Evaluation of myomectomy during cesarean section

Objective: We aimed to predict the benefits of myomectomy, intraoperative and postoperative risks and complications, the approach to these cases, and the efficacy and risks of cesarean section myomectomy by comparing pregnant patients with myoma in our clinic with and without myomectomy during cesarean section, in this study. Material and Methods: Our retrospective study was conducted among third trimester patients who applied to Dicle University Faculty of Medicine, Department of Obstetrics and Gynecology between January 1, 2015 and May 31, 2022 and received cesarean section. The study consisted of 3 groups. The first group consisted of myoma uteri+pregnant group who underwent cesarean section and simultaneous myomectomy, the second group consisted of myoma uteri+pregnant and only cesarean section group, and the third group was composed of only cesarean section pregnant patients without myoma uteri. The groups were evaluated in terms of preoperative and postoperative hemogram values, demographic characteristics, operation time, postoperative hospital stay, need for blood transfusion, myoma size, number of myomas, number of myomas removed during the operation of myomectomy patients, need for peroperative or postoperative hysterectomy, and need for additional surgical intervention. The information was obtained from the hospital electronic archive database. Results: Our study included 87 pregnant patients with myoma uteri and pregnancy diagnosis who underwent cesarean section, and 51 pregnant patients without myoma uteri as the control group. Group 1 consisted of 56 patients (40.6%), group 2 consisted of 31 patients (22.5%), and group 3 consisted of 51 patients (37%). The ages of group 1 and group 2 were found to be significantly higher than group 3 (p=0.001, p=0.001). The group with myoma uteri had a higher rate of nulligravid and nulliparous than the control group. The number of previous cesarean sections in group 3 was found to be significantly higher than group 1 and group 2 (p=0.001, p=0.017). It was determined that the gestational week of group 3 at birth was significantly higher than group 2 (p=0.008). In group 1, as myoma size increased, operation time, postoperative hospital stay, and erythrocyte transfusion increased (r=0.503, p=0.001), (r= 0.351, p=0.008) (r=0.352, p=0.008). As the number of myomas removed in group 1 increased, erythrocyte transfusion increased (r=0.350, p=0.008). Conclusion: Performing myomectomy operation during cesarean section; considering our data, it is an operation that can be performed by experienced surgeons in tertiary hospitals by evaluating possible risks. Precautions should also be taken in terms of complications. We think that the decision of whether to include myomectomy operation during cesarean section should be decided on a patient basis by discussing with the patient the profit-loss ratio and considering the factors mentioned above. Keywords: Pregnancy, cesarean section, myoma uteri, cesarean myomectomy