Surreal illustration of a flower blooming during C-section myomectomy, symbolizing surgical precision and fertility.

C-Section Myomectomy: Is Removing Fibroids During Delivery Safe?

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Jordan Keane in Health & Wellness November 2025 • 5 min read.

"Navigating the Controversies and Considerations of Myomectomy During Cesarean Sections."


Uterine leiomyomas, commonly known as fibroids, are the most frequently occurring benign tumors in women of reproductive age. Recent statistics confirm their presence in 20-50% of women in this demographic. In fact, if a uterus is examined closely during autopsy, fibroids can be detected in up to 77% of women. The incidence of uterine leiomyomas during pregnancy varies from 1.6% to 10.7%, depending on the trimester of assessment and the size threshold used for detection.

Fibroids are increasingly encountered in pregnancies due to factors such as advancing maternal age and other high-risk obstetrical conditions. While most leiomyomas are asymptomatic and require no treatment, they often exhibit maximum growth during the reproductive period, significantly impacting pregnancy and childbirth. Pregnancies complicated by uterine leiomyomas have a six-fold higher rate of cesarean sections compared to unaffected pregnancies. However, diagnosing uterine leiomyomas during pregnancy is not always straightforward. Physical examinations can detect only 42% of large fibroids (>5 cm) and 12.5% of smaller fibroids (3-5 cm).

Ultrasound diagnoses are further limited by the difficulty in distinguishing fibroids from the physiological thickening of the myometrium. Research indicates that the prevalence of uterine fibroids during pregnancy is likely underestimated. As such, the definitive diagnosis of uterine fibroids often occurs during cesarean sections. Managing leiomyomas discovered before or incidentally during cesarean delivery presents a complex therapeutic dilemma for obstetricians, requiring careful consideration to ensure the health of both mother and fetus.

Weighing the Risks: Why Myomectomy During C-Section Sparks Debate?

Surreal illustration of a flower blooming during C-section myomectomy, symbolizing surgical precision and fertility.

The management of pregnant women with uterine leiomyomas poses challenges, as clinical management must prioritize the health of both mother and fetus. Some literature suggests that performing a myomectomy during a cesarean section (C-section) is feasible under specific conditions, such as considering the size and location of the uterine leiomyomas. However, many obstetricians are hesitant to perform a myomectomy at the time of C-section due to concerns about intractable bleeding, massive hemorrhage, and the potential need for a hysterectomy.

A meta-analysis assessing the safety of myomectomy performed during C-sections showed that while hemoglobin levels dropped more in the caesarean myomectomy group, the difference was not significant. There was also no significant difference in estimated blood loss or incidence of hemorrhage between the two groups. Operative time was slightly longer in the caesarean myomectomy group (by 4.94 minutes), but again, this difference was not statistically significant. These results indicate that performing a myomectomy during a C-section is feasible, but careful attention must be paid to surgical techniques such as tourniquet use, uterine artery occlusion, and uterine artery ligation.

Unfortunately, clear guidelines for selecting appropriate candidates for caesarean myomectomy are lacking in current literature. Some obstetricians advocate myomectomy during C-section only in specific situations:
  • When the leiomyoma is pedunculated (attached by a stalk)
  • In select cases where the myomectomy can be performed without massive hemorrhage or hysterectomy
There is a consensus that easily accessible myomas, such as subserosal or pedunculated ones, are optimal for removal. A study in 2015 found that the size of leiomyomas alone did not significantly impact hemorrhage, as hemoglobin change and the frequency of blood transfusions were similar in patients with or without myomectomy during C-section, when grouped by leiomyoma size. Another study supported these findings, showing no differences in preoperative and postoperative hemoglobin changes, operative time, postoperative fever, and hospitalized days in women with large myomas (>5 cm), compared to those with smaller myomas (≤5 cm).

The Bottom Line: Informed Choices for C-Section Myomectomy

Myomectomy during cesarean delivery can be a reasonable and safe option, provided it is performed by an experienced obstetrician with quick and efficient techniques for managing potential intraoperative hemorrhage. A thorough understanding of patient-specific factors and adherence to established surgical best practices are essential to optimize outcomes and ensure the well-being of both mother and child.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4172/2090-7214.1000234, Alternate LINK

Title: Myomectomy During Caesarean Section Is Likely Feasible

Subject: General Medicine

Journal: Clinics in Mother and Child Health

Publisher: OMICS Publishing Group

Authors: Dianrong Song

Published: 2016-01-01

Everything You Need To Know

1

What are uterine leiomyomas (fibroids), and how common are they during pregnancy?

Uterine leiomyomas, also known as fibroids, are non-cancerous tumors that commonly occur in women of reproductive age. These growths are quite prevalent, affecting a significant percentage of women. While many fibroids are asymptomatic, they can grow during the reproductive period, potentially leading to complications during pregnancy and childbirth, such as an increased likelihood of cesarean sections.

2

Why are obstetricians often hesitant to perform a myomectomy during a C-section?

Obstetricians often hesitate to perform a myomectomy during a C-section primarily due to concerns about potential complications. These concerns include the risk of intractable bleeding and massive hemorrhage, which could create the necessity for a hysterectomy. The decision to proceed with a myomectomy during a C-section requires careful consideration of the risks and benefits, balancing the mother's health and the baby.

3

What does current research suggest about the safety of performing a myomectomy during a C-section, particularly concerning blood loss and operative time?

According to studies, performing a myomectomy during a C-section did not significantly increase the risk of hemorrhage or blood loss, although hemoglobin levels dropped more in the caesarean myomectomy group. The operative time was slightly longer in the myomectomy group. These results suggest that a myomectomy can be feasible during a C-section when performed with meticulous surgical techniques, such as tourniquet use, uterine artery occlusion, and uterine artery ligation, to control bleeding.

4

Who are the optimal candidates for a myomectomy during a C-section, and what types of leiomyomas are easiest to remove?

Optimal candidates for myomectomy during a C-section are generally those with easily accessible myomas, such as subserosal or pedunculated ones. While some studies indicate the size of leiomyomas may not significantly impact hemorrhage, clear guidelines for selecting candidates are lacking. However, the consensus is that myomas that are easily reachable are most suitable for removal during C-section.

5

Under what circumstances is a myomectomy during cesarean delivery considered a reasonable option, and what factors are essential for ensuring a positive outcome?

Myomectomy during cesarean delivery can be a reasonable and safe option if performed by an experienced obstetrician who can quickly and efficiently manage potential intraoperative hemorrhage. Thoroughly understanding patient-specific factors and adhering to established surgical best practices are essential to optimize outcomes and ensure the well-being of both mother and child. Further research is required to provide better guidelines for when to proceed with the procedure.

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