Combined cesarean section and myomectomy increases perioperative risks and affects postpartum recovery in women with uterine fibroids during late pregnancy.

BACKGROUND: Uterine fibroids present significant obstetric challenges, particularly in late pregnancy. This study compared the outcomes of cesarean section combined with myomectomy (CS+M) versus cesarean section followed by elective myomectomy (CS) in managing fibroids during late pregnancy. METHODS: A retrospective analysis was conducted on 243 pregnant women with uterine fibroids between September 2019 and September 2023. Participants were divided into two groups: 134 underwent CS followed by elective myomectomy, and 109 underwent combined CS+M. Perioperative outcomes, recovery indicators, rates of infection and complications, lactation status, neonatal Apgar scores, umbilical artery blood gas and blood lactate levels, postpartum depression (Edinburgh Postnatal Depression Scale (EPDS) scores), perceived stress (Perceived Stress Scale (PSS) scores), and health-related quality of life (Short Form 36 Health Survey (SF-36) scores) were compared between the two groups. RESULTS: Compared with the CS group, the CS+M group experienced significantly longer surgical duration (P = 0.041), greater intraoperative (P = 0.006) and postoperative blood loss (P = 0.007), and extended hospital stays (P = 0.004). Postoperative wound infections, abdominal distension, and intestinal obstruction occurred more frequently in the CS+M group (P = 0.035). The incidence of insufficient lactation was higher (P = 0.035), while Apgar scores at multiple time points were significantly lower (P = 0.030) in the CS+M group. Quality of life scores were consistently higher in the CS group, reflecting better postoperative recovery across various domains. CONCLUSION: CS+M, while advantageous for removing fibroids in a single procedure, is associated with increased perioperative risk, delayed recovery, higher complication rates, impaired lactation, and less favorable neonatal outcomes.