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Case Reports
. 2020 Nov 3;13(11):e235572.
doi: 10.1136/bcr-2020-235572.

Management of pregnancy in case of multiple and giant uterine fibroids

Catarina Reis-de-Carvalho  1   2 , João Lopes  2 , Alexandra Henriques  2 , Nuno Clode  2
Affiliations
Case Reports

Management of pregnancy in case of multiple and giant uterine fibroids

Catarina Reis-de-Carvalho et al. BMJ Case Rep. .

Abstract

Uterine fibroids are common among women of reproductive age. During the pregnancy, the potential complications of fibroids, although rare, are of frequent clinical concern. Available studies describing management and obstetrical outcomes in pregnant women with giant fibroids are limited. We present the case of a 39-year-old pregnant woman with multiple and large uterine fibroids. During the pregnancy, there was adequate fetal development, without major maternal complications. Given the characteristics of the fibroids and breech position of the fetus, an elective caesarean section was decided, and postpartum hysterectomy planned. This challenging obstetrical case required a multidisciplinary approach.We considered crucial discussing five main issues: preconceptional counselling, tailored pregnancy surveillance, decision of time and route of delivery, decision to perform a peripartum hysterectomy and management of decreasing blood loss perioperatively. Given the limitation of the published reports, we believe that sharing our experience, along with a literature review, is beneficial for other clinicians.

Keywords: anaesthesia; gynaecology and fertility; obstetrics; surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
MRI at 15th week of pregnancy showing giant and multiple nodes of myoma and the pregnancy located in the upper half of the abdomen. The biggest nodule has an anterior location and measures 20.4×13.9×10.8 cm.
Figure 2
Figure 2
Evolution of abdominal distension during pregnancy (A) 15 weeks; (B) 21 weeks; (C) 27 weeks; (D) 36 weeks.
See this image and copyright information in PMC

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