Z Geburtshilfe Neonatol 2015; 219 - FV10_4
DOI: 10.1055/s-0035-1566514

Evaluation of myomectomy during cesarean delivery in patients with uterus myomatosus

I Dedes 1, L Schäffer 2, R Zimmermann 1, C Haslinger 1
  • 1Universitätsspital Zürich, Geburtshilfe, Zürich, Switzerland
  • 2Kantonsspital Baden, Geburtshilfe, Baden, Switzerland

Aim: Evaluation of myomectomy during cesarean delivery (CD).

Methods: A retrospective cohort study was performed at our hospital between 2002 – 2013. Included were all women undergoing CD with uterine leiomyomas and singleton pregnancies. The CD was performed by a consultant. Excluded were multiple pregnancies, placentation disorders, preeclampsia/HELLP, primary coagulopathies, CD in 2nd stage of labor and CD with additional surgical interventions.

A multivariate logistic regression analysis was performed adjusting for localization of the leiomyoma (intramural+submucousal (IM/SM), pedunculated+subserosal (P/SS), multiple leiomyomas, size of leimyomas (≥5 cm, ≥3 cm), adipositas (BMI ≥30 kg/m2), maternal age (≥40 years), fetal birth weight (≥4 kg), and type of cesarean (primary CD or secondary CD in first stage of labor, repeated CD). Measured adverse outcome parameters were estimated blood loss, drop of hemoglobin, operation time and use of additional uterotonics.

Results: The search included 162 women with uterine leiomyomas during cesarean delivery of whom 48 underwent concurrent myomectomy. Myomectomy during cesarean was not associated with adverse outcome.

Size of leiomyoma ≥5 cm was associated with an increased risk for estimated blood loss ≥500 ml (adj. OR 2.7 CI 95% 1.2 – 6.2, p = 0.02). Increased drop in hemoglobin (≥20 g/l) was observed in women aged 40 years or older (adj. OR 2.4 CI 95% 1.0 – 5.4, p = 0.04). Prolonged operation time (≥45 minutes) was seen in repeat cesareans (adj. OR 3.2 CI 95% 1.4 – 7.3, p = 0.01). Additional use of uterotonics was observed in obese patients (adj. OR 4.9 CI 95% 1.1 – 22.5, p = 0.04). There were no cases of hysterectomy or blood transfusions.

Discussion: Myomectomy during cesarean delivery performed by an experienced obstetrician is safe in selected patients without additional preexisting risk factors. Risk factors that are significantly associated with increased blood loss are size of leiomyoma ≥5 cm and maternal age ≥40 years.