# Outcomes of Cesarean Myomectomies Performed at a Tertiary Care Hospital in North India: A Series of 10 Cases

## TL;DR

This study examines the safety and outcomes of cesarean myomectomies in 10 pregnant women at a hospital in North India, finding the procedure to be feasible and safe with favorable maternal and neonatal results.

## Contribution

The study provides real-world clinical outcomes of cesarean myomectomy in a North Indian tertiary care setting.

## Key findings

- Cesarean myomectomy was performed safely with no postpartum hemorrhage and minimal maternal complications.
- Neonatal outcomes were generally favorable, though three infants required NICU admission for minor issues.
- The average operative time was 74 minutes, and only two patients required blood transfusions.

## Abstract

Background

Uterine fibroids are common benign tumors in reproductive-aged women, and their prevalence in pregnancy is increasing. While cesarean myomectomy (CM) has traditionally been discouraged due to concerns about intraoperative hemorrhage and maternal morbidity, emerging evidence suggests it can be safely performed in selected cases. This retrospective case series evaluates the clinical outcomes of CM performed at a tertiary care center in North India over two years.

Methods

A total of 10 pregnant women who underwent CM were included in this study. Data were collected retrospectively from hospital records, including demographic details, indications for CM, fibroid characteristics, intraoperative parameters, and postoperative outcomes. Descriptive statistical analysis was used to summarize the findings.

Results

The mean maternal age was 34.5 years (range: 27-40 years), and the gestational age at delivery varied from 35 weeks and 4 days to 38 weeks and 6 days. The most common indication for cesarean section was fibroid-related concerns, including lower uterine segment (LUS) fibroids, multiple fibroids, and fibroids in patients with prior cesarean deliveries. Fibroid numbers ranged from one to fifteen per patient, with intramural fibroids (FIGO 4) being the most frequent type. The mean intraoperative blood loss was 620 mL (range: 450-800 mL), with no case of postpartum hemorrhage. The mean operative time was 74 minutes, and two patients required blood transfusions. No patients required intensive care, and the average hospital stay was 3.6 days. Neonatal outcomes were favorable, with a mean birth weight of 2.92 kg and reassuring APGAR scores. Three neonates required NICU admission for transient tachypnea, small for gestational age, and meconium aspiration syndrome.

Conclusion

CM, when performed in appropriately selected cases, is a feasible and safe procedure. It eliminates the need for a second surgery, reduces future fibroid-related complications, and does not significantly increase maternal morbidity. These findings support the growing consideration of CM as a viable surgical option in select cases. Further prospective studies are needed to establish standardized protocols for patient selection and surgical technique.