Our Summary

This research paper focuses on a common problem that affects 70-80% of women of reproductive age: uterine tumors known as fibroids or myomas. These non-cancerous tumors are the second most common reason for surgery among women who haven’t gone through menopause yet. As more older women have children, the chance of having these tumors during pregnancy is likely to increase.

Although most women with fibroids don’t experience any symptoms during pregnancy, up to 30% do face problems during pregnancy, childbirth, and the period after childbirth. One key issue is whether or not to remove these tumors during a cesarean section (C-section), a surgery to deliver a baby through the mother’s abdomen. This has become a more pressing issue as the rates of both fibroids and C-sections are increasing.

Traditionally, fibroids were removed during a C-section using a method called a cesarean myomectomy (CM), where the surgeon makes a cut through the outer layer of the uterus. However, a new surgical procedure has been introduced, which involves making a cut through the inner layer of the uterus instead. This new approach has led some to question the old method, and some experts are now advocating for this new approach due to its potential advantages.

This paper aims to evaluate the current method of cesarean myomectomy by comparing the differences between the two surgical procedures and providing examples of how the CM method is performed.

FAQs

  1. What are uterine fibroids or myomas and how prevalent are they among women of reproductive age?
  2. What is the risk of having myomas during pregnancy and how does it affect childbirth and the postpartum period?
  3. What is the difference between the trans-endometrial approach and the trans-serosal approach in cesarean myomectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to discuss the potential risks and benefits of the procedure, including its impact on fertility. It is important for patients to have a thorough understanding of the procedure and its potential outcomes before making a decision. Additionally, patients should be aware of the different surgical approaches to myomectomy, such as the trans-endometrial approach and the trans-serosal approach, and discuss with their doctor which approach may be most suitable for their individual case.

Suitable For

Patients who are typically recommended myomectomy include women of reproductive age who are experiencing symptoms such as heavy menstrual bleeding, pelvic pain, pressure on the bladder or bowel, and infertility. Myomectomy may also be recommended for women who wish to preserve their fertility or who are experiencing complications during pregnancy or childbirth due to the presence of fibroids. Additionally, myomectomy may be recommended for women with fibroids that are causing significant discomfort or impacting their quality of life.

Timeline

Before myomectomy:

  1. Patient experiences symptoms such as heavy menstrual bleeding, pelvic pain, and pressure.
  2. Patient undergoes diagnostic tests such as ultrasound or MRI to confirm the presence of fibroids.
  3. Patient discusses treatment options with their healthcare provider, including myomectomy as a surgical option.

After myomectomy:

  1. Patient undergoes the surgical procedure to remove the fibroids from the uterus.
  2. Patient may experience some pain and discomfort post-surgery, which can be managed with pain medication.
  3. Patient follows post-operative care instructions, including rest and avoiding strenuous activities.
  4. Patient may experience improvements in symptoms such as decreased menstrual bleeding and pelvic pain.
  5. Patient follows up with their healthcare provider for monitoring and to discuss any concerns or complications.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing a myomectomy procedure?
  2. How will my fertility be affected by undergoing a myomectomy?
  3. What is the success rate of a myomectomy in treating myomas?
  4. How long is the recovery period following a myomectomy procedure?
  5. Are there any alternative treatment options for myomas that I should consider?
  6. Will I still be able to have children after undergoing a myomectomy?
  7. What are the chances of myomas returning after a myomectomy?
  8. How will my regular activities be impacted following a myomectomy?
  9. Are there any specific precautions I should take before or after a myomectomy procedure?
  10. What is the experience of the healthcare provider in performing myomectomy procedures?

Reference

Authors: Sparić R, Andrić L, Guler O, Malvasi A, Babović I, Hatirnaz S, Dellino M, Tinelli A. Journal: Medicina (Kaunas). 2024 Apr 8;60(4):609. doi: 10.3390/medicina60040609. PMID: 38674255