A survey on the current practice of indicating an elective cesarean after a previous myomectomy

• Published in: Annals of medicine (Helsinki) 2023-12, Vol.55 (1), p.2197292-2197292
• Main Authors: Delli Carpini, Giovanni, Verdecchia, Valeria, Giannella, Luca, Di Giuseppe, Jacopo, Gardella, Barbara, Greco, Pantaleo, Cicinelli, Ettore, Ciavattini, Andrea
• Format: Article
• Language: English
• Subjects: cesarean section; Cesarean Section - adverse effects; Female; fibroids; Humans; Leiomyoma - complications; Leiomyoma - surgery; Myomectomy; Pregnancy; Pregnancy, Childbirth & Women's Health; Reproducibility of Results; trial of labor; Uterine Myomectomy - methods; Uterine Rupture
• ISSN: 0785-3890; 1365-2060
• DOI: 10.1080/07853890.2023.2197292

The objective of this study was to evaluate the attitude of obstetricians/gynecologists toward indicating an elective cesarean delivery in pregnant patients with a previous myomectomy. Web-based multiple-choice questions survey evaluating the attitude to indicate a cesarean with a composite summated score (range 56-280) from a 56-item Likert scale: score 56-112: weak attitude, 113-168: moderate, 169-224: strong, and 225-280: very strong. The reliability of the score (internal consistency) was evaluated with Cronbach's alpha coefficient. The association between the score and participants' characteristics was determined with a bivariate analysis followed by linear regression analysis. The "global importance" of each risk factor was defined as the prevalence of the answers: "moderately important", "very important", and "extremely important" on the Likert scale. Factors with a "global importance" >75% were considered "crucial" in influencing the choice to indicate a cesarean. One-hundred-twenty obstetricians/gynecologists responded (response rate 70.6%). The mean ± SD composite summated score was 137 ± 31; 30 (25.0%) participants presented a "weak attitude to cesarean", 68 (56.7%) a "moderate attitude", 22 (18.3%) a "strong attitude", and none a "very strong attitude". The Cronbach's alpha was 0.934 (high internal consistency). A self-reported number of myomectomies performed per year >50 was associated with a lower score (-25 points, 95% CI −50 to −1, p = 0.04). Eight criteria resulted "crucial" in indicating a cesarean: opening of the endometrial cavity, monopolar electrosurgery, time surgery-pregnancy