Case report Electro-cautery of myomas during caesarean sectionÐtwo case reports Luigi Cobellis a,* , Pasquale Florio a , Luigi Stradella b , Eugenio De. Lucia b , Enrico M. Messalli b , Felice Petraglia a , Giovanni Cobellis b a Department of Paediatrics, Obstetrics and Gynaecology, University of Siena, Siena, Italy b Department of Obstetric and Gynaecology, Second University of Naples, Naples, Italy Received 6 June 2000; accepted 23 October 2001 Abstract Myomectomy is a surgical procedure not usually performed during caesarean section because associated with high risk of haemorrhage and other complications. The goal of our study is to evaluate the feasibility of myomectomy during caesarean section, the outcome, and try to establish the favourable conditions to perform a myomectomy during the same surgical event. Electro-cautery of intramural-subserous myomas was performed on two different patients. Only the myomas of little or middle size were treated. Both patients had multiple ®broids, a ®rm contraindication for myomectomy during caesarean section. After 10 and 13 months since myoma electro-cautery, all uterine ®broids treated were completely reabsorbed. These preliminary results regard the ®broids of middle size. It could be interesting evaluating the electro-cautery on bigger ®broids. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Electro-cautery; Caesarean section; Myoma; Leiomyoma; Uterine ®broids 1. Introduction Myomectomy during caesarean section should be per- formed only after accurate evaluation of location, number, size and proximity to large vessels. Multiple ®broids, are unfavourable for myomectomy [1±6]. The aim of our study is to evaluate whether deferred myomectomy would be more easily performed if electro- cautery was used on some ®broids during the caesarean section. 2. Materials and methods 2.1. Case 1 P.V.Ð28-year-oldÐprimigravida. On the 10th week of pregnancy, a transabdominal ultrasonography showed a regular gestational sac in a myomatous uterus. The largest ®broid was located on the right side of the uterus body, and was about 4.8 cm in diameter. Lower abdominal pains characterised pregnancy. Short therapy of antispasmodics was used successfully to control patient's pain. During pregnancy, the volume of the ®broids increased. The largest one reached 6.2 cm in diameter. On the 39th week of pregnancy, a caesarean section was performed because of breech presentation and multiple myomas. During caesarean section, 11 ®broids were counted. A myoma electro-cautery was performed on three subserous-intramural myomas, whose ultrasonographic diameter was about 2.7±2.8 and 3.2 cm. The postoperative period was marked by 5 days of a sub- febrile state, without any peritoneal signs. The patient was discharged after 7 days. Ultrasonographic examination showed that the biggest ®broid on the right side of the uterus body was reduced to 5.4 cm in diameter. Laparotomic myomectomy was performed 13 months after the caesrean section. The three myomas, previously treated by electro-cautery, had become stellar-whitish scars with ®ne epiploic adhesions, which were removed. The postoperative course was uncomplicated and no blood transfusions were needed. The patient was discharged after 8 days. 2.2. Case 2 R.M.Ð33-year-oldÐprimigravida. On the 9th week of pregnancy, a transabdominal scan showed a regular gesta- tional sac in myomatous uterus. The largest ®broid was located on the back side of uterus body and was about 5.6 cm European Journal of Obstetrics & Gynecology and Reproductive Biology 102 2002) 98±99 * Corresponding author. Fax: 39-081-210772. E-mail address: luigicobellis@yahoo.it L. Cobellis). 0301-2115/02/$ ± see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-211501)00572-3