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A Gynaecology Case Study On Performing Myomectomy During Cesarean

Patient Profile

A 32-year-old lady who has conceived after a prolonged infertility treatment came to Zoi Hospitals for safe confinement as soon as she missed her period. For all the 9 months of her pregnancy, she underwent regular antenatal check-ups with us. At the beginning of her pregnancy, she was 95 kgs and after the full term, she was 103 Kgs and developed Hypertension (Pre-Eclampsia). Since she crossed her due date, she was induced for labour which failed and hence, she was taken up for C-section.

The Challenge

While we were performing the C-section, we noticed that the lower segment from where the baby is delivered was occupied by a fibroid, roughly about 6cm X 6cm in size.

The Treatment

For delivery, we had to remove the fibroid. This procedure was discussed with the couple during the surgery as it was undiagnosed in the antenatal scans. We explained to them that missing fibroids in antenatal scan is common as the uterus expands and gets bigger in size during pregnancy.
We also made them aware that it is a risky procedure which involves additional blood but also a necessary procedure as this can be combined with the C-section and help the mother escape from a second surgery just to remove the fibroid.

After understanding the condition, a decision to do Myomectomy was taken in the interest of the patient so that she could escape from a second surgery. We successfully performed a Cesarean Myomectomy without a lot of blood loss. The mother delivered a healthy baby. Post surgery, there was a 1.5GM drop in the hemoglobin which suggests that there was a moderate amount of blood loss.

Myomectomy during cesarean was practically absent in the literature until the last decade. It is always advised to postpone and perform before the second delivery in order to prevent unnecessary blood loss and hysterectomy during a cesarean. However, in the modern era of Obstetrics, in the hands of an expert, myomectomy during a cesarean is actually an opportunity to combine both surgeries.

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