Clinical Safety Outcomes Following Myomectomy during Cesarean Delivery: A Comparative Study

Background & Objective: Uterine fibroids are common in pregnancy and can complicate delivery. Traditionally, performing myomectomy during cesarean section has been discouraged due to concerns about excessive bleeding and increased maternal morbidity. However, recent evidence suggests that cesarean myomectomy may be safe and effective in carefully selected patients when performed by experienced surgeons. Materials & Methods:  This retrospective case-control study was conducted at Urmia University of Medical Sciences from October ۲۰۱۹ to March ۲۰۲۴. A total of ۱۰۰ pregnant women with diagnosed fibroids were divided into two groups: ۵۰ underwent cesarean myomectomy (case group) and ۵۰ had cesarean section alone (control group). Clinical, surgical, and hematologic outcomes were compared using t tests, chi-square tests, and multivariate regression analysis. Results: The cesarean myomectomy group had a significantly longer mean surgery duration (۹۶.۷±۳۵.۱ minutes) compared to controls (۸۰.۲±۲۲.۵ minutes; P=۰.۰۰۱). Blood transfusion was more frequent in the case group (۵۴% vs. ۳۲%; odds ratio ۲.۵۳, ۹۵% CI: ۱.۱۳-۵.۶۸; P=۰.۰۲). Despite this, there were no significant differences in hemoglobin drop, hospital stay length, or postoperative complications such as fever and infection. Larger fibroid size and higher BMI were associated with longer surgeries. Importantly, cesarean myomectomy did not increase maternal morbidity. Conclusion: Cesarean myomectomy appears to be a safe and feasible option for selected patients when performed by skilled surgeons. It may reduce the need for subsequent surgeries without significantly elevating maternal risk. Careful preoperative assessment and meticulous intraoperative management are essential for optimal outcomes.

Keywords:

Cesarean Section , Myomectomy , Uterine Fibroids , obstetric surgery