Large Uterine Fibroids in Pregnancy with Successful Caesarean Myomectomy

Abstract

Uterine fibroid is the commonest benign tumour of the female reproductive tract. It occurs in 20–40% of women, whereas the estimated incidence in pregnancy is 0.1–3.9%. Uterine fibroid in pregnancy is usually asymptomatic with complications occurring in 10–30% of cases. The first line of management is conservative with counselling for myomectomy after delivery. However, in the presence of intractable symptoms, both antepartum myomectomy and caesarean myomectomy have been reported to be successfully performed in carefully selected cases. We report a case of large subserous uterine fibroid in pregnancy that was referred to our centre at 14 weeks of gestation. She developed generalized body weakness, backache, and breathlessness at 27 weeks gestation. Thus, she was admitted and managed conservatively for eight weeks with significant relief of symptoms. She eventually had a caesarean myomectomy at 35 weeks of gestation; the outcome was a live female baby with a birth weight of 2.3 kg and a large subserous fibroid weighing 9.5 kg. We can therefore say that caesarean myomectomy can be safely performed in carefully selected cases.

Uterine Fibroids in Pregnancy

“…Eyong E et al also reported good fetal outcomes in patients with uterine fibroids. 18 4% of babies died in the early neonatal period and 4% were intrauterine fetal deaths,comparing well with a local study. 14 Most of the babies with poor outcomes were those who were delivered preterm.…”

Intraoperative Myomectomy during Caesarean Section

“…It used to be thought of as an operation with potentially disastrous effects on the mother and was used exclusively in cases of pedunculated subserosal fibroids (18). However, there have been cases of intracaesarian myomectomy with no complications (5,10). According to Kwawukume, enucleation of a myoma can be performed with minimal difficulty in pregnancy, since the tissue is softer (14).…”

“…Depending on the location of the myoma, pain, bleeding, premature membrane rupture, preterm labour, obstruction of delivery, and even miscarriage present as possible ramifications (4). An elective postnatal myomectomy is commonly employed due to the asymptomatic nature of myomas in 70% of cases (5).…”

“…Depending on the location of the myoma, pain, bleeding, premature membrane rupture, preterm labour, obstruction of delivery, and even miscarriage present as possible ramifications (4). An elective postnatal myomectomy is commonly performed due to the asymptomatic nature of myomas in 70% of cases (5). However, myomectomy during a caesarean section lowers the risk of many complications, such as post-operative haemor-rhage, multiple surgeries and complications of anaesthesia (6).…”

Large umbilical hernia complicating huge uterine fibroid: Case report in a tertiary hospital in Port Harcourt, Nigeria

“…In Nigeria, massive ascites complicating huge uterine fibroid [14] , large uterine fibroid in pregnancy with successful Caesarean section [15] , incarceration of sessile uterine fibroid in incisional hernia [16] , and successful pregnancy after surgery for giant uterine fibroid have all been reported [17] . Huge uterine fibroid mimicking feature of malignancy was reported in 2021 in Port Harcourt [18] , but we have not seen a co-existence of uterine fibroid with a large umbilical hernia in our practice hence this documentation.…”