A look at the problem of myomectomy during pregnancy and cesarean section


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Abstract

Uterine myoma is a benign tumor, which in 10-30% of cases grows rapidly during gestation and can cause serious complications in both the mother and the fetus. Myomectomy during pregnancy raises many controversial issues. For a better understanding of this surgical problem, a systematic analysis of the data available in modern Russian and foreign literature has been carried out using the databases: eLibrary, Scopus, PubMed, MEDLINE, ScienceDirect, and Cochrane Library from the moment of their creation to December 2019, which shows that abdominal myomectomy in pregnant women is not a common practice with successful rates in the hands of specialists with extensive surgical experience. In recent years, most authors have been inclined to believe that myomectomy during cesarean section does not increase the risk of perioperative bleeding and pyoseptic complications if necessary surgical technique is used. Conclusion. The problem of myomectomy during pregnancy and cesarean section requires further large-scale randomized trials to assess the risks and benefits of these operations for both the mother and the fetus.

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About the authors

Svetlana N. Buyanova

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: buyanova-sn@mail.ru
MD, professor, head

Evgenia L. Babunashvili

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: babounashvili@mail.ru
candidate of medical sciences, senior researcher

Lidia S. Logutova

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: lidialogutova@mail.ru
MD, professor, leading researcher of the educational and methodical department

Natalya A. Schukina

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: fluimucil@yandex.ru
MD, professor, chief researcher

Natalya V. Yudina

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: tatoscha@inbox.ru
candidate of medical sciences, researcher

Svetlana A. Gukasyan

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: guka.85@mail.ru
сandidate of Medical Sciences, Researcher

Marina G. Kashchuk

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: marina.kaschchuk@yandex.ru
graduate student of the gynecological department

Elena E. Ermolaeva

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: ermolaeva2564@mail.ru
candidate of medical sciences, senior researcher

Ketevan N. Akhvlediani

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: akhketi@mail.ru
сandidate of Medical Sciences, Senior Research Fellow of the Physiological Obstetric Department

Ekaterina V. Magilevskaya

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: katerinamag72@mail.ru
сandidate of Medical Sciences, Senior Research Fellow of the Physiological Obstetric Department

Tatyana V. Stotskaya

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: stotskaya.tatianal@gmail.com
candidate of medical sciences, senior researcher at the obstetric physiological department

