Myomectomy at the Time of Cesarean Section: A Prospective Multicentre Study

Objectives: To assess the safety and efficacy of myomectomy during cesarean section. Methods : The study design was a prospective multicentre study done in three tertiary care hospitals in Dhaka city. The subject were 30 pregnant women underwent elective or emergency myomectomy during cesarean section. All cesarean section myomectomy were performed by consultant. Intra-operative and post-operative complications such as change in haematocrit, length of operation, blood loss were estimated. Length of hospital stay was also recorded. Results : 50 Fibroid of various sizes (2-6cm) were removed from 30 women. Fibroid were on the anterior uterine wall with most being subserous and intramural. Four patients had one unit of whole blood transfusion in post-operative period. No hysterectomy was done at the time of cesarean section. There was no significant frequency of blood transfusion; incidence of post- operative fever and duration of operation. The mean duration of post operative hospital study was 7.3±1.2 days. Two patients subsequently became pregnant, were also underwent repeated cesarean section in the study period. Conclusion : In selected cases myomectomy during cesarean section does not appear to result in an increased risk of intrapartum or short-term postpartum morbidity if performed by an experienced practitioner. Cesarean myomectomy is a safe surgical options with no significant complications. Keywords : Cesarean section; myomectomy; uterine myoma. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8639 BSMMU J 2011; 4(2):102-10

Myomectomy at the Time of Cesarean Section: A Prospective Multicentre Study

Objectives: To assess the safety and efficacy of myomectomy during cesarean section. Methods : The study design was a prospective multicentre study done in three tertiary care hospitals in Dhaka city. The subject were 30 pregnant women underwent elective or emergency myomectomy during cesarean section. All cesarean section myomectomy were performed by consultant. Intra-operative and post-operative complications such as change in haematocrit, length of operation, blood loss were estimated. Length of hospital stay was also recorded. Results : 50 Fibroid of various sizes (2-6cm) were removed from 30 women. Fibroid were on the anterior uterine wall with most being subserous and intramural. Four patients had one unit of whole blood transfusion in post-operative period. No hysterectomy was done at the time of cesarean section. There was no significant frequency of blood transfusion; incidence of post- operative fever and duration of operation. The mean duration of post operative hospital study was 7.3±1.2 days. Two patients subsequently became pregnant, were also underwent repeated cesarean section in the study period. Conclusion : In selected cases myomectomy during cesarean section does not appear to result in an increased risk of intrapartum or short-term postpartum morbidity if performed by an experienced practitioner. Cesarean myomectomy is a safe surgical options with no significant complications. Keywords : Cesarean section; myomectomy; uterine myoma. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8639 BSMMU J 2011; 4(2):102-10

Effect of dexamethasone on newborn survival at different administration-to-birth intervals: A secondary analysis of the WHO ACTION (Antenatal CorticosTeroids for Improving Outcomes in Preterm Newborn)-I trial

Background: The WHO ACTION-I trial demonstrated that dexamethasone significantly reduced neonatal mortality when administered to women at risk of early preterm birth in low-resource countries. We conducted a secondary analysis to determine how these benefits can be optimised, by evaluating the effect of dexamethasone compared to placebo on newborn mortality and severe respiratory distress outcomes at different administration-to-birth intervals, and identifying the interval with the greatest benefits. Methods: The WHO ACTION-I trial was a multi-country, individually-randomised, parallel-group, double-blind, placebo-controlled trial. It was conducted in 29 hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan. Women with a viable singleton or multiple pregnancy who presented to participating hospitals at a gestational age of 26 weeks 0 days–33 weeks 6 days and who were at risk of imminent preterm birth were eligible. In this secondary analysis, 2638 women and their newborns treated with single course of dexamethasone or placebo were analysed. Multivariate logistic regression was used to assess the effect of dexamethasone versus placebo on neonatal death, stillbirth or neonatal death, and severe respiratory distress at 24 h and at 168 h, by administration-to-birth interval (from 0 through 28 days), adjusting for gestational age at first dose. We used relative risks to identify the administration-to-birth interval with the greatest benefits of dexamethasone compared to placebo on the newborn outcomes. Findings: Between 24 December 2017 and 21 November 2019, 2852 women and their 3070 babies were enrolled in the WHO ACTION-I trial; 1332 women (1464 babies) in the dexamethasone group and 1306 women (1440 babies) in the placebo group were included in this secondary analysis. Neonatal mortality risk was lower with increasing time between initiating dexamethasone and birth, achieving peak mortality reduction by days 13 and 14 and then diminishing as the interval approached 28 days, regardless of gestational age at administration. For other outcomes, the overall pattern of risk reduction extending into the second week was consistent with that of neonatal death. Interpretation: In women at risk of preterm birth prior to 34 weeks’ gestation, the neonatal benefits of antenatal dexamethasone appear to increase with longer administration-to-birth intervals than previously thought. This knowledge can support clinical assessment and estimation of the risks of adverse preterm newborn outcomes at the time of birth, and the potential benefits of antenatal dexamethasone treatment for a known administration-to-birth interval. Funding: Bill and Melinda Gates Foundation; World Health Organization.Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; ArgentinaFil: Vogel, Joshua P.. Organizacion Mundial de la Salud; ArgentinaFil: Piaggio, Gilda. Organizacion Mundial de la Salud; ArgentinaFil: Nguyen, My Huong. Organizacion Mundial de la Salud; ArgentinaFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Organizacion Mundial de la Salud; ArgentinaFil: Bahl, Rajiv. Organizacion Mundial de la Salud; ArgentinaFil: Rao, Suman P. N.. Organizacion Mundial de la Salud; ArgentinaFil: De Costa, Ayesha. Organizacion Mundial de la Salud; ArgentinaFil: Gupta, Shuchita. Organizacion Mundial de la Salud; ArgentinaFil: Baqui, Abdullah H.. Organizacion Mundial de la Salud; ArgentinaFil: Shahidullah, Mohammod. Organizacion Mundial de la Salud; ArgentinaFil: Chowdhury, Saleha Begum. Organizacion Mundial de la Salud; ArgentinaFil: Goudar, Shivaprasad S.. Organizacion Mundial de la Salud; ArgentinaFil: Dhaded, Sangappa M.. Organizacion Mundial de la Salud; ArgentinaFil: Qureshi, Zahida P.. Organizacion Mundial de la Salud; ArgentinaFil: Were, Fredrick. Organizacion Mundial de la Salud; ArgentinaFil: Kinuthia, John. Organizacion Mundial de la Salud; ArgentinaFil: Ayede, Adejumoke I.. Organizacion Mundial de la Salud; ArgentinaFil: Adesina, Olubukola A.. Organizacion Mundial de la Salud; ArgentinaFil: Kuti, Oluwafemi. Organizacion Mundial de la Salud; ArgentinaFil: Adejuyigbe, Ebunoluwa A.. Organizacion Mundial de la Salud; ArgentinaFil: Ariff, Shabina. Organizacion Mundial de la Salud; ArgentinaFil: Soofi, Sajid B.. Organizacion Mundial de la Salud; ArgentinaFil: Sheikh, Lumaan. Organizacion Mundial de la Salud; ArgentinaFil: Carvalho, Jose. Organizacion Mundial de la Salud; ArgentinaFil: Nilsson, Vania A.. Organizacion Mundial de la Salud; ArgentinaFil: Abreu, Luciana. Organizacion Mundial de la Salud; Argentin