Prevention of complications cesarean section with conservative myomectomy in women with uterine leiomyoma

Aim - to evaluate the effectiveness of the improved technique of cesarean section (CS) with conservative myomectomy (CME) using modern medical and instrumental means іn pregnant women with uterine leiomyoma (LM) type 3-6 by FIGO (International Federation of Gynecology and Obstetrics). Materials and methods. A fragment of a prospective study with a comprehensive examination and selection of optimal delivery tactics for pregnant women with LM at the clinical bases of the Ob/Gyn. Department No. 1 of Shupyk National Healthcare University of Ukraine for the period 2020-2023. The main group (MG, 1) of the study consisted of 37 pregnant women with LM >5 cm type 3-6 according to FIGO, who underwent CS with CME according to an improved technique with the use of modern drugs: tranexamic acid, carbetocin and technical support (argon-plasma coagulation, radio-wave scalpel). The comparison group (CG, 2) included 28 pregnant women with LM >5 cm type 3-6 according to FIGO with CS and CME performed according to the standard method. The control group (KG, 3) was made up of 17 pregnant women without LM, who underwent a planned CS. The reliability of the results was assessed using the Student's t-test. The difference of the obtained indicators was considered to be significant at p<0.05. Results. The improved technique of CS with CME made it possible to reliably reduce the volume of blood loss in MG women compared to CG women (р1,2<0.01) and was statistically insignificant with KG (р1,3>0.05). A decrease in the frequency of complications during surgery and in the postpartum period in the main group was noted: a 2-fold decrease in purulent-inflammatory complications and a faster pace of uterine involution in the first 3 days of the postpartum period (р1,2<0.05). Conclusions. Pregnant women with LM have an increased risk of bleeding, purulent-inflammatory complications, and the frequency of hysterectomies. The improved technique of performing CS with CME makes it possible to reduce the frequency of complications during surgery and postpartum period, preserve the organ in women of reproductive age and helps to avoid repeated surgery in the future for LM. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.