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

Figures & data

Table 1. Bivariate analysis of factors associated with the composite summated score for indicating an elective cesarean.

Factor	n	Composite summated score	p*
Geographical provenience
Northern Italy	28	143 ± 29	0.362
Central Italy	73	135 ± 32
Southern Italy	19	131 ± 27
Institution
First-level hospitals	53	139 ± 35	0.365
Second-level teaching hospitals	67	134 ± 28
Scientific societies
Member	66	133 ± 29	0.234
Not-member	54	140 ± 33
Subspecialty
Gynaecology	67	130 ± 31	0.042
Obstetrics	50	143 ± 29
Reproductive endocrinology/infertility	3	167 ± 19
N° of pregnant patients with the previous myomectomy managed per year
<10	78	141 ± 29	0.025
11–30	35	133 ± 32
31–50	7	106 ± 29
N° of myomectomies performed per year
0–10	78	143 ± 28	0.002
11–25	22	136 ± 36
25–50	13	117 ± 21
>50	7	105 ± 33
Management of at least one case of uterine rupture post-myomectomy
Yes	9	139 ± 42	0.804
No	111	136 ± 30

*t-test or one-way ANOVA as appropriate.

Table 2. Importance of selection criteria for elective cesarean delivery.

Factor	Global importance (5 + 4 + 3)	Extremely important 5	Very important 4	Moderately important 3	Slightly important 2	Not at all important 1
Maternal age <25 years	4.2%	5 (4.2%)	0 (-)	0 (-)	67 (55.8%)	48 (40.0%)
Maternal age 26–35 years	5.8%	2 (1.7%)	4 (3.3%)	1 (0.8%)	48 (40.0%)	65 (54.2%)
Maternal age 36–45 years	39.2%	4 (3.3%)	27 (22.5%)	16 (13.3%)	25 (20.8%)	48 (40.0%)
Maternal age > 45 years	54.2%	37 (30.8%)	26 (21.7%)	2 (1.7%)	7 (5.8%)	48 (40.0%)
Maternal BMI <20	5.0%	0 (-)	0 (-)	6 (5.0%)	59 (49.2%)	55 (45.8%)
Maternal BMI 20–25	6.7%	0 (-)	0 (-)	8 (6.7%)	55 (45.8%)	57 (47.5%)
Maternal BMI 26–30	10.8%	0 (-)	0 (-)	13 (10.8%)	52 (43.3%)	55 (45.8%)
Maternal BMI 31–35	41.7%	6 (5.0%)	22 (18.3%)	22 (18.3%)	15 (12.5%)	55 (45.8%)
Maternal BMI > 36	45.8%	30 (25.0%)	16 (13.3%)	9 (7.5%)	8 (6.7%)	57 (47.5%)
Pregnancy obtained by ART	37.5%	10 (8.3%)	22 (18.3%)	13 (10.8%)	9 (7.5%)	66 (55.0%
One removed fibroid	6.7%	0 (-)	6 (5.0%)	2 (1.7%)	96 (80.0%)	0 (-)
Two removed fibroids	50.0%	9 (7.5%)	13 (10.8%)	38 (31.7%)	44 (36.7%)	9 (7.5%)
Three or more removed fibroids	79.2%	55 (45.8%)	30 (25.0%)	10 (8.3%)	9 (7.5%)	55 (13.3%)
Diameter of the removed fibroid <5 cm	14.2%	2 (1.7%)	0 (-)	15 (12.5%)	77 (64.2%)	26 (21.7%)
Diameter of the removed fibroid 6–10 cm	61.7%	16 (13.3%)	37 (30.8%)	21 (17.5%)	20 (16.7%)	26 (21.7%)
Diameter of the removed fibroid 11–20 cm	73.3%	46 (38.3%)	31 (23.8%)	11 (9.2%)	6 (5.0%)	26 (21.7%)
Diameter of the removed fibroid >20 cm	73.3%	53 (44.2%)	31 (23.8%)	4 (3.3%)	6 (5.0%)	26 (21.7%)
Anterior localization	30.8%	4 (3.3%)	20 (16.7%)	13 (10.8%)	30 (25.0%)	53 (44.2%)
Posterior localization	15.8%	0 (-)	4 (3.3%)	15 (12.5%)	48 (40.0%)	53 (44.2%)
Fundal localization	33.3%	14 (11.7%)	11 (9.2%)	15 (12.5%)	27 (22.5%)	53 (44.2%)
Lateral localization	21.7%	2 (1.7%)	11 (9.2%)	13 (10.8%)	41 (34.2%)	53 (44.2%)
