Blood Pressure Management and Fluid Administration After Septal Myomectomy
Immediate Postoperative Hemodynamic Management
After septal myomectomy, maintain normotensive blood pressure targets and administer intravenous fluids cautiously to ensure adequate perfusion while avoiding excessive volume that could increase bleeding risk at the surgical site.
Blood Pressure Targets
- Maintain systolic blood pressure between 100-140 mmHg in the immediate postoperative period to ensure adequate uterine perfusion without increasing risk of bleeding from the myomectomy site
- Avoid hypotension (SBP <90 mmHg) as this compromises uterine blood flow and healing
- Avoid hypertension (SBP >140 mmHg) as elevated pressure increases risk of bleeding from the surgical site and may compromise suture integrity 1, 2
Intravenous Fluid Administration
- IVF administration is appropriate and necessary after myomectomy to maintain adequate intravascular volume and tissue perfusion 1, 2
- Use balanced crystalloid solutions (lactated Ringer's or normal saline) as first-line fluid replacement
- Monitor fluid balance carefully, particularly during and immediately after hysteroscopic procedures where fluid overload is a recognized complication 3, 4
- Target urine output of at least 0.5 mL/kg/hour as an indicator of adequate perfusion
Critical Monitoring Parameters
- Serial hemoglobin/hematocrit monitoring is essential as myomectomy carries risk of significant blood loss requiring transfusion 3
- Monitor for signs of ongoing bleeding: tachycardia, hypotension, decreasing hemoglobin, abdominal distension
- Correct preoperative anemia before elective myomectomy using GnRH agonists/antagonists or selective progesterone receptor modulators plus iron supplementation 1, 2, 5
Common Pitfalls to Avoid
- Do not restrict fluids excessively in an attempt to minimize bleeding—this compromises perfusion and healing
- Do not allow permissive hypotension as you might in trauma settings—uterine healing requires adequate perfusion pressure
- Be vigilant for fluid overload during hysteroscopic myomectomy specifically, where glycine or sorbitol solutions can cause hyponatremia and volume overload 3, 4
- Watch for postoperative fever, which may indicate infection or post-embolization syndrome if uterine artery procedures were performed 3
Specific Postoperative Considerations
- Laparoscopic myomectomy is associated with less postoperative fever and smaller decreases in hemoglobin compared to open procedures 3
- Patients may require additional surveillance for complications including abscess, venous thromboembolism, or damage to adjacent organs 3
- Pain management with NSAIDs is appropriate and may help reduce bleeding 1, 2