English abstract
abstract: Objectives: Caesarean myomectomy has traditionally been discouraged due to fears of intractable
haemorrhage and increased postoperative morbidity. However, a number of authors have recently shown that
myomectomy during Caesarean section does not increase the risk of haemorrhage or postoperative morbidity.
Methods: We present a series of 8 cases from Sultan Qaboos University Hospital, Oman, where myomectomy was
performed during Caesarean section for large lower segment fibroids. Seven were anterior lower segment fibroids,
while one was a posterior lower uterine fibroid which interfered with closure of the uterine incision. The antenatal
course, perioperative management, and postoperative morbidity are discussed. Results: The average age of the
women was 28.7 years and mean gestational age at delivery was 36.75 weeks. Regarding intra-operative blood loss,
1 patient lost 900 ml, 5 patients lost 1–1.5 litres, 2 lost 1.5–2 L, and 1 patient with a 10 x 12 cm fibroid lost 3.2 L.
Despite the majority being large myomas (7 of the 8 patients had myomas >5 cm in size) and 50% being intramural,
no hysterectomy was required. Stepwise devascularisation was necessary in one case and preoperative placement
of uterine balloon catheters was necessary in another. The size of the fibroids was confirmed by histopathology.
Myomectomy added 15 minutes to the operating time and 1 day to the hospital stay, but there was no significant
postoperative morbidity. Neonatal outcome was good in all patients. Conclusion: In selected patients, myomectomy
during Caesarean section is a safe and effective procedure at tertiary centres with experienced surgeons.