FIGO1 removed fibroid	35.8%	4 (3.3%)	24 (20.0%)	15 (12.5%)	67 (55.8%)	10 (8.3%)
FIGO2 removed fibroid	69.2%	17 (14.2%)	42 (35.0%)	24 (20.0%)	27 (22.5%)	10 (8.3%)
FIGO3 removed fibroid	75.8%	24 (20.0%)	27 (22.5%)	40 (33.3%)	19 (15.8%)	10 (8.3%)
FIGO4 removed fibroid	76.7%	23 (19.2%)	42 (35.0%)	27 (22.5%)	18 (15.0%)	10 (8.3%)
FIGO5 removed fibroid	34.2%	6 (5.0%)	11 (9.2%)	24 (20.0%)	69 (57.5%)	10 (8.3%)
FIGO6 removed fibroid	16.7%	4 (3.3%)	8 (6.7%)	8 (6.7%)	90 (75%)	10 (8.3%)
FIGO7 removed fibroid	1.7%	2 (1.7%)	0 (-)	0 (-)	108 (90.0%)	10 (8.3%)
Opening of the endometrial cavity	88.3%	62 (51.7%)	28 (23.3%)	16 (13.3%)	2 (1.7%)	12 (10.0%)
Laparotomy	28.3%	8 (6.7%)	7 (5.8%)	19 (15.8%)	47 (39.2%)	39 (32.5%)
Laparoscopy	53.3%	19 (15.8%)	21 (17.5%)	24 (20.0%)	16 (13.3%)	40 (33.3%)
Robotic surgery	38.3%	15 (12.5%)	17 (14.2%)	14 (11.7%)	33 (27.5%)	41 (34.2%)
Single strate	52.5%	23 (19.2%)	25 (20.8%)	15 (12.5%)	14 (11.7%)	43 (35.8%)
Double strate	25.0%	6 (5.0%)	11 (9.2%)	13 (10.8%)	46 (38.3%)	44 (36.7%)
3+ strates	21.7%	9 (7.5%)	9 (7.5%)	8 (6.7%)	57 (47.5%)	37 (30.8%)
None or minimal use of electrosurgery	5.0%	0 (-)	0 (-)	6 (5.0%)	59 (49.2%)	55 (45.8%)
Monopolar	88.3%	62 (51.7%)	28 (23.3%)	16 (13.3%)	2 (1.7%)	12 (10.0%)
Bipolar	30.8%	4 (3.3%)	20 (16.7%)	13 (10.8%)	30 (25.0%)	53 (44.2%)
Monofilament surgical thread	20.0%	4 (3.3%)	17 (14.2%)	3 (2.5%)	13 (10.8%)	83 (69.2%)
Twisted surgical thread	10.8%	5 (4.2%)	6 (5.0%)	2 (1.7%)	23 (19.2%)	84 (70.0%)
Barbed surgical thread	6.7%	2 (1.7%)	3 (2.5%)	3 (2.5%)	25 (20.8%)	87 (72.5%)
Duration <60 min	6.7%	0 (-)	4 (3.3%)	4 (3.3%)	35 (29.2%)	77 (64.2%)
Duration 60–90 min	9.2%	0 (-)	5 (4.2%)	6 (5.0%)	32 (26.7%)	77 (64.2%)
Duration 90–120 min	25.8%	9 (7.5%)	8 (6.7%)	14 (11.7%)	12 (10.0%)	77 (64.2%)
Duration >120 min	29.2%	16 (13.3%)	15 (12.5%)	4 (3.3%)	8 (6.7%)	77 (64.2%)
Surgical hematoma	81.7%	50 (41.7%)	32 (26.7%)	16 (13.3%)	4 (3.3%)	18 (15.0%)
One previous myomectomy	18.3%	2 (1.7%)	4 (3.3%)	16 (13.3%)	89 (74.2%)	9 (7.5%)
Two or more previous myomectomies	86.7%	40 (33.3%)	44 (36.7%)	20 (16.7%)	7 (5.8%)	9 (7.5%)
Low surgical experience	59.2%	35 (29.2%)	22 (18.3%)	14 (11.7%)	0 (-)	49 (40.8%)
Intermediate surgical experience	36.7%	6 (5.0%)	10 (8.3%)	28 (23.3%)	24 (20.0%)	52 (43.3%)
High surgical experience	8.3%	3 (2.5%)	2 (1.7%)	5 (4.2%)	58 (48.3%)	52 (43.3%)
Time surgery – pregnancy <6 months	86.7%	71 (59.2%)	31 (25.8%)	2 (1.7%)	4 (3.3%)	12 (10.0%)
Time surgery – pregnancy 7–12 months	65.8%	10 (8.3%)	28 (23.3%)	41 (34.2%)	29 (24.2%)	12 (10.0%)
Time surgery – pregnancy >12 months	20.8%	2 (1.7%)	9 (7.5%)	14 (11.7%)	83 (69.2%)	12 (10.0%)
Maternal will	55.8%	19 (15.8%)	18 (15.0%)	30 (25.0%)	8 (6.7%)	45 (37.5%)
Previous vaginal birth	37.5%	17 (14.2%)	13 (10.8%)	15 (12.5%)	6 (5.0%)	69 (57.5%)

Data are reported as n (%).

Figure 1. Diverging stacked bar chart of global importance for indicating an elective cesarean delivery after myomectomy.

Data availability statement

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.