An intramural uterine fibroid became submucosal in the puerperium – proposed probable mechanism: a case report

Abstract

BackgroundVaginal prolapse of a large uterine fibroid is a rare phenomenon in a woman who delivered vaginally recently, given that this fibroid might have obstructed labor. The author presents a case report of a vaginally prolapsed large pedunculated submucosal uterine myoma in a woman with a recent uncomplicated vaginal delivery.Case presentationA 25-year-old black African woman had four intramural uterine fibroids of diameters 62 to 94 mm diagnosed in April 2013 with standard ultrasound scan. She got pregnant in July 2014. An ultrasound scan done on 31 August 2014 at 10 weeks’ gestation identified four intramural uterine fibroids, with sizes varying from 70 to 150 mm. Her pregnancy was well followed up, without any complications. She had an uneventful vaginal delivery on 10 April 2015. During uterine exploration, indicated for retention of parts of fetal membranes, no pedunculated submucosal fibroid was found. On 15 May 2015, she consulted for difficult micturition and partial urinary retention that occurred 2 days ago. A vaginally prolapsed 10 cm uterine fibroid was diagnosed. Forty-eight hours after administration of intravenously administered broad spectrum antibiotics, the myoma was successfully twisted off by means of vaginal route under general anesthesia, which relieved her symptoms.ConclusionsTo the best of our knowledge, this is the first case of vaginally prolapsed large submucosal uterine fibroid in a woman who delivered vaginally recently. The author recommends that women with known large low situated uterine fibroid should be well observed during the postpartum period to diagnose a vaginally prolapsed uterine fibroid early, so as to prevent fibroid superinfection and obstructive complications.

Prolapse of a pedunculated uterine leiomyoma through the cervix during GnRH antagonist treatment: Case report and literature review

“…Based on these results, one of the possible mechanisms of leiomyoma prolapse is rapid decrease in leiomyoma volume. The rapid reduction of leiomyoma volume also occurs in the post‐partum, and in fact, it has been reported that leiomyoma prolapse occurred in the puerperium 8 . In addition to the cases of literature review, leiomyoma prolapse took place after rapid reduction of leiomyoma volume in our GnRH antagonist case.…”

“…The rapid reduction of leiomyoma volume also occurs in the post-partum, and in fact, it has been reported that leiomyoma prolapse occurred in the puerperium. 8 In addition to the cases of literature review, leiomyoma prolapse took place after rapid reduction of leiomyoma volume in our GnRH antagonist case. In the present case, the duration of GnRH antagonist treatment until leiomyoma prolapse was 35 days, which was relatively short compared to all the cases of leiomyoma prolapse during GnRH agonist treatment in the literature review (Table 1).…”

Transvaginal prolapsed submucosal leiomyoma after cesarean section misdiagnosed as bladder prolapse: A case report with literature review

“…There are currently no clinical guidelines for treating a pedunculated submucosal myoma during pregnancy or postpartum, as this type of myoma is rare, and there have only been 14 cases reported since 1945, all of which have been accompanied by an occult development of suppuration ( 1 – 13 ). Sirha et al ( 18 ) have found that surgical intervention combined with more effective antibiotics is the most appropriate treatment.…”

“…Each article abstract was evaluated, and the relevant original English language articles were read. Relevant articles were cross-referenced to identify related studies or publications on the subject, and cases of transvaginal prolapse of uterine submucous myoma or cervical myoma after delivery since 1949 were summarized ( 1 , 3 – 13 ) ( Table 1 ). The literature review found that transvaginal prolapse of postpartum submucosal fibroids occurred from immediate postpartum to seven weeks postpartum, with 7 of the 14 cases occurring at 4–5 weeks postpartum.…”

Sonographic assessment of uterine leiomyoma among pregnant women.

“…The most common complications of leiomyoma are anemia (due to menorrhagia), infertility and miscarriages. 7 Leiomyomas or myomas can either be single, or multiple in numbers and can also differ in perfusion, location and size. Intramural leiomyoma, the most common, develops within the muscular uterine wall.…”