Caesarean myomectomy is not a risk factor for blood products transfusion among pregnant individuals with fibroids: a retrospective cohort study.

BackgroundUterine fibroids are common benign tumors during reproductive age. Among pregnant individuals with uterine fibroids, myomectomy at the time of cesarean delivery (CD) allows individuals to avoid a second surgery later in life. ObjectiveTo examine the safety of myomectomy performed at the time of CD and the factors that increase the risk of greater blood loss in cesarean myomectomy. Study designThis was a retrospective cohort study of all cesarean myomectomies (CM) performed at a tertiary care center in Toronto, Ontario between January 1, 2012, and June 1, 2019. The study group included individuals who had CM, and the control group included individuals with fibroids who had a CD without removing their fibroids. The primary outcome was the rate of blood products transfusion. Secondary outcomes were the need for hysterectomy and estimated blood loss (EBL). Subgroup analyses were performed for fibroid size, previous CD, and elective vs urgent CD. Logistic regression analysis was performed to assess for confounders. ResultsOverall, 110 CM were compared with 152 CD. The overall transfusion rate for CM was 7.3% compared to 0.7% in the control group (p = 0.005). All procedures requiring transfusion from both groups were performed < 370/7 weeks of gestation. In logistic regression analysis, performing a myomectomy was not associated with a higher risk for transfusion. The only factors associated with transfusion were preterm birth (aOR 14.43, p=0.049) and low pre-operative hemoglobin (aOR 0.90, p=0.02). The median reported EBL was 800 mL for CM and 700 mL for controls (p<0.001). No individuals in either group required concomitant hysterectomy. Subgroup analysis showed that fibroid size [&ge;]5cm and previous CD were not associated with increased risk of transfusion among those who had a CM, while urgent CM was significantly associated with the need for transfusion (p=0.02). ConclusionThis study demonstrates that the transfusion rate was not significantly higher in those undergoing CM at term, compared to those with fibroids undergoing CD without a myomectomy.