Myomectomy at caesarean section: descriptive study of clinical outcome in a tropical setting

In the tropics, leiomyoma are commonly encountered in women of the reproductive age group, although they are mostly asymptomatic. Surgery for uterine fibroid at caesarean section has remained controversial.

To analyse the clinical outcome of women that had selective caesarean myomectomy in a community teaching hospital.

Twenty-two women that had selective myomectomy at caesarean section between January 2002 and October 2007 were analysed.

The patients mean age was 31.5 years with age range of 27-44 years. Of the 22 patients, 16 (72.7%) were primigravida, 19 (86.4%) of the patients had caesarean section at term, 2 (9.1%) and 1 (4.5%) ofthe patients were preterm and post term respectively. A significant number of the patients (16/22, 72.7%) had elective caesarean section and the remaining 6 (27.3%) patients had emergency caesarean section. The 3 leading indications for caesarean section among the patients were malpresentation/abnormal lie 36.4%, uterine fibroids 18.2%, and a previous caesarean section with complication in 13.6% ofthe patients. Indications for myomectomy at caesarean section were fibroid in lower uterine segment in 15 (68.2%) patients, pedunculated uterine fibroid in 4 (18.2%) patients and anterior subserous fibroid in 3 (13.6%) patients. Intraopertively in the 22 patients, 10 (45.5%) had fibroid(s) removed only in the lower uterine segment; while 6 (27.3%) patients each, had it removed in the upper uterine segment and both upper and lower uterine segments respectively. A total of 46 fibroids were removed in the 22 patients, of which 24 (52.2%) were subserous/pedunculated, 16 (34.8%) intramural and 6 (13.0%) were submucous. Of the 46 fibroids, 32 (69.9%) were between 6 to 10 cm size. Sixteen (72.2%) of the 22 patients lost between 751 to 1000 ml of blood intraoperatively with an average of 806.8 ml of blood loss. Two (9.1%) of the 22 patients had blood transfusion due to anaemia. Other complications encountered were puerperal pyrexia and sepsis in 2 (9.1%) patients, and fracture of the humerus and clavicle of the baby in 1 (2.3%) patient. There was no maternal and perinatal mortality.

Selection of patients for caesarean myomectomy reduces blood loss, anaemia and other complications.