Myomectomy during Caesarean Section is Likely Feasible
نویسنده
چکیده
Uterine leiomyoma is the most common uterine neoplasm of women. The latest statistics confirm that uterine leiomyomas are present in 20-50% women of reproductive age [1]. Indeed, they are found in up to 77% of women if the uterus is examined closely at autopsy [2]. The incidence of uterine leiomyomas in pregnancy varies from 1.6% to 10.7% according to the trimester of assessment and the size threshold [3-6], with fibroids being more frequent in women of advancing maternal age, as with other high risk obstetrical factors, there has been an increasing incidence of pregnancies complicated by uterine leiomyomas in recent years. The majority of leiomyomas are asymptomatic and might not need any therapy. However, uterine leiomyomas demonstrate their maximum growth during the reproductive period and have a definite impact on pregnancy and childbirth. Compared with normal unaffected gestations, pregnancies associated with uterine leiomyomas also result in a six fold increase in the rate of caesarean section [7]. However, the diagnosis of uterine leiomyomas during pregnancy is neither simple nor straightforward. Only 42% of large fibroids (>5 cm) and 12.5% of smaller fibroids (3-5 cm) can be found in physical examination [8]. The fibroids diagnosed by ultrasound in pregnancy are even more limited, because it is difficult to differentiate fibroids from physiologic thickening of the myometrium [9-11]. Qidwai et al researched 15,104 women underwent routine second trimester prenatal ultrasonography and 401 (2.7%) women were identified with at least 1 leiomyoma from 1993 to 2003 [12].
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Myomectomy during Caesarean Birth in Fibroid-Endemic, Low-Resource Settings
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This study was conducted at Korle Bu Teaching Hospital and Family Health Hospital, Accra, Ghana, between April 2000 and January 2001 to compare the efficacy and safety of myomectomy done at caesarean section with the application of a tourniquet with caesarean section without myomectomy. Twenty four patients were recruited into the study. Average haemoglobin of patients both pre and post-operati...
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At the University of Benin Teaching Hospital, Benin City, Nigeria, after our first publication titled “Inevitable Caesarean Myomectomy”1, we have since 1996 routinely carried out myomectomy during caesarean section. The result of our first 25 cases was published in 2001.2 We have since then carried out more than 70 procedures of caesarean myomectomy. Our investigations on comparative blood loss...
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Uterine myomas are being observed in pregnancy more frequently now than in the past, because many women are delaying child bearing till their late thirties, which is the time for the greatest risk of the myoma growth. Traditionally, obstetricians are trained to avoid myomectomies during caesarean sections as severe haemorrhages can occur, which may often necessitate hysterectomies. Pedunculated...
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