Is cesarean myomectomy in patients with large multiple myomas always a hazardous procedure? A case report (Running title: Cesarean myomectomy in the treatment of large multiple myomas)

Abstract

Introduction: Although large multiple myomas are a well-known cause of infertility, it is not uncommon to encounter pregnancy with such myomas. Management of women with large multiple myomas is controversial, both during pregnancy and delivery. Such myomas can also cause significant morbidity during the puerperium. Caesarean section is the most common way of delivery. Case report: A patient with large multiple myomas underwent a cesarean myomectomy with intraoperative cell salvage at 36 weeks of gestation. Both fetal and maternal outcomes were favorable. The lower uterine segment was accessible, despite the presence of myomas, and a live fetus weighing 2600 g was delivered without difficulties. Following a hysterotomy suturing, the largest myoma (210 × 180 × 155 mm) was removed and the myoma bed was sutured in two layers. Cell-saver was introduced during myomectomy saving significant amount of blood. Careful inspection confirmed appropriate hemostasis, so it was decided to remove the remaining eight myomas, and this was done without breaching the uterine cavity. Conclusion: There are few literature reports on intraoperative cell salvage as a technique of handling intraoperative hemorrhage during a CM. As documented by our case, the use of intraoperative cell salvage represents a significant advantage in such cases when combined with extensive surgical experience in conventional myomectomy.

Keywords

• myoma
• pregnancy
• delivery complications
• cell-saver