Study objective: Comparing surgical outcomes of a novel surgical technique endometrial myomectomy (EM) to serosal myomectomy (SM) during ceserean section (CS). Design: Retrospective cohort study (Canadian task force classification level II 1). Setting: Private hospital. Patients: Fourty-six women with leiomyomas during cesarean section Interventions: Endometrial myomectomy and serosal myomectomy during cesarean section between 2013 and 2016. Main outcome measures: Total 22 consequtive cases (Group 1) underwent EM in the last 2 years. The control group created from SM (Group 2) cases performed before EM implemented in our practice. Group 2 was matched based on anteriorly located intramural or submucosal leiomyoma. The size, location and number of leiomyoma, hematological course during pre- and postoperative period, the need for blood transfusion, duration of surgery, and any prolongation of hospital stay also documented. Results: Median number of leiomyoma was higher in EM than in SM (p = 0.001). Median myomectomy procedure time and amount of intra-operative bleeding in SM were higher than EM (respectively, p = 0.005 and p = 0.001). In terms of other variables, there is no difference between the two myomectomy groups (p > 0.05). Conclusion: This novel technique EM is a safe, feasible surgical technique compared with SM. Besides the less intra-operative blood loss, it also has the potential to diminish the risk of abdominal adhesion formation.

Objective: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). Methods: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. Results: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 – 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). Conclusions: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.

Colposcopic biopsy is a discomfortable procedure. Additionally, it creates negative influence on sexuality. This study aimed to investigate the relationships among tenaculum, pain perception, and biopsy size during colposcopy. In total, 228 patients who underwent colposcopy-directed biopsy were included, and randomized into 4 groups based on whether analgesic and tenaculum were used and replaced (tenaculum with n=58/without analgesic n=56, no tenaculum replacement with n=57/without analgesic n=57). Lidocaine hydrochloride (40 mg) plus adrenaline (0.025 mg) was administered in the analgesic groups. The pain was assessed using a linear visual analog scale. The biopsy specimen size was measured in millimeters. The mean age of the patients was 42.85±8.88 years. The most frequent colposcopy indications were atypical squamous cells of undetermined significance and human papilloma virus-positive results on cervical cytology (30.2%; n=69). Low- and high-grade intraepithelial lesions were noted in 14.91% (n=34) and 10.96% (n=25) women through colposcopy-directed biopsy results, respectively. Tenaculum replacement increased pain perception in the without analgesic group; however, no statistically significant differences were noted between of the groups with and without tenaculum replacement with analgesic. The size and number of biopsy specimens were not associated with tenaculum replacement and analgesic use. Administration of analgesics decreased discomfort and pain in patients. Tenaculum replacement aided colposcopists in manipulating the cervix. Additionally, administration of analgesics relieved pain in the tenaculum replacement group. ClinicalTrials.gov Identifier: NCT03279666.

Objective This study aimed to compare the level of anxiety in pregnant women who were admitted to our institute before and after confirmation of COVID-19 outbreak have reached Turkey. Methods One-hundred and fifty consecutive pregnant women admitted to our institute following the emergence of the global COVID-19 outbreak (Group 1) and 150 age-matched pregnant women who were admitted to our institute for delivery following the confirmation of COVID-19 outbreak have reached Turkey (Group 2) were enrolled in this study. All patients were asked to fill out the State and Trait Anxiety Inventory (STAI). Results STAI-Trait scores, which reflect long term anxiety levels were similar in subjects admitted to our institute for delivery before the COVID-19 outbreak in Turkey compared to those admitted after COVID-19 outbreak (42.5±5.8 vs. 42.2±3.2, respectively; p=0.487). However, there was a significant difference in STAI-State scores, indicating state anxiety, between subjects admitted to our institute for delivery before and after confirmation of COVID-19 outbreak in Turkey (44.6±5.3 vs. 42.9±5.1, respectively; p=0.05). Conclusion Pregnant women admitted to our institute for delivery subsequent to the announcement of first COVID-19 case and declaration of the state of alarm have higher levels of state anxiety compared to those admitted before the establishment of first COVID-19 cases and containment measures.

Additional surgical interventions apart from emergencies during cesarean section are not recommended in the textbooks; thus, surgical procedures like myomectomy as an adjunct to cesarean section remains a hot topic of discussion. There are many publications supporting serosal myomectomy during cesarean section, but studies published so far are poor in quality of evidence. To clarify the efficacy and safety of cesarean myomectomy, large-scale randomized controlled studies and studies explaining the mid-term and long-term outcomes of the cesarean myomectomy are required. Traditionally, cesarean myomectomy is performed from the uterine serosa as in the usual abdominal myomectomy. Although the surgical technique is the same as intracapsular myomectomy, a novel cesarean myomectomy technique, endometrial myomectomy, introduced into the obstetrics practice for minimizing the risk of adhesion formation and diminishing the blood loss during surgery. Further, strong studies are needed to overcome the controversy on cesarean myomectomy.

Up to 70–80% of women of reproductive age may be affected with the most common uterine tumors, known as fibroids or myomas. These benign tumors are the second most prevalent cause of surgery among premenopausal women. Predictions show that the occurrence of myomas in pregnancy will increase, and that the risk of having myomas during pregnancy increases with advanced maternal age. Although most women with fibroids do not experience any symptoms during pregnancy, up to 30% of women experience problems during pregnancy, childbirth, and the puerperium. The viability of myoma excision during cesarean surgery (CS) is a contentious issue raised by the rising incidence of myomas in pregnancy and CS rates. A new surgical procedure for removing fibroids using a trans-endometrial approach, which involves making an incision through the decidua itself, has put into doubt the long-standing practice of cesarean myomectomy (CM) with a trans-serosal approach. Some authors have recently advocated for this last approach, highlighting its advantages and potential uses in real-world situations. The purpose of this paper is to critique the present approach to cesarean myomectomy by analyzing the clinical and surgical distinctions between the two approaches and providing illustrations of the CM methods.