Abstract
Background: Sezaryen operasyonu sırasında myomektomi yapılan olgularda myom boyutlarının intraoperatif ve postoperatif klinik sonuçlar üzerine etkisinin araştırılması amaçlandı.
Methods: Sezaryen myomektomi yapılan 34 olgunun sonuçları retrospektif olarak incelendi. Hastaların demografik, klinik ve patolojik verileri olgular myom boyutuna göre 5 cm altı ve 5 cm ve üstü olarak iki grup olarak incelendi. Anne yaşı, gravida, parite, abortus, doğumdaki gebelik haftası, bebek doğum kilosu, operasyon süresi, myom özellikleri, operasyon öncesi ve sonrası hemoglobin değerleri, transfüzyon ihtiyacı, patoloji sonuçları karşılaştırıldı.
Results: Çalışmamızda myom boyutları 5 cm altı 17 gebe hastaya ve 5 cm ve üstü olarak 17 gebe hastaya sezaryen esnasında myomektomi operasyonu aynı anda uygulandı. En sık korpus yerleşimli (%79.4), patolojik olarak en sık normal leiomyoma nodülü (%82.4) en az ise sellüler leiomyoma (%2.99) izlendi. En sık myoma çeşidi ise %64.7 oranında subserozal yerleşimli olarak görüldü. iki grup arasında yaş, gebelik haftası, doğumda bebek kilosu, operasyon öncesi ve sonrası kanama, transfüzyon ihtiyacı, myom yerleşimi, myom çeşidi ve patolojik inceleme açısından istatistiksel olarak farklılık saptanmadı. Tüm klinik veriler incelendiğinde ise 5 cm altı ve 5 cm ve üstü iki grup operasyon süresi açısından değerlendirildiğinde iki grup arasında istatistiksel olarak anlamlı farklılık izlendi (45.47±9.94 vs 52.88±11.09) (p:0.048).
Conclusion: Tecrübeli kliniklerde, sezaryen sırasında myom boyutundan bağımsız olarak myomektomi yapılması seçilmiş hastalarda güvenli ve etkin bir yöntem olarak kabul edilebilir. Operasyon süresinin myom boyutu arttıkça uzayabileceği unutulmamalıdır. Uygun yerleşimli myomlarda sezaryen sırasında myomektomi yapılması maternal morbidite ve mortaliye artırmamaktadır.
Ethical Statement
Osmaniye Korkut Ata Üniversitesi Sağlık Bilimleri Araştırma Etik Kurulu, Prof. Dr. Alpaslan DAYANGAÇ başkanlığında 18/04/2025 tarihinde saat 10.00’da toplanarak aşağıdaki kararı almıştır. karar tarih: 18/04/2025, karar no: 4/19
Supporting Institution
Osmaniye Devlet Hastanesi
Thanks
Osmaniye Devlet hastanesi tüm sağlık çalışanlarına.
References
- 1. Kashani BN, Centini G, Morelli SS, Weiss G, Petraglia F. Role of Medical Management for Uterine Leiomyomas. Best Pract Res Clin Obstet Gynaecol. 2016;34:85-103.
- 2. Li Z, Maeda D, Kudo-Asabe Y, Tamura D, Nanjo H, Hayashi A, et al. MED12 is frequently mutated in ovarian and other adnexal leiomyomas. Hum Pathol. 2018;81:89-95.
- 3. Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers. 2016;2:16043.
- 4. Ciavattini A, Clemente N, Delli Carpini G, Di Giuseppe J, Giannubilo SR, Tranquilli AL. Number and size of uterine fibroids and obstetric outcomes. J Matern Neonatal Med. 2015; 28(4):484–8.
- 5. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.
- 6. Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol 2000;95:764–9.
- 7. Neiger R, Sonek JD, Croom CS, Ventolini G. Pregnancyrelated changes in the size of uterine leiomyomas. J Reprod Med 2006;51:671–4.
