Consequences of Concurrent Myomectomy and Caesarean Section versus Caesarean Section Alone in the Last Two Decades: Systematic Review and Meta-Analysis

Background: Performing myomectomy concurrently with a caesarean section has been controversial for many decades. Objective: The present study mainly aims to evaluate the consequences of concurrent myomectomy and caesarean section versus caesarean section alone. Methods: In this systematic review, we have followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic resources, such as MEDLINE, Cochrane, EMBASE, Scopus, and PubMed, were searched. A total of 3057 articles were reviewed. Of these, 33 met the inclusion criteria and were included in the final analysis. The reviewed outcomes were hemoglobin (Hb) before and after the operation, blood transfusion rate, hemorrhage, operation time, duration of hospitalization, and complications, such as fever. Results: A meta-analysis of 33 articles with 5586 participants in the caesarean myomectomy (CM) group and 2935 participants in the caesarean section (CS) group showed a statistically significant Hb decrease in the CM group [MD = 0.26, CI=95%(-0.33 to -0.19)]. The transfusion rate was higher in the CM group [OR=0.39(0.42-0.67)], and intraoperative hemorrhage was higher in the CM group [OR=0.56 (0.45 - 0.75) CI=95%]. The mean operation time [MD=1.17(1.10 -1.24) CI=95] and hospitalization time [MD=0.41 (0.34-0.48) CI=95%] were significantly higher in the CM group. There was no significant difference in the incidence of fever between the two groups [MD =1.06, CI=95%, p=0.923(0.78-1.43)]. Conclusion: Concurrent CM is associated with a reduction in mean Hb and an increase in operation time and hospitalization time; however, it prevents additional surgery and costs; it is worthwhile to perform myomectomy at the time of caesarean section, especially by experienced surgeons with necessary preparations.