Successful Bloodless Caesarean Myomectomy in Patient with Potentially Massive Bleeding: A case report
Mirah Avisha1*, Trika Irianta1, Umar Malinta1

1Department of Obstetrics and Gynaecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
*mirahavisha2020[at]gmail.com

Abstract

Background: Fibroids are remarkably common, its benign, monoclonal tumours of the smooth muscle cells of the myometrium. Fibroids are often associated with pregnancy because the prevalence is higher in reproductive age. In contrast, Caesarean Myomectomy is still considered high-risk surgery and controversial.
Clinical Case: Our patient had a uterine torsion (around 90 degrees) due to huge multiple fibroids with preterm pregnancy with superimposed preeclampsia. Myomectomy began with double-circle stitch technique to block tumours vascularization after delivery the baby.
Result: Multiple Uterine Myoma with the largest measuring 23x20x18 cm and weighting 2800 gram was removed. Estimated blood loss were 350 cc and duration of operation was 90 minutes which slightly longer than a normal caesarean section. No blood transfusion was given.
Conclusion: The risk-benefit ratio of caesarean myomectomy should be re-evaluated. Its considerable as safe and reasonable option with appropriate technique and experienced hand.

Keywords: Double Circle Stitch, Hemorrhage, Caesarean Myomectomy, Uterine Torsion

Topic: Maternal, neonatal, and child health