Maternal morbidity with planned cesarean after myomectomy

  • Gimovsky AC & al.
  • J Matern Fetal Neonatal Med
  • 29 Oct 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Increased maternal risks with planned cesarean delivery (CD) after previous myomectomy.

Why this matters

  • Uterine fibroids are benign tumors affecting women of reproductive age and are associated with pain, abnormal bleeding, increased risk of miscarriage, preterm labor, and postpartum hemorrhage.
  • Surgical removal may result in recommendations for planned CD because of concerns about uterine rupture during labor.

Key results

  • The rate of intraoperative blood transfusion was higher in the myomectomy group (aOR, 2.8; 95% CI, 1.15-6.79).
  • The rate of postpartum blood transfusion was higher in the myomectomy group (aOR, 2.03; 95% CI, 1.06-3.92).
  • Women with myomectomy were more likely to experience bowel injury, have a cesarean hysterectomy, and require a classical uterine incision.
  • No significant differences in rates of uterine atony, uterine rupture, wound complications, or endometritis.
  • No differences in neonatal outcomes.

Study design

  • Retrospective cohort study using data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Cesarean Registry database.
  • Women undergoing planned CD with (n=367) and without (n=33,635) a history of myomectomy compared.
  • Primary outcome was the incidence of blood transfusion.
  • Funding: None.

Limitations

  • No operative details of myomectomy including size of fibroids or type of closure.

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