Περίληψη:
OBJECTIVE: To assess the association of myomectomy during cesarean
delivery with intraoperative and peri-operative maternal morbidity.
DATA SOURCES: We searched MEDLINE (1966-2017), Scopus (2004-2017),
ClinicalTrials.gov (2008-2017), EM-BASE (1980-2017), and Cochrane
Central Register of Controlled Trials CENTRAL (1999-2017) databases.
METHODS OF STUDY SELECTION: We selected all observational studies that
reported outcomes on patients undergoing myomectomy at the time of
cesarean delivery. Statistical meta-analysis was performed with RevMan
5.3.
RESULTS: Nineteen studies were included in our systematic review with a
total number of 3,900 women. Among them, 2,301 women had myomectomy
during cesarean delivery and 1,599 had cesarean delivery only. Women
undergoing concomitant myomectomy had a mild decline in hemoglobin
compared with those who had cesarean delivery only (mean difference 0.25
mg/dL, 95% CI 0.06-0.45). Myomectomy at the time of cesarean delivery
is associated with longer surgical time compared with cesarean delivery
alone (mean difference 13.87 minutes, 95% CI 4.78-22.95). Blood
transfusion (odds ratio [OR] 1.41, 95% CI 0.96-2.07) and
postoperative fever (OR 1.12, 95% CI 0.80-1.56) rates did not differ
between the two groups (myomectomy compared with no myomectomy). A
statistically, but not clinically, significant increase in postoperative
hospitalization was evident in the myomectomy group (mean difference
0.35 days, 95% CI 0.25-0.46).
CONCLUSION: This systematic review and meta-analysis of observational
studies demonstrated an association with increased operative time and
hemoglobin drop in patients who underwent cesarean myomectomy compared
with cesarean delivery alone. No increased rate of major hemorrhage or
need for transfusion was identified. Cesarean myomectomy may be
considered in cases of isolated myomas, although randomized trials are
needed.
Συγγραφείς:
Pergialiotis, Vasilios
Sinanidis, Ilias
Louloudis,
Ioannis-Evangelos
Vichos, Theodoros
Perrea, Despina N. and
Doumouchtsis, Stergios K.
