Vol.3, No.3, 156-158 (2011) Health
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Unavoidable myomectomy during cesarean section: a
case report
Ayse Nur Aksoy1, Kemal Tolga Saracoglu2, Mehmet Aksoy3, A yten Saracoglu4
1Department of Obstetrics and Gynecology, Nenehatun State Hospital, Erzurum, Turkey
2Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey;
*Corresponding Author: saracoglukt@gmai;
3Department of Anesthesiology and Reanimation, Nenehatun State Hospital, Erzurum, Turkey
4Department of Anesthesiology and Reanimation, Uskudar State Hospital, Istanbul, Turkey
Received 28 December 2010; revised 15 February 2011; accepted 28 February 2011.
Since myomectomy throughout cesarean deliv-
ery may lead to hemorrhage and uterinal atony,
it is not recommended. But, myomectomy has
been reported during cesarean section in recen t
studies. We presented a patient with large in-
tramural myoma who was diagnosed at 34 weeks
of pregnancy and operated w ith an unavoidable
cesarean-com bi ned myomectomy. A 33-year-old
unpursued primigravida was referred to emer-
gency department with abdominal pain and
amenorrhea of 34 weeks duration. A sonographic
diagnosis of myoma in pregnancy was made.
Cesare an sect ion was r equire d for f etal distress
and alive 2300 g weighted male infant with Ap-
gar score of 6 at one minute, was born. As ute-
rine incision could not be closed because of the
myoma, myomectomy was performed dur- ing
cesarean section unavoidably. A single 970 g
and 15 × 18 cm sized myoma was removed. The
physical examinations were unremarkable in the
postoperative period. Although there are case
series that have demonstrated the safety of
myomectomy during cesarean section, we con-
cluded that myomectomy during cesarean sec-
tion is not a safe procedure accept inevitable
Keywords: Pregnancy; Cesarean Sectio n; Myoma
The incidence of uterine myomas varies from 0.3 to
7.2% during pregnancy (1). The size of myomas usually
increases during pregnancy and may produce pressure
injuries such as fetal malpresentation, hydronephrosis,
preterm labour and torsion of uterus depending on num-
ber, size and location of myomas. Because myomectomy
throughout cesarean delivery may lead to hemorrhage
and uterinal atony, is not recommended by some authors
(2-4). It also carries increased risk of postoperative mor-
bidity. On the other hand, some investigators suggested
that myomectomy may be performed during cesarean
section in selected patients (5-7).
In this case, we presented a patient with large intra-
mural myoma who was diagnosed at 34 weeks of preg-
nancy and operated with cesarean-combined myomec-
A 33-year-old unpursued primigravida was referred to
emergency department of Nenehatun Obstetrics and
Gynecology Hospital with abdominal pain and amenor-
rhea of 34 weeks duration. The patient was examined
vaginally and ultrasonographically. The procedure was
carried out in accordance with the ethical standards and
written informed consent was obtained from the patient.
We conducted that she had regular uterine contractions,
no cephalopelvic disproportion, 3 cm of cervical dilate-
tion, vertex presentation, 34 weeks of fetus, 150/minute
of fetal heart rate and about 15 × 20 cm of abdominal
mass. Primarily, we attempted for normal progress of la-
bor. Whereas fetal distress appeared on the ultrasound
doppler principle, we urgently decided for cesarean de-
livery. Blood test showed a hematocrit of 33% and nor-
mal electrolytes levels. The patient’s blood type was A
Rhesus positive.
The patient was convinced to spinal anesthesia and
pfannenstiel incision was performed. The uterinal struc-
ture was adequate for 34 weeks of gestation and the in-
tramural myoma (15-17 cm in diameter) was situated
through the muscle wall. Uterine cavity was distorted
and lower uterine segment was deformed by myoma
A. N. Aksoy et al. / Health 3 (2011) 156-1 58
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
partially. A vertical uterine incision was made and alive
male infant with Apgar score of 6 at one minute and
2300 g weighted was born. Uterine incision could not be
closed because of the myoma. Then, the myometrium
overlying the myoma was incised and pseudocapsule
was dissected (Figure 1) by using electro-cautery to re-
duce blood loss. A single myoma measuring 15 × 18 cm
sized, 970 g weighted was removed (Figure 2). Hemo-
stasis was achieved by 1-0 and 0 vicryl sutures (Figure
3). The serosa was sutured using absorbable suture (2-0
or 3-0 vicryl). Prophylactic an tibiotics wer e used and th e
patient received antibiotics for seven days post-operatively.
Approximately 700 ml of blood loss was replaced by
colloids without blood transfusion. The operation took
place in 1.5 hours time. Intra-abdominal drain of hemovac
was placed without vacuum. The postoperative hema-
tocrit value was 30% and there were no maternal or fetal
complications. The patient was discharged from the hos-
pital at 8th postoperative day. The physical examinations
Figure 1. Dissection of the pseudocapsule and removing the
Figure 2. The appearance of myoma after removal.
Figure 3. Final appearance after myomectomy.
were unremarkable in the four weeks period after hospi-
Myomectomy is rarely performed during an ongoing
pregnancy because of the risk of uncontrolled hemor-
rhage necessitating hysterectomy. In recent studies,
Bhatla et al. (8) performed successful myomectomy in
the second trimester for a large subserous fibroid, weigh-
ing 3900 g. Then the pregnancy continued uneventfully
until term. Li H et al. (9) arised that mymectomy during
cesarean section was a safe and effective procedure.
Adesiyun et al. (10) investigated the fertility perform-
ance and pregnancy outcome in pregnants who had ce-
sarean myomectomy at last delivery. They noticed no
maternal or perinatal mortality factors. They suggested
that the future fertility and or subsequent pregnancy
outcome in patients were not affected by cesarean myo-
Hassiakos et al. (11) previously investigated the si-
multaneous surgical removal of myoma diagnosed dur-
ing cesarean section and they recommended that this
procedure may be applied during cesarean section.
Kaymak et al. (12) compared myomectomy during ce-
sarean section with myomas and underwent alone. They
found no significant diferences in the incidence of post-
operative fever, hemorrhage and frequency of blood
transfusion between myomectomy and control groups.
They concluded that myomectomy can be performed
without significant complications by experienced obste-
tricians during the cesarean section. In our case, we per-
formed unavoidable myomectomy in cesarean surgery
without blood transfusion and maternal complication.
Because the reclosure of the abdomen was impossible,
we performed mymectomy without any complication.
However, possible life threatening complications such as
A. N. Aksoy et al. / Health 3 (2011) 156-1 58
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
hemorrhage or disseminated intravascular coagulation
might ocur.
In conclusion, we do not always recommend but myo-
mectomy during cesarean section may be performed in
unavoidable conditions like in our present case.
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