- 8. Vitale S G, Padula F, Gulino F A. Management of uterine fibroids in pregnancy: recent trends. Curr Opin Obstet Gynecol 2015;27:432–7.
- 9. Kwawukume EY. Caesarean myomectomy. Afr J Reprod Health 2002;6(3):38–43.
- 10. Samy A, Raslan AN, Talaat B, El Lithy A, El Sharkawy M, Sharaf MF, et al. Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis. Fertil Steril. 2020;113(1):224-33.e6.
- 11. Thaler I, Manor D, Itskovitz J, Rottem S, Levit N, Timor-Tritsch I, et al. Changes in uterine blood flow during human pregnancy. Am J Obstet Gynecol. 1990;162(1):121-5.
- 12. Roman AS, Tabsh KM. Myomectomy at time of cesarean delivery: a retrospective cohort study. BMC Pregnancy Childbirth 2004;4(1):14.
- 13. Song D, Zhang W, Chames MC, Guo J. Myomectomy during cesarean delivery. Int J Gynaecol Obstet 2013;121:208–13.
- 14. Hatırnaz Ş, Güler O, Başaranoğlu S, Tokgöz C, Kılıç GS. Endometrial myomectomy: a novel surgical method during cesarean section. J Matern Fetal Neonatal Med 2018;31:433–8.
- 15. Akbas M, Mihmanli V, Bulut B, Temel I, Karahisar G, Demirayak G. Myomectomy for intramural fibroids during caesarean section: A therapeutic dilemma. J Obstet Gynaecol. 2017;37(2):141-5.
- 16. Akkurt MO, Yavuz A, Eris Yalcin S, Akkurt I, Turan OT, Yalcin Y, et al. Can we consider cesarean myomectomy as a safe procedure without long-term outcome? J Matern Fetal Neonatal Med 2016;9:1–6.
- 17. İncebiyik A, Hilali NG, Camuzcuoglu A, Vural M, Camuzcuoglu H. Myomectomy during cesarean: a retrospective evaluation of 16 cases. Arch Gynecol Obstet 2014;289: 569–73.
- 18. Goyal M, Dawood AS, Elbohoty SB, Abbas AM, Singh P, Melana N, et al. Cesarean myomectomy in the last ten years; A true shift from contraindication to indication: A syste-matic review and metaanalysis. Eur J Obstet Gynecol Reprod Biol. 2021;256:145-57.
- 19. Zhao R, Wang X, Zou L, Zhang W. Outcomes of myomectomy at the time of cesarean section among pregnant women with uterine fibroids: A retrospective cohort study. Biomed Res Int. 2019;2019:7576934.
- 20. Kwon DH, Song JE, Yoon KR, Lee KY. The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Sci. 2014;57(5):367-72.
- 21. Pergialiotis V, Sinanidis I, Louloudis IE, Vichos T, Perrea DN, Doumouchtsis SK. Perioperative Complications of Cesarean Delivery Myomectomy: A Meta-analysis. Obstet Gynecol. 2017;130(6):1295- 303.
- 22. Sakinci M, Turan G, Sanhal CY, Yıldız Y, Hamidova A, Guner FC, et. al. Analysis of myomectomy during cesarean section: A terti-ary center experience. J Invest Surg. 2022;35(1):23-9.
- 23. Kaymak O, Ustunyurt E, Okyay RE, Kalyoncu S, Mollamahmutoglu L. Myomectomy during cesa-rean section. Int J Gynaecol Obstet. 2005;89(2):90-3.
- 24. Özcan A, Kopuz A, Turan V, Sahin C, Töz E, Aksoy S et al. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?. Ginekol Pol. 2016;87(1):54-8.
- 25. Guler AE, Guler ZD, Kinci MF, Mungan MT. Myomectomy during cesarean section: Why do we abstain from?. J Obstet Gynaecol India. 2020;70(2):133-7.
- 26. Bayram F, Aslan MM. The Effect of Myoma Size on Cesarean Myomectomy Results. OTJHS. 2022;7(3):371-5.
- 27. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3-9.
