Blood loss during caesarean myomectomy: a retrospective analysis of 36 cases carried out at a cottage hospital in the Niger delta region of Nigeria

Abstract

Background Myomectomy during Caesarean delivery is thought to be associated with increased risk of haemorrhage but some studies have demonstrated that myomectomy during Caesarean section is a safe procedure.
Method Anaesthetic records of all parturients who had Caesarean myomectomy between September, 2011 and August, 2012 were analysed for the following parameters: packed cell volume (PCV) change, length of operation, intra-operative blood loss, need for blood transfusion and post-partum hospital stay. The data collected were subjected to descriptive analysis of average, mean, percentages, and compared to previous studies
Result Thirty six patients had caesarean myomectomy during the study period. Twenty three of the patients were undergoing emergency surgery while 13 had elective caesarean section and myomectomy. The mean age of the subjects in the study was 28.83years, and the average duration of surgery was 59.66 minutes.The number of fibroids removed ranged between 1 and 23 with an average of 4.13. The average change in packed cell volume was 7.03% and average estimated blood loss was 690.27ml ml. Four of the 36 patients who had Caesarean myomectomy were transfused with a total of 11 units of blood and Cross-match: Transfusion ratio was 6.54. The average length of stay after surgery was 4.16 days. Twenty five patients had postoperative anaemia (PCV less than 30%) and 1 of the patients had wound dehiscence. No mortality was recorded and none of the patients had hysterectomy as a result of uncontrolled haemorrhage.
Conclusion: Caesarean myomectomy does not significantly increase the risk of intra-operative blood loss if appropriate measures are taken to maintain the tonicity of the uterus during the procedure. Selected cases of Caesarean myomectomy could therefore reduce the incidence of repeat laparotomy, and its attendant complications especially in a resource – poor economy like ours.

Key words: Blood loss, Caesarean myomectomy