November 2019 · Volume 8 · Issue 11 Page 4646 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Khan FZA et al. Int J Reprod Contracept Obstet Gynecol. 2019 Nov;8(11):4646-4653 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Review Article Navigating through the maze of caesarean myomectomy: generating evidence Fouzia Zahid A. Khan 1 *, Imose Itua 2 INTRODUCTION Uterine myomas, fibroids and leiomyomas are synonymous terms used interchangeably to describe monoclonal, estrogen dependent, benign uterine tumors of reproductive age. 1 Previously called as uterine stones, their existence have been reported by ancient Greeks in 460-375 BC. 2 The term ‘fibroid’ was first coined by Rokitansky (1860) and Klob (1863) which was later replaced by another term ‘myoma’ by a German pathologist Virchow who demonstrated that these neoplasms were derived from the smooth muscle cells. 2 Their prevalence range from 20% to 40% in women of reproductive age and exceed 70% if examined at autopsy. 3,4 They are three to nine times higher in Afro- Caribbean than White women or those with a family history of myomas. 4 The incidence rises with the increasing age of a woman but the real frequency in general population is still undefined, as many women remain asymptomatic unless otherwise diagnosed on ultrasonographic scan. 1,2,4 Various growth factors like insulin-like growth factor (IGF), transforming growth factor (TGF), epidermal growth factor (EGF), acidic Fibroblast growth factor (FGF), Heparin binding EGF (HB-EGF), platelet-derived growth factor (PDGF), TGF- a, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), are thought to play some role in the development and proliferation of fibroids. 1,2 ABSTRACT Management of myomas during pregnancy and labor is a contested subject so far. Currently no recommended national or international guidelines are in place resulting in conflicted opinion and management variation across the globe. Many obstetricians still discourage its practice due to fear of uncontrolled haemorrhage which may lead to unwanted hysterectomy in a reproductive age. However, some researchers have challenged the conventional perspective and argue that caesarean myomectomy (CM) is a safe procedure. The aim of this study is to examine all aspects of CM with an evaluative lens and to weigh its risk-benefit ratio. For this purpose, we conducted a literature review of studies, including those from low-resource countries indexed in scientific databases like PubMed, Google Scholar and Scopus. Most recent articles that reported benefits, complications and different techniques to safely perform caesarean myomectomy with proven benefit for the patient were examined thoroughly so that solid evidence on pros and cons of caesarean myomectomy could be generated. There is a dire need to conduct large sample size studies or randomized controlled trials for the risk-benefit evaluation of CM and to produce evidence-based clinical conclusion. Keywords: Caesarean section, Caesarean myomectomy, Fibroid, Myomas, Myoma in pregnancy DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194916 1 Consultant Gynaecologist, Primary and Secondary Health Care Department, Government of Punjab, Pakistan 2 Department of Public Health, University of Liverpool, United Kingdom Received: 25 August 2019 Accepted: 04 October 2019 *Correspondence: Dr. Fouzia Zahid A. Khan, E-mail: drfauz78@hotmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.