Cesarean myomectomy and possible risk factors for admission to intensive care unit - a retrospective study

Cesarean myomectomy (CM) allows to remove fibroids and to restore uterine anatomy during delivery combining two operations in one. It was opposed in the past due to surgical risks, although many reports showed that CM was not associated with increased morbidity The risk for admission to an intensive care unit (ICU) following CM - as an objective indicator of maternal morbidity potentially resulting in greater morbidity for patients, increased length of hospital stay and higher hospital costs - has been poorly evaluated in the literature. The aim of our investigation is to estimate risk factors for ICU admission after CM.

The patients were subdivided into two groups: 57 women who were postoperatively admitted to the ICU (study group), and 45 women not treated in the ICU (control group). The p-value of <0.05 was considered as statistically significant.

Data showed no statistically significant differences with regard to demographic factors, comorbidity and indications for cesarean section, as well as experience of the surgeon, number of hysterotomies, and incidence of emergency CS between the two groups. The most common reason for admission to the ICU was intraoperative hemorrhage (61.40%). As for the surgical characteristics, the study group showed significant increase in the rates of intraoperative transfusion (p=0.000) and intraoperative hemorrhage (p=0.000), as well as prolongation of surgical time (p=0.002). Myoma type and size were also significantly different between the groups (p=0.003 and p=0.000, respectively).

The most important factor contributing to ICU admission after CM is intraoperative hemorrhage in case of bigger myomas and prolonged surgeries.