References

  1. Odejinmi F., Oliver R., Mallick R. Is ulipristal acetate the new drug of choice for medical management of uterine fibroids? Women’s Health. 2017; 13(3): 98-105. https://dx.doi.org/10.1177/1745505717740218.
  2. Khan F.Z.A., Itua I. Navigating through the maze of caesarean myomectomy: generating evidence. Int. J. Reprod. Contracept. Obstet. Gynecol. 2019; 8(11): 4646-53. https://dx.doi.org/10.18203/2320-1770.ijrcog20194916.
  3. Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е., ред. Акушерство. Национальное руководство. М.: ГЭОТАР-Медиа; 2018; 1088 с. [Savel'eva G.M., Suhih G.T., Serova V.N., Radzinskij V.E., red. Obstetrics. National leadership. M.: GEOTAR-Media; 2018. 1088 р. (in Russian)]. ISBN: 978-5-9704-4551-8.
  4. Кондриков Н.И., Баринова И.В. Патология матки. Руководство для врачей, 2-е изд. М.: Практическая медицина; 2019. 362 с. [Kondrikov N.I., Barinova I.V. Pathology of the uterus. Rukovodstvo dlja vrachej, 2-e izd./ Manual for Doctors, 2nd ed. Moscow: Practical Medicine. 2019. 362 p. (in Russian)]. ISBN: 978-5-98811-495-6.
  5. Краснопольский В.И., Буянова С.Н., Щукина Н.А., Попов А.А. Оперативная гинекология. М.: МЕДпресс-информ; 2018. 320 р. [Krasnopol’skii V.I., Buyanova S.N., Shchukina N.A., Popov A.A. Operative gynecology. Edition revised. Moscow: MEDpress-inform, 2018; 320 р. (in Russian)]. ISBN: 9785-00030-588-1.
  6. Lagana A.S., Vergara D., Favilli A., La Rosa V.L., Tinelli A., Gerli S. et al. Epigenetic and genetic landscape of uterine leiomyomas: a current view over a common gynecological disease. Arch. Gynecol. Obstet. 2017; 296(5): 855-67. https://dx.doi.org/10.1007/s00404-017-4515-5.
  7. Буянова С.Н., Щукина Н.А., Чечнева М.А., Бабунашвили Е.Л., Юдина Н.В., ГукасянС.А. Атипичная миомаматки умолодыхженщин:диагностика, лечение, реабилитация. Российский вестник акушера-гинеколога. 2019; 19(6): 77-83
  8. Щукина Н.А., Буянова С.Н., Кондриков Н.И., Тихомирова А.С., Баринова И.В., Шеина Е.Н. Клинико-морфологические аспекты лейомиомы матки у молодых женщин. Российский вестник акушера-гинеколога. 2016; 16(1): 21-7. [Shchukina N.A., Buyanova S.N., Kondrikov N.I., Tikhomirova A.S., Barinova I.V., Sheina E.N. Clinical and morphological aspects of uterine leiomyoma in young women. Rossiiskii vestnik akushera-ginekologa/Russian Bulletin of the Obstetrician-Gynecologist. 2016; 16(1): 21-7. (in Russian)]. https://dx.doi.org10.17116/rosakush201616121-27.
  9. Sparic R., Kadija S., Stefanovic A., Radjenovic S.S., Ladjevic I.L., Popovic J., Tinelli A. Cesarean myomectomy in modern obstetrics: More light and fewer shadows. J. Obstet. Gynaecol. Res. 2017; 43(5): 798-804. https:// dx.doi.org/10.1111/jog.13294.
  10. De Vivo A, Mancuso A., Giacobbe A., Savasta L.M., De Dominici R., Dugo N. et al. Uterine myomas during pregnancy: a longitudinal sonographic study. Ultrasound Obstet. Gynecol. 2011; 37(3): 361-5. https://dx.doi.org/10.1002/ uog.8826.
  11. Laughlin S.K., Baird D.D., Savitz D.A., Herring A.H., Hartmann K.E. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet. Gynecol. 2009; 113(3): 630-5. https:// dx.doi.org/10.1097/AOG.0b013e3181 97bbaf.
  12. Sparic R. Uterine myomas in pregnancy, childbirth and puerperium. Srp. Arh. Celok. Lek. 2014; 142(1-2): 118-24. https://dxdoi.org/10.2298/SARH1402118S.
  13. Краснопольский В.И., Сергеев П.В,Гастрян Н.Д, Карева Е.Н., Логутова Л.С., Буянова С.Н., Титченко Л.И., Бабунашвили Е.Л., Горбунова Т.Н. Беременность и прогестеронзависимая миома матки. Российский вестник акушера-гинеколога. 2003; 3(3): 55-7. [Krasnopol'skij V.I., Sergeev P.V., Gasparjan N.D., Kareva E.N., Logutova L.S., Bujanova S.N., Titchenko L.I., Babunashvili E.L., Gorbunova T.N. Pregnancy and progesterone-dependent uterine fibroids. Rossijskij vestnik akushera-ginekologa/Russian Bulletin of the Obstetrician-Gynecologist. 2003; 3(3): 55-7. (in Russian)].
