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Re: caesarean myomectomy From: Robert J. Carpenter, Jr. MD (zygote@icsi.net) Sun Oct 17 09:37:42 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: JSBowpat@aol.com: "OB response times" Previous message: Kenneth A. Thomas, M.D.: "Re: caesarean myomectomy" In reply to: Kenneth A. Thomas, M.D.: "Re: caesarean myomectomy" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: caesarean myomectomy" I echo Dr. Thomas' reply below. Many times any though one has made reasonable incision, the incision will not close and myomectomy is required. Depending on location, if bleeding is significant, one can quickly open a portal in each broad ligament and use penrose drain to acutely create a tourniquet until bleedidng is completed. Same method with better skeletalization can be done when there is a placenta accreta etc. I have done an elective myomectomy when their is a pedunculated myoma. Dilute pitresin can be injected at its base to decrease blood flow. There are clearly times when this is indicated. It sames a potential 2nd operation even if that is laparoscopy which as a MFM I do not do. RJC On 16 Oct 2004 at 20:01, Kenneth A. Thomas, M.D. wrote: > I also had one like this a number of years ago in a patient who needed > a C/S for reasons unrelated to the fibroid. The fibroid was right in > the middle of the anterior lower segment. I made the incision > immediately inferior to the fibroid and got the baby out without any > problems. But it was impossible to suture the lower segment to the > upper segment with the fibroid in the way. I used the scalpel to > split the upper segment into anterior and posterior halves just enough > to expose the fibroid which was then easily shelled out. Several > running mattress sutures closed the defect, and the uterus was then > closed routinely. There was no excessive blood loss and no postop > complications. I would never do an elective cesarean myomectomy, but > if you are forced into it because a fibroid is in your way, then this > method should hopefully prove useful. > > KT > *********************************** > At Fri, 15 Oct 2004, DoctorJoe@aol.com wrote: > > > >In a message dated 10/15/04 16:03:52, hsheld@anv.net writes: > > > >> Had a case similar to this some years ago in a primigravida. Left > >> the myoma alone at C/S. The patient began to abort it about a week > >> after delivery, presenting this huge necrotic mass the size of a > >> fetus' head at the introitus. Ended up doing a hysterectomy. I > >> would leave it alone and monitor for this kind of complication. > >> > >Had a patient with a very lower uterine segment fibroid that > >aggravated the pregnancy for 37 weeks (was on terbutaline, Mg++, > >etc.). Ultrasound showed from early pregnancy blood trickling down > >from the fibroid. Finally she had a primary elective C/S. > > > >About a month postpartum, she had a crampy slimy bloody D/C and the > >fibroid magically all but disappeared. Obviously, it infarcted and > >mostly resorbed. > > > >The next pregnancy went much smoother, although she had PTL and was > >treated (by another doc) with a Ca++ channel blocker (which she > >incidentally said made her feel TERRIBLE, contrary to how she felt on > >the t-pump). > > > >Joe P. > > -- > Kenneth A. Thomas, M.D. FACOG > Stratford, CT > -- Robert J. Carpenter, Jr. MD 6624 Fannin, #2720 St. Luke's Medical Tower Houston,TX 77030-2339 713-795-4600 Next message: JSBowpat@aol.com: "OB response times" Previous message: Kenneth A. Thomas, M.D.: "Re: caesarean myomectomy" In reply to: Kenneth A. Thomas, M.D.: "Re: caesarean myomectomy" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: caesarean myomectomy"

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