Agarwal Mukta, Singh Smita, Sinha Shivangni, Sinha Upasna
Obstetrics and Gynaecology, All India Institute of Medical Sciences Patna, Patna, IND.
Radiology, All India Institute of Medical Sciences Patna, Patna, IND.
Cureus. 2023 May 29;15(5):e39642. doi: 10.7759/cureus.39642. eCollection 2023 May.
We regularly face pregnancy with fibroid since pregnancy at advanced ages has been more prevalent and the prevalence of lower segment caesarean section (LSCS) has also increased over the previous three decades. Myomectomy with cesarean section has historically been avoided because of the danger of haemorrhage, but obstetricians now place more emphasis on it. Since fibroids can range widely in terms of location, size, and patient features, the intervention should be individualized. Under this article, we, therefore, provide a case series of seven pregnant women with uterine myomas who had delivery via LSCS.
Seven pregnant patients who had uterine fibroid and undergone cesarean section were enrolled in this observational study done over the period of one year with consent and after taking ethical approval. Results: The mean age was 27.7 years. Three of the cases were primigravida, while the remainder were multigravida. One patient had red degeneration and was hospitalized with abdominal discomfort at 29 weeks gestation. Four patients had a solitary fibroid, while the three had numerous. The biggest myoma size was 8×7 cm, while the smallest was 5×5 cm. Due to the presence of the fibroid in the lower segment of the uterus, three patients had a caesarean myomectomy, while in rest four cases it was not done. During cesarean myomectomy, two of them had uterine artery ligation to limit the moderate intraoperative haemorrhage.
If the patient is wisely chosen and the surgeon has the experience, a caesarean myomectomy can be performed safely and successfully during LSCS, especially if located in the lower uterine segment (LUS).
随着高龄妊娠越来越普遍，且在过去三十年中下段剖宫产（LSCS）的发生率也有所增加，我们经常面临合并子宫肌瘤的妊娠情况。由于出血风险，以往一直避免剖宫产时行肌瘤切除术，但现在产科医生对此更为重视。由于子宫肌瘤在位置、大小和患者特征方面差异很大，干预措施应个体化。因此，在本文中，我们提供了一组七例合并子宫肌瘤的孕妇经下段剖宫产分娩的病例系列。
七例患有子宫肌瘤并接受剖宫产的孕妇参与了这项为期一年的观察性研究，研究经患者同意并获得伦理批准后进行。
平均年龄为27.7岁。其中三例为初产妇，其余为经产妇。一名患者发生红色变性，在妊娠29周时因腹部不适住院。四例患者有单个肌瘤，三例有多个肌瘤。最大肌瘤大小为8×7 cm，最小为5×5 cm。由于子宫肌瘤位于子宫下段，三例患者在剖宫产时行肌瘤切除术，其余四例未行。在剖宫产肌瘤切除术中，其中两例进行了子宫动脉结扎以控制术中中度出血。
如果患者选择得当且外科医生有经验，剖宫产时行肌瘤切除术可以在经下段剖宫产期间安全、成功地进行，尤其是肌瘤位于子宫下段时。
