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African Journal of Reproductive Health
Women's Health and Action Research Centre
ISSN: 1118-4841
Vol. 7, Num. 1, 2003, pp. 125
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African Journal of Reproductive Health, Vol. 7, No. 1, April, 2003 pp.
125
Caesarean Myomectomy: New Frontier
in Surgical Practice
Ehigiegba AE, Ande
AB* and Ojobo SI*
Code Number: rh03016
The study conducted
by E Yao Kwawukume on myomectomy during caesarean section at Korle Bu
Teaching Hospital and Family Health Hospital, Accra, Ghana, and published in
Volume 6, Number 3 of the African Journal of Reproductive Health made
very interesting read.
At the University of Benin Teaching
Hospital, Benin City, Nigeria, after our first publication titled Inevitable
Caesarean Myomectomy1, we have since 1996 routinely carried out
myomectomy during caesarean section. The result of our first 25 cases was published
in 2001.2 We have since then carried out more than 70 procedures
of caesarean myomectomy. Our investigations on comparative blood loss, duration
of surgery and morbidity at caesarean section, caesarean myomectomy and myomectomy
will soon be published.
Our findings and conclusions regarding
blood loss during this once dreaded procedure are similar to those of Kwawukume.
We are particularly interested in the fact that contrary to the previous widely
held belief, no patient in his and our series suffered sufficient blood loss
to require a hysterectomy. There was also no case fatality. However, his surgical
technique for minimising blood loss differs significantly from ours. The use
of tourniquet may be more cumbersome and more likely to be as effective as
the use of high dose oxytocin. We also think it may be more traumatic to a
recently pregnant uterus. In our series, we relied solely on high dose oxytocin
infusion to bring about a bloodless operation field for the myomectomy that
followed the delivery of the baby. It is also important to stress that the
infusion of 30 units of oxytocin in 500ml of 5% dextrose in water over four
hours was continued for 1224 hours. Ben-Rafael et al in Tel Aviv, Israel,
recently also reported similar results as ours using high dose oxytocin infusion
in their series of 32 patients.3
We hasten to say that the only
constant procedure in this world is change. We are excited that another researcher
from Africa has re-emphasised the positive findings in his series of myomectomy
at caesarean section. It certainly takes more than being a surgeon to undertake
a caesarean myomectomy. Uterine fibroids are commoner among black women and
encountering them at caesarean section is inevitable in our practice. We certainly
need more reports on the present day serious adverse complications (if any!)
of myomectomy at caesarean section.
REFERENCES
- Ehigiegba AE and Evbuomwan
C.E. Inevitable caesarean myomectomy. Trop J Obstet Gynaecol 1998;
15(1): 62.
- Ehigiegba AE, Ande AB and
Ojobo S.I. Myomectomy during caesarean section. Int J Gynecol Obstet 2001;
75: 2125.
- Ben-Rafael Z, Perri T,
Krissi H, Dicker D and Dekel A. Myomectomy during caesarean section time
to reconsider? Abstracts of the 3rd World Congress on Controversies in Obstetrics,
Gynecology & Infertility, Washington DC, June 22, 2002.
Copyright 2003 - Women's Health and Action Research Centre
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