Risk factors for intraoperative hemorrhage during cesarean myomectomy
Objective: We intended to identify the risk factors of intraoperative hemorrhage on occasions of a combined operation of myomectomy with cesarean section for patients with uterine leiomyoma. Materials and methods: A retrospective cohort study was done of all patients who underwent cesarean myomectom...
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doaj-9cbf12b0bc6a4306aa46a7b8638580b32021-01-24T04:26:36ZengElsevierTaiwanese Journal of Obstetrics & Gynecology1028-45592021-01-016014144Risk factors for intraoperative hemorrhage during cesarean myomectomyJi Young Kwon0Ji Hea Byun1Inhye Shin2Subeen Hong3Rayon Kim4In Yang Park5Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of KoreaDepartment of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of KoreaDepartment of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of KoreaDepartment of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of KoreaDepartment of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of KoreaCorresponding author. Department of Obstetrics and Gynecology, Maternal Fetal Medicine, The Catholic University of Korea, 222 Banpodaero, Sechogu, Seoul St. Mary's Hospital, 06591, Seoul, Republic of Korea.; Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of KoreaObjective: We intended to identify the risk factors of intraoperative hemorrhage on occasions of a combined operation of myomectomy with cesarean section for patients with uterine leiomyoma. Materials and methods: A retrospective cohort study was done of all patients who underwent cesarean myomectomy for intramural leiomyoma at a single university hospital. Cases identified with subserosal leiomyoma, placental disorder, and comorbid conditions related to coagulopathy were excluded. All the included cases were classified into intraoperative hemorrhage and non-hemorrhage group. Obstetric and demographic factors and parameters of leiomyoma were compared between two groups. Results: A total of 302 women underwent cesarean myomectomy during the study period. Among these women, 212 pregnant women met the inclusion criteria. Intraoperative hemorrhage occurred in 43 women (20.3%). There was no significant intergroup difference in the number of removed leiomyomas. Multiple logistic regression analysis demonstrated that lower segmental location (odds ratio [OR], 2.827; 95% confidence interval [CI], 1.033–7.734, P = 0.043) and the diameter (OR, 1.167; 95% CI, 1.044–1.305, P = 0.006) were significant independent risk factors for hemorrhage during cesarean myomectomy. The combination of ≥ 8 cm diameter or lower segmental position of the leiomyoma yielded a specificity of 79.3% for operative hemorrhage during cesarean myomectomy. The negative predictive value of this combination was 88.7% for operative hemorrhage with a prevalence of 20%. Conclusion: The large size and lower segmental position of the leiomyoma are significantly risk factors for intraoperative hemorrhage during cesarean myomectomy. If the leiomyoma is located in the uterine fundus or body and its diameter is less than 8 cm, the removal of leiomyoma may be considered at the time of cesarean section.http://www.sciencedirect.com/science/article/pii/S1028455920302837Cesarean myomectomyOperative hemorrhageLeiomyoma |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ji Young Kwon Ji Hea Byun Inhye Shin Subeen Hong Rayon Kim In Yang Park |
spellingShingle |
Ji Young Kwon Ji Hea Byun Inhye Shin Subeen Hong Rayon Kim In Yang Park Risk factors for intraoperative hemorrhage during cesarean myomectomy Taiwanese Journal of Obstetrics & Gynecology Cesarean myomectomy Operative hemorrhage Leiomyoma |
author_facet |
Ji Young Kwon Ji Hea Byun Inhye Shin Subeen Hong Rayon Kim In Yang Park |
author_sort |
Ji Young Kwon |
title |
Risk factors for intraoperative hemorrhage during cesarean myomectomy |
title_short |
Risk factors for intraoperative hemorrhage during cesarean myomectomy |
title_full |
Risk factors for intraoperative hemorrhage during cesarean myomectomy |
title_fullStr |
Risk factors for intraoperative hemorrhage during cesarean myomectomy |
title_full_unstemmed |
Risk factors for intraoperative hemorrhage during cesarean myomectomy |
title_sort |
risk factors for intraoperative hemorrhage during cesarean myomectomy |
publisher |
Elsevier |
series |
Taiwanese Journal of Obstetrics & Gynecology |
issn |
1028-4559 |
publishDate |
2021-01-01 |
description |
Objective: We intended to identify the risk factors of intraoperative hemorrhage on occasions of a combined operation of myomectomy with cesarean section for patients with uterine leiomyoma. Materials and methods: A retrospective cohort study was done of all patients who underwent cesarean myomectomy for intramural leiomyoma at a single university hospital. Cases identified with subserosal leiomyoma, placental disorder, and comorbid conditions related to coagulopathy were excluded. All the included cases were classified into intraoperative hemorrhage and non-hemorrhage group. Obstetric and demographic factors and parameters of leiomyoma were compared between two groups. Results: A total of 302 women underwent cesarean myomectomy during the study period. Among these women, 212 pregnant women met the inclusion criteria. Intraoperative hemorrhage occurred in 43 women (20.3%). There was no significant intergroup difference in the number of removed leiomyomas. Multiple logistic regression analysis demonstrated that lower segmental location (odds ratio [OR], 2.827; 95% confidence interval [CI], 1.033–7.734, P = 0.043) and the diameter (OR, 1.167; 95% CI, 1.044–1.305, P = 0.006) were significant independent risk factors for hemorrhage during cesarean myomectomy. The combination of ≥ 8 cm diameter or lower segmental position of the leiomyoma yielded a specificity of 79.3% for operative hemorrhage during cesarean myomectomy. The negative predictive value of this combination was 88.7% for operative hemorrhage with a prevalence of 20%. Conclusion: The large size and lower segmental position of the leiomyoma are significantly risk factors for intraoperative hemorrhage during cesarean myomectomy. If the leiomyoma is located in the uterine fundus or body and its diameter is less than 8 cm, the removal of leiomyoma may be considered at the time of cesarean section. |
topic |
Cesarean myomectomy Operative hemorrhage Leiomyoma |
url |
http://www.sciencedirect.com/science/article/pii/S1028455920302837 |
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