- 28. Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol. 2000;183(6):1448-55.
- 29. Miller C, Laparoscopic myomectomy. In: O’Donovan P, Miller C (eds). Modern management of abnormal uterine bleeding. Boca Raton, Fla.: CRC Press; 2008: 232–9
Abstract
Background: The purpose of this study was to examine the impact of myoma size on intraoperative and postoperative clinical results among caesarean section patients who underwent myomectomy.
Methods: The results of 34 cases who had caesarean myomectomy were analysed retrospectively. Patients' demographic, clinical, and pathological data was analysed in two categories based on the size of their myomas: those less than 5 cm, those 5 cm and greater than 5 cm. The study analysed many factors including maternal age, gravida, parity, history of abortions, gestational age at delivery, birth weight of the infant, duration of the operation, features of the myoma, pre- and post-operative haemoglobin levels, requirement for blood transfusion, and pathology results.
Results: Our study involved performing myomectomy operation concurrently with caesarean delivery in 17 pregnant patients with myomas measuring less than 5 cm and in 17 pregnant patients with myomas measuring greater than 5 cm. The most prevalent kind was corpus localised (79.4%), the most pathologically normal leiomyoma nodule (82.4%), and the most uncommon one was cellular leiomyoma (2.99%). Subserosal myoma was the most common kind, accounting for 64.7% of cases. There were no statistical differences seen between the two groups in terms of age, gestational age, infant weight at delivery, pre- and post-operative haemorrhage, requirement for blood transfusion, myoma location, myoma type, and pathological examination. Upon analysing all clinical data, a statistically significant difference was detected between the two groups when evaluating the operation duration of individuals with myomas measuring under 5 cm and those with myomas measuring 5 cm or greater (45.47±9.94 vs 52.88±11.09) (p:0.048).
Conclusion: In proficient medical facilities, the practice of conducting myomectomy during caesarean delivery, irrespective of the size of the myoma, may be regarded as a secure and efficient method in selected patients. It is important to acknowledge that the duration of the operation may be extended as the size of the myoma grows.
Ethical Statement
18/04.2025 tarih ve 4/19 nolu karar ile etik kurul onamı alınmıştır.
Supporting Institution
Osmaniye Devlet Hastanesi
Thanks
Osmaniye Devlet hastanesi sağlık çalışanlarına destek ve katkıları için teşekkür ediyoruz.
References
- 1. Kashani BN, Centini G, Morelli SS, Weiss G, Petraglia F. Role of Medical Management for Uterine Leiomyomas. Best Pract Res Clin Obstet Gynaecol. 2016;34:85-103.
- 2. Li Z, Maeda D, Kudo-Asabe Y, Tamura D, Nanjo H, Hayashi A, et al. MED12 is frequently mutated in ovarian and other adnexal leiomyomas. Hum Pathol. 2018;81:89-95.
- 3. Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers. 2016;2:16043.
- 4. Ciavattini A, Clemente N, Delli Carpini G, Di Giuseppe J, Giannubilo SR, Tranquilli AL. Number and size of uterine fibroids and obstetric outcomes. J Matern Neonatal Med. 2015; 28(4):484–8.
- 5. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.
- 6. Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol 2000;95:764–9.
- 7. Neiger R, Sonek JD, Croom CS, Ventolini G. Pregnancyrelated changes in the size of uterine leiomyomas. J Reprod Med 2006;51:671–4.
- 8. Vitale S G, Padula F, Gulino F A. Management of uterine fibroids in pregnancy: recent trends. Curr Opin Obstet Gynecol 2015;27:432–7.
- 9. Kwawukume EY. Caesarean myomectomy. Afr J Reprod Health 2002;6(3):38–43.
- 10. Samy A, Raslan AN, Talaat B, El Lithy A, El Sharkawy M, Sharaf MF, et al. Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis. Fertil Steril. 2020;113(1):224-33.e6.