  14. КареваЕ.Н., Сереброва С.Ю., КочинаН.А., КоноваловаИ.Н., Олейникова О.М., Тихонов Д.А. Селективные модуляторы рецепторов прогестерона. Экспериментальная и клиническая фармакология. 2018; 81(10): 36-44. [Kareva E.N.,Serebrova S.Ju., Kochina N.A., Konovalova I.N., Olejnikova O.M., Tihonov D.A. Selective Progesterone Receptor Modulators. 'Eksperimental'naja i klinicheskaja farmakologija. 2018. 81 (10):36-44. (in Russian)]. https://doi.org/10.30906/0869-2092-2018-81-10-36-44.
  15. Lee H.J., Norwitz E.R., Shaw J. Contemporary management of fibroids in pregnancy. Rev. Obstet. Gynecol. 2010; 3(1): 20-7.
  16. Sarais V., Cermisoni G.C., Shimberni M., Alteri A., Papaleo E., Somigliana E. et al. Human chorionic gonadotropin as a possible mediator of leiomyoma growth during pregnancy: molecular mechanisms. Int. J. Mol. Sci. 2017; 18(9): 2014. https://dx.doi.org/10.3390/ijms18092014.
  17. Vitale S.G., Padula F, Gulino F.A. Management of uterine fibroids in pregnancy: recent trends. Curr. Opin. Obstet. Gynecol. 2015; 27(6): 432-7. https://dx.doi. org/10.1097/GCO.0000000000000220.
  18. Chill H.H., Karavani G., Rachmani T., Dior U., Tadmor O., Shushan A. Growth pattern of uterine leiomyoma along pregnancy. BMC Women's Health. 2019; 19: 100. https://dx.doi.org/10.1186/s12905-019-0803-5.
  19. Tian J., Hu W Cervical leiomyomas in prengnancy: report of 17 cases. Aust. N. Z. J. Obstet. Gynaecol. 2012; 52(3): 25-61. https://dx.doi.org/10.1111/ j.1479-828X.2012.01414.x.
  20. Valenti G, Milone P., D'Amico S., Caldaci L., Vitagliano A., Sapia F., Fichera M. Use of pre-operative imaging for symptomatic uterine myomas during pregnancy: a case report and a systematic literature review. Arch. Gynecol. Obstet. 2018; 299: 13-33. https://dx.doi.org/10.1007/s00404-018-4948-5.
  21. Буянова С.Н., Юдина Н.В., Гукасян С.А., Ермолаева Е.Е. Показания к миомэктомии во время беременности и ее исходы. Акушерство и гинекология. 2019; 6: 70-7. [Bujanova S.N., Judina N.V., Gukasjan S.A., Ermolaeva E.E. Indications for myomectomy during pregnancy and its outcomes. Akusherstvo i Ginekologija/Obstetrics and Gynecology. 2019; 6: 70-7. (in Russian)]/ https://dx.doi.org/10.18565/ aig.2019.6.70-77.
  22. Ezzedine D., Norwitz E.R. Are women with uterine broids at increased risk for adverse pregnancy outcome? Clin. Obstet. Gynecol. 2016; 59(1): 119-27. https:// dx.doi.org/10.1097/GRF.00000 00000000169.
  23. Буянова С.Н., Гукасян С.А., Юдина Н.В. Миомэктомия во время беременности: показания, особенности хирургической тактики и анестезии, предоперационная подготовка и реабилитация. Клинический случай. Русский медицинский журнал. 2014; 19(22): 1428-30. [Bujanova S.N., Gukasjan S.A., Judina N.V. Myomectomy during pregnancy: indications, features of surgical tactics and anesthesia, preoperative preparation and rehabilitation. Clinical case. Russkij meditsinskij zhurnal/Russian medical journal. 2014; 19(22): 1428-30. (in Russian)]/ ISSN: 2618-8430.
  24. Basso A., Catalano M.R., Loverro G., Nocera S., Di Naro E., Loverro M., Natrella M., Mastrolia S.A. Uterine fibroid torsion during pregnancy: a case of laparotomic myomectomy at 18 weeks’ gestation with systematic review of the literature. Case Rep. Obstet. Gynecol. 2017; 4970802: 11. https://dx.doi. org/10.1155/2017/4970802.
  25. Saccardi C., Visentin S., Noventa M., Cosmi E., Litta P., Gizzo S. Uncertainties about laparoscopic myomectomy during pregnancy: a lack of evidence or an inherited misconception? A critical literature review starting from a peculiar case. Minim. Invasive Ther. Allied Technol. 2015; 24(4): 189-94. https://dx.doi.org/1 0.3109/13645706.2014.987678
