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

Abstract

Background: 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.

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

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

Results: 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.

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