Myomectomy during cesarean delivery

BackgroundThe optimal management of leiomyomas during cesarean delivery is unclear.ObjectivesTo assess the safety of myomectomy performed during cesarean delivery.Search strategyPubMed, MEDLINE, EMBASE, and Cochrane Library were searched to identify potentially relevant studies published prior to June 30, 2012.Selection criteriaCase-control study comparing myomectomy with no myomectomy in patients undergoing cesarean delivery.Data collection and analysisThe quality of the studies was assessed and data were extracted independently by 2 authors.Main resultsNine studies, including 1 082 women with leiomyomas, met the inclusion criteria; 443 (41.0%) women underwent cesarean myomectomy and 639 (59.1%) underwent cesarean delivery alone. The drop in hemoglobin after surgery was 0.30 g/dL greater in the cesarean myomectomy group than in the control group, but the difference was not significant. The operative time was 4.94 minutes longer in the cesarean myomectomy group, but again the difference was not significant. The overall incidence of fever was comparable in the 2 groups. No hysterectomies were performed in any of the included studies.ConclusionsCesarean myomectomy may be a reasonable option for some women with leiomyoma. However, no definite conclusion can be drawn because the data included in the meta-analysis were of low quality.