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Paper Title: Inevitable Caesarean Myomectomy: Report of Two Cases

Authors: Okeji N.A.E, Eli S, Abam D.S, Nnaka M.P

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Caesarean myomectomy is contraindicated during caesarean section unless there are inevitable indications such as severe haemorrhage,
inability to access the lower uterine segment or any other justifiable reason. This procedure may be associated with maternal mortality if not
properly handled.

These case reports highlight such occasions when it may be necessary to perform myomectomy during caesarean section.

Mrs. NN and Mrs. MN, both 32year old booked multigravidae at 39 weeks gestation had caesarean myomectomy with good fetomaternal
outcomes. They registered for ante-natal care at gestational ages of 26 and 28 weeks respectively. Obstetric sonogram done at 37
weeks of gestation revealed live fetuses with abnormal lie and presentation. Estimated fetal weights were 3.2 and 3.5 kilograms,
anteriofundal placentae and uterine leiomyoma masses at the lower uterine segments measuring 14 by 12 centimetres and 18 by 14
centimetres. They inevitably had caesarean myomectomy with good feto-maternal outcomes. Estimated blood losses were 600 and 700
milliliters respectively. The post-operative periods were uneventful. They were discharged home on the 7th post-operative day and seen in post-natal clinic in stable clinical state.

Caesarean myomectomy is not commonly carried out, except for inevitable reasons such as leiomyoma occupying the lower uterine segment as
seen in these patients.

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