THE ISSUE OF CAESAREAN
MYOMECTOMY AND CAESAREAN
SECTION IN PREGNANCY COEXISTING WITH FIBROIDS
Caesarean section in a woman with fibroids should be done
by an obstetrician because of the challenges that can arise,
which requires expertise to handle. They usually bleed more
than women without fibroids during caesarean section. Blood
should be grouped and cross-matched for them. Fibroids
blocking access to the baby can be removed before delivering
the baby.
Other fibroids should be left in-situ to avoid excessive blood
loss. Occasionally, it may be necessary to do a De lee vertical
incision in the womb instead of a transverse lower uterine
segment incision, if fibroids are present in the lateral aspects
of the lower segment to avoid cutting into them. Cutting into
fibroids provokes a lot of bleeding.
Sometimes a classical incision on the uterus (vertical incision
in the body of the uterus) may be the only option for safe
delivery if fibroids occupy most of the lower aspect of the
uterus. Sometimes, the baby is sitting as it were on top of a
huge fibroid. Removing such a fibroid will still not guarantee
a vaginal birth in the next pregnancy.
Caesarean section is still recommended. Women who had a
classical uterine incision should be delivered by caesarean
section in the next pregnancy by thirty-four (34) weeks of
gestation to avoid uterine rupture. Generally, if the fibroid is
not blocking access to the baby during a caesarean section, it
should be left alone to avoid death from excessive bleeding.
Such bleeding is usually difficult to stop.
