Maternal and neonatal outcomes following cesarean myomectomy: a comparison between fibroid-associated and fibroid-free cesarean deliveries

Objective: To compare maternal and neonatal outcomes among women undergoing cesarean section (CS) with concomitant myomectomy, women with uterine fibroids managed conservatively at cesarean delivery, and women without uterine fibroids. Material and Methods: This retrospective cohort study included women who delivered by CS between May 2017 and December 2024. Patients were classified into three groups: CS with myomectomy (Group 1), CS with fibroids without myomectomy (Group 2), and CS without fibroids (Group 3). Maternal outcomes included perioperative changes in hemoglobin, hematocrit, and platelet counts, transfusion requirement, and length of hospital stay. Neonatal outcomes included birth weight, birth length, and Apgar scores. Appropriate parametric and non-parametric statistical tests were used for group comparisons. Results: The study cohort numbered 682 with 252 (36.95%), 178 (26.1%) and 252 (36.95%) women in Groups 1, 2 and 3, respectively. Postoperative hemoglobin, hematocrit, and platelet levels differed significantly among the three groups (all p<0.05). However, hemoglobin deficit did not differ significantly between Group 1 and Group 2 (p=0.346), while both groups showed greater hemoglobin deficit than Group 3 (p<0.05). Transfusion rates and hospitalization duration differed significantly between groups (p<0.05), with longer hospital stay observed in transfused patients regardless of group. Maximum myoma volume was higher in Group 1, whereas myoma count was greater in Group 2 and total myoma volume was comparable between these groups (p=0.09). Neonatal birth weight was significantly lower in Group 2 compared with Groups 1 and 3 (p<0.05), while no difference was observed between Groups 1 and 3 (p=0.956). Other neonatal outcomes were similar. Conclusion: Cesarean myomectomy was associated with larger changes in hematologic parameters and transfusion rates; however, hemoglobin deficit appears related to fibroid presence rather than myomectomy itself. Neonatal outcomes were not adversely affected by cesarean myomectomy, whereas untreated fibroids appeared to be associated with lower birth weight.