Myomectomy during a C-section – Is it really a sensible option?

When a pregnant woman has uterine fibroids, these benign tumors can cause various symptoms such as pelvic pain, excessive bleeding, or complications during pregnancy. In certain situations, a C-section may be necessary to ensure a safe delivery. But the question arises: is it really sensible to perform a myomectomy during a C-section? Is this procedure, which involves removing fibroids, advisable or does it carry too many risks?

What is a myomectomy?

A myomectomy is a surgical procedure aimed at removing one or more fibroids from the uterus. This procedure is often recommended when fibroids cause troublesome symptoms or when they are considered an obstacle to fertility. During a C-section, some obstetricians may consider performing a myomectomy if a fibroid is detected, especially if it is seen as responsible for obstetric complications.

Why consider a myomectomy during a C-section?

In theory, a myomectomy during a C-section may be considered for various reasons, including preventing future complications. For instance, if a fibroid interferes with labor or compromises the health of the uterus, it may be removed during the C-section. However, this decision should be made with great caution, as it introduces additional risks for the mother and the outcome of the pregnancy.

The uterus after a C-section: a more fragile environment

The uterus after a C-section is in a particular condition. The incision made to access the baby weakens the organ, and its healing process is different from that of an intact uterus. After a C-section, the uterus is already under significant surgical stress and requires time to recover. Any additional procedure, like a myomectomy, can complicate this healing process.

Performing a myomectomy in this context poses greater risks for the mother’s health. Adding such a procedure during the C-section further weakens the uterus, increasing the chances of complications like hemorrhage or infection. Healing is also delayed, and the uterus may take longer to recover. Moreover, this intervention can make the uterus more vulnerable in future pregnancies, raising the risk of uterine rupture.

Why postpone certain interventions?

Many specialists, including those from the American College of Obstetricians and Gynecologists (ACOG), recommend delaying necessary interventions on the uterus, like myomectomy, until after childbirth. This approach minimizes risks for the mother and ensures better recovery. After a C-section, the uterus is already in a fragile state, and any additional surgery can compromise its healing. In some cases, operations on the uterus are even planned for a later time, several months after delivery, to allow the organ to recover fully.

When can a C-section be indicated because of fibroids?

While myomectomy should never be the primary reason for performing a C-section, certain fibroids can make a C-section necessary. For example, if a fibroid is located in a part of the uterus that obstructs the baby’s passage or if a fibroid is particularly large and threatens to cause complications during labor (such as excessive bleeding or distortion of the uterine cavity), a C-section may be recommended to ensure the safety of both mother and baby.

However, the decision to perform a C-section for these reasons must be made on a case-by-case basis, depending on the location, size, and effects of the fibroid. Fibroids can sometimes complicate deliveries, but this does not justify a C-section as a routine procedure. The approach should be individualized, taking into account the mother’s health and the associated risks of each option.

Exception: never plan a C-section solely for myomectomy

It is important to emphasize that a C-section should never be planned solely for the purpose of performing a myomectomy. A C-section is already a major surgical procedure with inherent risks. The decision to perform a C-section should be based on clear medical indications related to the safety of both the mother and the baby. Adding a myomectomy to this procedure should only be considered if the fibroid presents a direct risk to the pregnancy or delivery.

Exceptions to the rule

In very specific cases, such as when fibroids obstruct the baby’s exit or pose an immediate danger to the mother’s health, a myomectomy may be considered during a C-section. However, these situations are rare, and the decision should be made after careful evaluation of the risks and benefits. In most cases, it is better to avoid performing this procedure during a C-section.

Conclusion: Is it really sensible?

In conclusion, while myomectomy can be performed during a C-section in exceptional cases, it is generally not a recommended option due to the significant risks for the mother and the increased fragility of the uterus after surgery. The healing process of the uterus after a C-section requires time and caution. Adding an additional procedure, like myomectomy, can compromise this healing and increase the risks of serious complications. Therefore, it is essential to carefully consider the necessity of such an intervention during a C-section. As a rule, it is better to delay this procedure until after childbirth, when the uterus has had time to recover more fully, and the risks are more manageable.

Kind regards,

Dr. Sandra Yene Amougui