Successful myomectomy during pregnancy: a case report

Abstract

Background: The medical literature has reported an increase in myomectomy during caesarean section in the past decade. However, myomectomy performed during pregnancy remains a rarity. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery. We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy.

Case presentation: A 30 year old woman presented with a one year history of abdominal swelling, amenorrhea and severe epigastric discomfort of 19 weeks duration. The abdomen was grossly distended and tense. A sonographic diagnosis of ovarian tumor in pregnancy was made. Laparotomy revealed a 32 cm degenerating subserosal uterine fibroid co-existing with an intrauterine pregnancy. Myomectomy was successfully performed. The subsequent antenatal period was uneventful with a spontaneous vaginal delivery of a female baby at 38 weeks.

Conclusion: This report supports other studies and case series that have demonstrated the safety of myomectomy during pregnancy in selected circumstances.

Figure 1

Uterus with massive subserosal fibroid. The photograph is JPEG format. It shows a cystic subserous fibroid measuring 32 cm in diameter and situated at the right posterior aspect of the uterus.