Caesarean myomectomy – An option in fibroid-endemic, low-resource settings?
Context: Widespread use of myomectomy during caesarean delivery could potentially eliminate multiple surgeries for both indications. However, many surgeons have been reluctant to adopt this policy without conclusive evidence demonstrating its safety.
Objective: To evaluate the safety of myomectomy during caesarean delivery.
Study Design: A review of the publications on caesarean myomectomy especially from the African continent.
Main outcome measures: Duration of surgery, blood loss, length of hospital stay and blood transfusions.
Results: Judging from the lack of large studies on caesarean myomectomy, the proportion of surgeons who attempt the procedure is low largely because of concerns about its safety. However, most of the authors suggested that the complications and morbidity following caesarean myomectomy do not significantly differ from those occurring during caesarean section alone, while fertility is apparently not compromised by this treatment. With careful patient selection, adequate experience and efficient haemostatic measures, the procedure does not appear as hazardous as was once thought. This information is relevant for counseling women who request for the simultaneous removal of previously diagnosed fibroids during caesarean section.
Conclusion: Although complications could occur, caesarean myomectomy appears safe. Staff and facilities for safe management of haemorrhage are a requisite for the procedure. Large randomized trials are needed to guide decisions as to the best clinical practice regarding myomectomy during caesarean delivery.
Key words: Caesarean section, myomectomy, fibroids, complications, Africa.
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