Mumtaz P1, Reshma Sajan2, Abdul Vahab3, Hassan Sheik Imrana2
ABSTRACT: The traditional teaching was not to touch a fibroid during pregnancy, in fear of possibility of intractable intra operative bleeding and post-operative morbidity. In the recent years with advent in obstetric analgesia and availability of blood banks, many have been attempting myomectomy along with caesarean section [CS]. The advantages being avoiding laparotomy at the later date, for a myomectomy or hysterectomy and also preventing the complications like abortions, preterm deliveries that can occur in the future pregnancy of the patient. In the developing countries where the cost of surgery is being paid by the individuals, it is of much significance, if we can perform 2 surgeries in one sitting, sparing the cost and hospitalization time of a second surgery. A 2 years retrospective study from June 1st 2011 to May 31st 2013 was conducted on the effects of myomectomy during caesarean section and compared the morbidity with normal caesarean section deliveries. The routine protocol of Myomectomy, like a written informed consent, availability of blood products and antibiotic prophylaxis is recommended. All principles of Myomectomy were followed. In places where it is possible, myoma was removed through the caesarean incision itself. In subjects requiring additional incision, it was placed according to the site of fibroids. In cornual fibroids a vertical incision was preferred to avoid trauma to fallopian tube. In most of the other cases transverse incision was used. Obliteration of dead space in the bed of fibroid was done with sutures in multiple layers. It was found that myomectomy during caesarean section did not cause significant morbidity to the patient. There was no need for hysterectomy in this series of 26 cases. Thus has the advantage of avoiding a second laparotomy and anesthesia later for myomectomy / hysterectomy. Each surgery adds to the risk of adhesions adding to the importance of removing the fibroid along with caesarean.
