Caesarean myomectomy is not a risk factor for blood products transfusion among pregnant individuals with fibroids: a retrospective cohort study
Bibliographic record
Abstract
ABSTRACT Background Uterine fibroids are common benign tumors during reproductive age. Among pregnant individuals with uterine fibroids, myomectomy at the time of cesarean delivery (CD) allows individuals to avoid a second surgery later in life. Objective To examine the safety of myomectomy performed at the time of CD and the factors that increase the risk of greater blood loss in cesarean myomectomy. Study design This was a retrospective cohort study of all cesarean myomectomies (CM) performed at a tertiary care center in Toronto, Ontario between January 1, 2012, and June 1, 2019. The study group included individuals who had CM, and the control group included individuals with fibroids who had a CD without removing their fibroids. The primary outcome was the rate of blood products transfusion. Secondary outcomes were the need for hysterectomy and estimated blood loss (EBL). Subgroup analyses were performed for fibroid size, previous CD, and elective vs urgent CD. Logistic regression analysis was performed to assess for confounders. Results Overall, 110 CM were compared with 152 CD. The overall transfusion rate for CM was 7.3% compared to 0.7% in the control group (p = 0.005). All procedures requiring transfusion from both groups were performed < 37 0/7 weeks of gestation. In logistic regression analysis, performing a myomectomy was not associated with a higher risk for transfusion. The only factors associated with transfusion were preterm birth (aOR 14.43, p=0.049) and low pre-operative hemoglobin (aOR 0.90, p=0.02). The median reported EBL was 800 mL for CM and 700 mL for controls (p<0.001). No individuals in either group required concomitant hysterectomy. Subgroup analysis showed that fibroid size ≥5cm and previous CD were not associated with increased risk of transfusion among those who had a CM, while urgent CM was significantly associated with the need for transfusion (p=0.02). Conclusion This study demonstrates that the transfusion rate was not significantly higher in those undergoing CM at term, compared to those with fibroids undergoing CD without a myomectomy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".