Successful Cesarean Myomectomies of Large Uterine Fibroids: Two Cases and a Literature Review.

BACKGROUND No standard guidelines have been specified for a cesarean myomectomy, and several centers remain divided on the justification to perform this procedure, especially for large fibroids. Only a few case reports have been published of cesarean myomectomy for large fibroids. Here, we report 2 cases of successful cesarean myomectomies for large fibroids (>15 cm) during the 38th week of pregnancy. CASE REPORT We encountered 2 primigravida patients, aged 34 and 36 years, respectively, with large fibroids >15 cm in diameter. Using the Pfannenstiel incision, we performed cesarean myomectomies in both patients at term pregnancy. The surgeries were performed by a gynecologic oncologist in a tertiary hospital. Both patients experienced a postoperative decrease in hemoglobin but neither required a blood transfusion. Three days after the operation, the patients were discharged from the hospital in good condition. One year later, the patients and their babies continued to be in good health. The patients did not experience chronic pelvic pain or menstrual abnormalities. Neither patient is currently planning another pregnancy. CONCLUSIONS Based on our report, it may be assumed that cesarean myomectomy for a large fibroid (even for fibroids >15 cm in diameter) is safe if performed by experts in a tertiary hospital. Further larger studies of cesarean myomectomy of large fibroids are required to confirm the safety of this procedure.