- 11. Thaler I, Manor D, Itskovitz J, Rottem S, Levit N, Timor-Tritsch I, et al. Changes in uterine blood flow during human pregnancy. Am J Obstet Gynecol. 1990;162(1):121-5.
- 12. Roman AS, Tabsh KM. Myomectomy at time of cesarean delivery: a retrospective cohort study. BMC Pregnancy Childbirth 2004;4(1):14.
- 13. Song D, Zhang W, Chames MC, Guo J. Myomectomy during cesarean delivery. Int J Gynaecol Obstet 2013;121:208–13.
- 14. Hatırnaz Ş, Güler O, Başaranoğlu S, Tokgöz C, Kılıç GS. Endometrial myomectomy: a novel surgical method during cesarean section. J Matern Fetal Neonatal Med 2018;31:433–8.
- 15. Akbas M, Mihmanli V, Bulut B, Temel I, Karahisar G, Demirayak G. Myomectomy for intramural fibroids during caesarean section: A therapeutic dilemma. J Obstet Gynaecol. 2017;37(2):141-5.
- 16. Akkurt MO, Yavuz A, Eris Yalcin S, Akkurt I, Turan OT, Yalcin Y, et al. Can we consider cesarean myomectomy as a safe procedure without long-term outcome? J Matern Fetal Neonatal Med 2016;9:1–6.
- 17. İncebiyik A, Hilali NG, Camuzcuoglu A, Vural M, Camuzcuoglu H. Myomectomy during cesarean: a retrospective evaluation of 16 cases. Arch Gynecol Obstet 2014;289: 569–73.
- 18. Goyal M, Dawood AS, Elbohoty SB, Abbas AM, Singh P, Melana N, et al. Cesarean myomectomy in the last ten years; A true shift from contraindication to indication: A syste-matic review and metaanalysis. Eur J Obstet Gynecol Reprod Biol. 2021;256:145-57.
- 19. Zhao R, Wang X, Zou L, Zhang W. Outcomes of myomectomy at the time of cesarean section among pregnant women with uterine fibroids: A retrospective cohort study. Biomed Res Int. 2019;2019:7576934.
- 20. Kwon DH, Song JE, Yoon KR, Lee KY. The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Sci. 2014;57(5):367-72.
- 21. Pergialiotis V, Sinanidis I, Louloudis IE, Vichos T, Perrea DN, Doumouchtsis SK. Perioperative Complications of Cesarean Delivery Myomectomy: A Meta-analysis. Obstet Gynecol. 2017;130(6):1295- 303.
- 22. Sakinci M, Turan G, Sanhal CY, Yıldız Y, Hamidova A, Guner FC, et. al. Analysis of myomectomy during cesarean section: A terti-ary center experience. J Invest Surg. 2022;35(1):23-9.
- 23. Kaymak O, Ustunyurt E, Okyay RE, Kalyoncu S, Mollamahmutoglu L. Myomectomy during cesa-rean section. Int J Gynaecol Obstet. 2005;89(2):90-3.
- 24. Özcan A, Kopuz A, Turan V, Sahin C, Töz E, Aksoy S et al. Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?. Ginekol Pol. 2016;87(1):54-8.
- 25. Guler AE, Guler ZD, Kinci MF, Mungan MT. Myomectomy during cesarean section: Why do we abstain from?. J Obstet Gynaecol India. 2020;70(2):133-7.
- 26. Bayram F, Aslan MM. The Effect of Myoma Size on Cesarean Myomectomy Results. OTJHS. 2022;7(3):371-5.
- 27. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3-9.
- 28. Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol. 2000;183(6):1448-55.
- 29. Miller C, Laparoscopic myomectomy. In: O’Donovan P, Miller C (eds). Modern management of abnormal uterine bleeding. Boca Raton, Fla.: CRC Press; 2008: 232–9
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Original Research |
| Authors | |
| Publication Date | June 15, 2025 |
| Submission Date | April 23, 2025 |
| Acceptance Date | May 18, 2025 |
| Published in Issue | Year 2025 Volume: 15 Issue: 2 |