  26. Буянова С.Н., Щукина Н.А., Чечнева М.А., Бабунашвили Е.Л. Ультразвуковая диагностика при планировании органосберегающих операций по поводу миомы матки. Российский вестник акушера-гинеколога. 2018; 18(6): 83-7
  27. Sammet S. Magnetic resonance safety. Abdom. Radiol. (NY). 2016; 41(3): 444 51. https://dx.doi.org/10.1007/s00261-016-0680-4
  28. Puac P., Rodriguez A., Vallejo C., Zamora C.A., Castillo M. Safety of contrast material use during pregnancy and lactation. Magn. Reson. Imaging Clin. N. Am. 2017; 25(4): 787-97. https://dx.doi. org/10.1016/ j.mric.2017.06.010.
  29. Jauniaux E., Khan K.S. Caesarean myomectomy: Victor Bonney reports the first case in 1913. BJOG. 2014; 121(2): 193. https://dx.doi.org/10.1111/1471-0528.12548.
  30. Senturk M.B., Polat M., Dogan O., Pulatoglu C., Yardimci O.D., Karakus R., Tayyar A. T. Outcome ofcesarean myomectomy: Is it a safe procedure? Geburtshilfe Frauenheilkd 2017; 77(11): 1200-6. https://dx.doi.org/10.1055/s-0043-120918.
  31. Sparic R., Radunovic N., Tinelli A., Radevic O., Kadija S. Large myomas as a complicating factor necessitating cesarean myomectomy followed by cesarean hysterectomy. Srp. Arh. Celok. Lek. 2017; 146(7-8): 452-5. https:// dx.doi.org/10.2298/SARH170404150S.
  32. Бабунашвили Е.Л., Буянова С.Н., Новикова С.В., Гукасян С.А., Юдина Н.В., Ермолаева Е.Е. Кесарево сечение и миомэктомия гигантского перешеечно-интралигаментарного узла. Российский вестник акушера-гинеколога. 2019; 19(5): 68-71. [Babunashvili E.L., Bujanova S.N., Novikova S.V., Gukasjan S.A., Judina N.V., Ermolaeva E.E. Cesarean section and myomectomy of the giant isthmus-intraligamentary node. Rossijskij vestnik akushera-ginekologa/Russian Bulletin of the Obstetrician-Gynecologist. 2019; 19(5): 68-71. (in Russian)]. https://doi.org/10.17116/ rosakush20191905168.
  33. Malvasi A., Stark M., Tinelli A. Cesarean myomectomy. In: Tinelli A., Andrea, Malvasi A., eds.Antonio chapter in the book Uterine myoma, myomectomy and minimally invasive treatments. Springer; 2015: 237-52. https:// dx.doi.org/10.1007/978-3-319-10305-1_16.
  34. Li H., Du J., Jin L., Shi Z., Liu M. Myomectomy during cesarean section. Acta Obstet. Gynecol. Scand. 2009; 88(2): 183-6. https://dx.doi.org/10.1080/ 00016340802635526.
  35. Ehigiegba E.A., Ande A.B., Ojobo S.I. Myomectomy during cesarean section. Int. J. Gynaecol. Obstet. 2001; 75(1): 21-5. https://dx.doi.org/10.1016/ S0020-7292(01)00452-0.
  36. Desai B.R., Patted S.S., Pujar Y.V., Sherigar B.Y., Das S.R., Ruge J.C. A novel technique of selective uterine devascularization before myomectomy at the time of cesarean section: a pilot study. Fertil. Steril. 2010; 94(1): 362-4. https:// dx.doi.org/10.1016/j.fertnstert.2009.09.027.
  37. Ozcan A., Kopuz A., Turan V., Sahin C., Toz E., Aksoy S., Ozeren M. Cesarean myomectomy for solitary uterine fibroids: is it a safe procedure? Ginekol. Pol. 2016; 87(1): 54-8. https://dx.doi.org/10.17772/gp/57833.
  38. Dawood A.S. Cesarean section and associated surgeries: feasibility and surgical outcomes. Women Health Open. 2017; 3(1): 21-9. https://dx.doi.org/10.17140/ WHOJ-3-118.
  39. Pergialiotis V., Sinanidis I., Louloudis I.E., Vichos T., Perrea D.N., Doumouchtsis S.K. Perioperative complications of cesarean delivery myomectomy: A meta-analysis. Obstet. Gynecol. 2017; 130(6): 1295-303. https://dx.doi.org/10.1097/AOG.0000000000002342.
  40. Song D., Zhang W., Chames M.C., Guo J. Myomectomy during cesarean delivery. Int. J. Gynaecol. Obstet. 2013; 121(3): 208-13. https://dx.doi.org/10.1016/j. ijgo.2013.01.021.
  41. Kanthi J.M., Sumathy S., Sreedhar S., Rajammal B., Usha M.G., Sheejamol V.S. Comparative study of cesarean myomectomy with abdominal myo- mectomy in terms of blood loss in single fibroid. J. Obstet. Gynaecol. India. 2016; 66(4): 287-91. https://dx.doi.org 10.1007/s13224-015-0685-x.
