Navigating Pyomyoma in Pregnancy and Postpartum: A Systematic Review
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To assess the different presentations of pyomyoma in pregnant and postpartum populations, and review the treatment modalities. This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a comprehensive search of PubMed, Scopus, Google Scholar and Embase during the years 1945 to October 2024. Included case reports assessed the types of intervention (hysterectomy, myomectomy, or other forms of treatments) to treat Pyomyoma. All case studies confirming a diagnosis of pyomyoma on either operative and/or histological findings were eligible. A total of 123 studies were initially screened and after a full-text evaluation, 40 articles with a total of 43 cases were included in this systematic review. Pyrexia and abdominal pain were the most common presenting symptoms found in 79% and 77% of patients, respectively. The most common causative organism was E-Coli (23%). Hysterectomy was performed in a total of 13 (30%) patients, myomectomy in 24 (56%) patients and 6 (14%) patients were treated conservatively. Given the considerable morbidity associated with pyomyoma, the benefits of surgical treatment tend to outweigh the potential risks. However, since pregnant and postpartum women are a younger cohort and fertility is a concern, myomectomy is preferred to hysterectomy.