interfere with the cesarean section procedure or those who have myomas that are causing significant symptoms during pregnancy may be recommended for myomectomy during the cesarean section.

It is important for healthcare providers to carefully assess each individual patient and consider the risks and benefits of myomectomy in their specific case before making a recommendation for the procedure.

Timeline

Before myomectomy:

  • Patient experiences symptoms such as heavy menstrual bleeding, pelvic pain, and pressure
  • Patient undergoes diagnostic tests such as ultrasound or MRI to confirm the presence of myomas
  • Patient discusses treatment options with their healthcare provider, including the possibility of myomectomy

During myomectomy:

  • Patient undergoes surgery to remove the myomas while also undergoing a cesarean section if pregnant
  • Surgeon carefully removes the myomas while minimizing damage to the uterus
  • Patient is monitored closely for any complications during and after the procedure

After myomectomy:

  • Patient recovers in the hospital for a few days before being discharged
  • Patient may experience pain, cramping, and vaginal bleeding during the recovery period
  • Patient follows post-operative instructions provided by their healthcare provider, including restrictions on physical activity and medications for pain management
  • Patient attends follow-up appointments to monitor their recovery and assess any potential complications

Overall, the timeline of a patient’s experience before and after myomectomy involves a careful evaluation of symptoms, discussions with healthcare providers, undergoing surgery, and post-operative care to ensure a successful recovery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with myomectomy during a cesarean section?
  2. Are there alternative treatment options for myomas that may be safer or more appropriate for my specific case?
  3. How will my recovery from a cesarean myomectomy differ from a regular cesarean section?
  4. What is the likelihood of myomas regrowing after a myomectomy during a cesarean section?
  5. How will my fertility be affected by undergoing a myomectomy during a cesarean section?
  6. Are there any long-term effects or complications that I should be aware of after undergoing a myomectomy during a cesarean section?
  7. What is the success rate of cesarean myomectomy in preventing future complications related to myomas?
  8. How experienced are you in performing myomectomies during cesarean sections?

Reference

Authors: Sparić R, Kadija S, Stefanović A, Spremović Radjenović S, Likić Ladjević I, Popović J, Tinelli A. Journal: J Obstet Gynaecol Res. 2017 May;43(5):798-804. doi: 10.1111/jog.13294. Epub 2017 Feb 7. PMID: 28168805