  42. Kwon D.H., Song J.E., Yoon K.R., Lee K.Y. The safety of cesarean myomectomy in woman with large myomas. Obstet. Gynecol. Sci. 2014; 57(5): 367-72. https://dx.doi.org/10.5468/ogs.2014.57.5.367.
  43. Topcu H.O., iskender C.T., Hakan T., Oktay K., Tuba M., Nuri D. Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas. Int. J. Gynaecol. Obstet. 2015; 130(3): 244-6. https:// dx.doi.org/10.1016/j.ijgo.2015.03.035.
  44. Tinelli A., Malvasi A, Mynbaev O.A., Barbera A., Perrone E., Guido M., Kosmas I., Stark M. The surgical outcome of intracapsular cesarean myomectomy: A match control study. J. Matern. Fetal Neonatal Med. 2014; 27: 66-71. https://dx.doi. org/10.3109/14767058.2013.804052.
  45. Tinelli A. Concepts and thoughts about modern uterine intramural and subserosal myomectomy. Int. J. Gynecol. Obstet. Neonatal Care. 2017; 4(1): 11-9. https:// dx.doi.org/10.15379/2408-9761.2017.04.01.03.
  46. Hatirnaz §., Guler O., Ba§aranoglu S., Tokgoz C., Kilig G.S. Endometrial myomectomy: A novel surgical method during cesarean section. J. Matern. Fetal Neonatal Med. 2018; 31(4): 433-8. https://dx.doi.org/10.1080/1476705. 2017.1286320.
  47. Tokgoz C., Hatirnaz S., Oguz Guler O. Pros and cons of myomectomy during cesarean. 2018; ch.5: 65-78. https://dx.doi.org/10.5772/intechopen.75365.
  48. Seshdri S., Khalil M., Osman A., Clough A., Jayaprakasan K., Khalaf Y. The evolving role of saline infusion sonography (SIS) in infertility. Eur. J. Obstet. Gynecol. Reprod. Med. 2015; 185: 66-73. https://dx.doi.org/10.1016/j. ejogrb.2014.11.037.
  49. Akkurt M.O., Yavuz A., Eris Yalcin S.E., Akkurt I., Turan O.T., Yalkin Y., Sezik M. Can we consider cesarean myomectomy as a safe procedure without long-term outcome? J. Matern. Fetal Neonatal Med. 2017; 30(15): 1855-60. https://dx.doi.org/10.1080/14767058.2016.1228057.
  50. Ящук А.Г., Даутова Л.А., Тюрина А.А., Имельбаева А.Г. Оценка результатов одномоментной миомэктомии при кесаревом сечении. Креативная хирургия и онкология. 2018; 8(1): 45-51. [Jaschuk A.G., Dautova L.A., Tjurina A.A., Imel'baeva A.G. Evaluation of the results of simultaneous myomectomy with cesarean section. Kreativnaja hirurgija i onkologija/ Creative surgery and oncology. 2018; 8(1): 45-51 (in Russian)]. https://doi. org/10.24060/2076-3093-2018-8-1-45-51.
  51. Щукина Н.А., Буянова С.Н., Бабунашвили Е.Л., Земскова Н.Ю. Опыт применения противоспаечного барьера при органосохраняющих операциях в гинекологии. Медицинский алфавит. 2017; 4(37): 10-3. [Schukina N.A., Bujanova S.N., Babunashvili E.L., Zemskova N.Ju. The experience of using the anti-adhesion barrier in organ-preserving operations in gynecology. Meditsinskij alfavit/ Medical alphabet. 2017; 4 (37): 10-3 (in Russian)]. ISSN: 2078-5631.
  52. Буянова С.Н., Бабунашвили Е.Л., Гукасян С.А. Гигантская интралигаментарная миома матки и беременность. Российский медицинский журнал. 2015; 1: 53-4. [Bujanova S.N., Babunashvili E.L., Gukasjan S.A. Giant intraligamentary uterine fibroids and pregnancy. Rossijskij meditsinskij zhurnal/ Russian medical journal. 2015; 1: 53-4 (in Russian)].
  53. Буянова С.Н., Краснопольский В.И., Щукина Н.А., Мгелиашвили М.В., Бабунашвили Е.Л., Титченко И.П. Хирургическая коррекция репродуктивной функции при миоме матки. Российский вестник акушера-гинеколога. 2005; 5(2): 74-6. [Bujanova S.N., Krasnopol'skij V.I., Schukina N.A., Mgeliashvili M.V., Babunashvili E.L., Titchenko I.P. Surgical correction of reproductive function in uterine myoma. Rossijskij vestnik akushera-ginekologa/ Russian Bulletin of the Obstetrician-Gynecologist. 2005; 2: 74-6 (in Russian)].

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