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Pathan, et al.: Caesarean myomectomy in multiple maternal and fetal comorbidities16 MOGS Chronicles | Volume 1 | Issue 1 | September 2024myomectomy was performed to remove the anterior wall subserosal pedunculated fibroid [Figure 1] measuring 7 %u00d7 6 cm. Vasopressin, diluted to 1:200, was injected into the fibroid until blanching occurred while monitoring the patient%u2019s pulse rate. The fibroid was then dissected from the myometrium, and the defect was sutured in two layers [Figures 2 and 3]. Haemostasis was achieved using several measures, including bilateral uterine artery ligation, oxytocin infusion, intra-myometrial carboprost, tranexamic acid injection, and compression of the raw area with a hot mop.The estimated blood loss during surgery was 1.2 L, and the patient received one unit of packed red cells intraoperatively. Her postoperative haemoglobin level was 11.3 g/dL. The patient tolerated the procedure and anaesthesia well. Post-delivery, the baby was diagnosed with a tracheoesophageal fistula, which was the likely cause of the gross polyhydramnios and required surgery on the 5th day of life.DiscussionSustained estrogen release during pregnancy and breastfeeding is a significant risk factor for the formation of uterine fibroids. These benign tumors affect 20-40% of women during their reproductive years, leading to various complications, including menorrhagia, anaemia, and abdominal pain. If myomectomy could be successfully performed during cesarean deliveries, it would significantly reduce the need for separate surgeries, thereby decreasing patient morbidity and healthcare costs.This approach is particularly advantageous in resourceconstrained settings.[2]Additionally, addressing fibroids during cesarean sections can mitigate the risks of complications associated with untreated fibroids, such as torsion or %u201cred%u201d degeneration during subsequent pregnancies. Removing fibroids located in the lower uterine segment not only simplifies surgical procedures but also increases the likelihood of vaginal delivery in future pregnancies. Studies indicate that scar integrity following cesarean myomectomy is superior to that after interval myomectomy, highlighting its safety.[3]ConclusionElective myomectomy after caesarean birth should be approached with caution, and may possibly be limited to individuals with pedunculated fibroids or situations in which the lower segment incision (for retrieving the baby) cannot be closed without removal of the fibroid(s). In order for caesarean myomectomy to be performed on a regular basis, blood banks must be sufficiently staffed and equipped, and their methods must match international standards. Caesarean myomectomy is a safe and effective procedure in a tertiary care centre at the hands of an experienced surgeon.DeclarationConflict of interestNone.DisclosureNone.Figure 2: Sutured uterusFigure 1: Intraoperative findings of anterior wall subserosal pedunculated fibroidFigure 3: Resected myoma