What the Surgeons need to Know:Important considerations in caesarean myomectomy
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Authors
Maria C.
Dhanuson D.
Claudia R.
Jurell F.P.
Charlotte D.
Guldzhan, V.
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Issue Date
2026
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Conference Proceedings
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Objectives The management of fibroids encountered during caesarean section remains controversial due to risks of haemorrhage and hysterectomy. Caesarean myomectomy is rarely performed. We aimed to evaluate the safety and outcomes of myomectomy at caesarean in selected patients with large fibroids, and whether this may reduce future surgical intervention. Methods We report a case series of four patients undergoing caesarean myomectomy at Whittington Hospital, London (2023-2025). All had large symptomatic fibroids detected on antenatal imaging and were reviewed by a tertiary fetal medicine multidisciplinary team. Procedures were planned preoperatively with haemostatic strategies including intramyometrial vasopressin, uterine tourniquet, tranexamic acid, cell salvage, ultrasonic bipolar device(THUNDERBEAT), and VerisetTM haemostatic patch. Results Indications included degenerated symptomatic fibroids and difficulty with uterine closure. Mean age was 38 years(33-40), parity 0-1;three had prior caesareans. Mean BMI was 27.8 kg/m2 . Common antenatal symptoms were pain, pelvic pressure, and urinary/bowel dysfunction. Delivery occurred at 37+5-38+2 weeks;mean birthweight 3.53 kg, Apgar >9. Fibroids measured 7-13 cm wide, 5-20 cm high, mean 11 x 10.4 cm, weight 176-1905 g(mean 859 g). Estimated blood loss averaged 1.5 L;no allogeneic transfusion was needed, one received 200 mL autologous blood. Mean operative time was 87 minutes. All followed ERAS pathway with mean stay 1.7 days. No intra-or postoperative complications occurred. Conclusions Caesarean myomectomy can be safe in selected patients with experienced teams and meticulous planning. Adjunctive haemostatic measures minimise bleeding and avoid hysterectomy, potentially preventing future fibroid surgery and improving longterm outcomes.
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The journal of obstetrics and gynaecology research