A cohort study of maternal and fetal outcomes for myomectomy at caesarean section in Aba, South Eastern Nigeria

Chisara C. Umezurike, Emmanuel M. Akwuruoha, Kelechi N. Eguzo

Abstract


Background: Fibroids in pregnancy are common in Nigeria but myomectomy during caesarean section is not popular due to concerns for severe hemorrhage. Previous studies did not directly compare outcome for routine Caesarean Section (CS) with Caesarean Myomectomy (CM). This prospective cohort study compares the maternal and fetal outcomes of caesarean myomectomy (exposed arm) with caesarean section (control arm); (n=64; CM=34; CS=30).

Methods: Variables include maternal age, durations of surgery and hospitalization, Estimated Blood Loss (EBL), as well as pre and postoperative hematocrit. Fetal weight, number and weight of fibroids were also considered. Data was analyzed with SPSS using descriptive statistics and chi-square tests.

Results: There was no significant difference in EBL, incidence of postoperative complications, fetal APGAR score at 5 minutes as well as duration of hospitalization between both groups. Number of fibroids (>10) was significantly associated with blood transfusion (X2=11.46, P <0.001), and was found to be strongly correlated with longer duration of surgery (r=0.79; P <0.001).

Conclusions: Study suggests that caesarean myomectomy maybe a safe procedure, with good maternal and fetal outcomes, in well-selected patients, especially those with <10 fibroids in pregnancy. Caution should be applied in patients with >10 fibroids. We recommend use of total number of fibroids as an index of surgical risk, instead of dimension of fibroids, as correlates significantly with duration of surgery and estimated blood loss. 


Keywords


Caesarean section, Caesarean myomectomy, Fibroid in pregnancy, Cohort study, Maternal outcome

Full Text:

PDF

References


Kwawukume EY. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2002;76(2):183-4.

Baird DD, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynaecol. 2003;188(1):100-7.

Kaymak O, Ustunyurt E, Okyay RE, Kalyoncu S, Mollamahmutoglu L. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2005;89(2):90-3.

Umezurike C, Waboso FP. Successful myomectomy during pregnancy: a case report. Reprod Health. 2005;2:6.

Ehigiegba AE, Ande AB, Ojobo SI. Myomectomy during cesarean section. Int J Gynaecol Obstet. 2001;75(1):21-5.

Lee HJ, Norwits ER, Shaw J. Contemporary management of uterine fibroids in pregnancy. Rev Obstet Gynaecol. 2010;3(1):20-7.

Roman AS, Tabsh KMA. Myomectomy at time of caesarean delivery: a retrospective cohort study. BMC Pregnancy Childbirth. 2004;4(1):14.

Park BJ, Kim KY. Safety of caesarean myomectomy. J Obstet Gynaecol Res. 2009;35:906-11.

Lin H, Juan D, Jin L, Shi Z, Lui M. Myomectomy during caesarean section. Acta Obstet Gynaecol. 2009;88(2):183-6.

Umezurike CC. Caesarean myomectomy in Aba, Southeastern Nigeria. Trop Doctor. 2007;37:109-11.

Song D, Zhang W, Chames MC, Guo J. Myomectomy during cesarean delivery. Int J Gynaecol Obstet. 2013;121(3):208-13.

Ikedife D. Surgical challenge of myomectomy at caesarean section. Niger J Surg Sci. 1993;3:15-7.

Cobellis L, Peroci E, Cobellis G. Hemostatic technique for myomectomy during caesarean section. Int J Gynaecol Obstet. 2002;79:261-2.

Kim YS, Choi SD, Bas DH. Risk factors for complications in patients undergoing myomectomy at the time of caesarean section. J Obstet Gynaecol Res. 2010;36(3):550-5.

ACOG Committee Opinion No. 333. American College of Obstetricians and Gynecologists. The APGAR score. Obstet Gynaecol. 2006;107:1209-12.