Intraoperative hemorrhage as a complication of cesarean myomectomy: Analysis of risk factors
Background/Aim. Cesarean myomectomy is a controversial issue. It was considered relatively contraindicated for many years due to increased risk of intraoperative hemorrhage. Recent studies showed that cesarean myomectomy in some women may not be associated with increased morbidity. The aim...
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| Main Author: | |
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| Format: | Article |
| Language: | English |
| Published: |
Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2016-01-01
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| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2016/0042-84501600029S.pdf |
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| Summary: | Background/Aim. Cesarean myomectomy is a controversial issue. It was
considered relatively contraindicated for many years due to increased risk of
intraoperative hemorrhage. Recent studies showed that cesarean myomectomy in
some women may not be associated with increased morbidity. The aim of the
study was to determine the causes and risk factors for intraoperative
hemorrhage in patients subjected to cesarean myomectomy. Methods. This
retrospective study included women subjected to cesarean myomectomy, divided
into the study group of 36 patients in whom intraoperative hemorrhage was
registered, and the control group of 66 patients in whom it was absent. The
following parameters were analyzed: age, parity, gestational age of delivery,
indications, type and duration of cesarean section, surgeon's experience,
type, localization, size and number of myomas, number of incisions on uterus
and neonatal birth weight. Results. There was a significant difference
between the groups in terms of the type and size of myomas (p = 0.007 and p =
0.000, respectively) and duration of the surgery (p = 0.000). The size of the
defect resulting from myoma enucleation and speed of suturing it have
significant influence on the occurrence of intraoperative hemorrhage. In our
study, operation on the patients of the study group lasted 14.53 minutes
longer and their myomas were 39 mm bigger compared to the controls, with no
difference in surgical experience of the obstetricians (p = 0.111).
Conclusion. Cesarean myomectomy is associated with an increased risk of
hemorrhage. Therefore, it would be advisable to discuss the hemorrhage and
transfusion risks with patients with large multiple and intramural myomas
before making decision to perform cesarean myomectomy. Those who perform
cesarean myomectomy should be prepared to manage intraoperative hemorrhage
during surgery in cases they encounter it. |
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| ISSN: | 0042-8450 2406-0720 |