The inevitable and incidental caesarian myomectomy

The management of fibroid encountered during caesarean remains controversial. The traditional approach has always been, not to perform myomectomy, because of the fear of haemorrhage due to increased vascularity and uterine atonicity of pregnant uterus and increased morbidity. Caesarean section was performed in 27-year G2P1 in view of previous LSCS, short inter-conception period, frank leaking and poor bishop score. After delivery of baby a fibroid of 6 cm by 5 cm was seen jutting out of left side of incision line. Myomectomy was performed, without any complication, as it was not possible to approximate the incision line without that. No excessive hemorrhage or postoperative complications were encountered.

Incarceration of the Gravid Uterus with Myoma: Report of One Patient Managed with Uterine Reduction / 대한산부인과학회잡지

Incarceration of the gravid uterus is a rare but serious complication of pregnancy. Reported is the case of a gravid 2, para 0, abortus 1 with known uterine subserosal myoma(5.3 x5.5cm sized) 26-year-old woman presented with acute dysuria and urinary retention. The patient was 14 weeks and 3 days pregnant and presented several week history of urinary frequency and sensation of incomplete bladder emptying. Examination revealed a retroflexed uterus with cervical opening pointing toward the anterior abdominal wall. An ultrasound revealed a thin, elongated maternal bladder and a uterus incarcerated between the sacral promontary and the pubis. The incarceration was successfully reduced by tenaculum traction of the cervical posterior lip without surgical intervention and had a normal infant of appropriate weight at term.

The contractility of myometrial strips from the lower segment of human term gravid uterus in vitro.

Myometrial strips were taken from the lower segment of 20 parturients undergoing low transverse caesarean section. Nine were in latent phase and 11 were in active phase of labor. Each strip was divided into 2-8 small strips of equal size. The pattern of isotonic contraction in vitro was observed. Spontaneous contraction, showing viability of the strips, could be obtained in 83.70 percent of total of 49 strips from the latent phase parturients and in 90.40 percent of a total of 52 strips from the active phase parturients. The period of contraction was the only parameter analysed to demonstracte the active phase parturients. The period of contraction was 11.33+6.31 minutes in the latent phase group and 11.99+5.23 minutes in the active phase group. The data showed no statistically significant difference by the Wilcoxon rank-sun test (p=0.425). In conclusion, the pattern of contraction of the myometrial strips from the lower segment of human term pregnant uterus in vitro was the same in the latent phase as in the active phase. Further study is suggested to confirm and further investigate the aetiologies of this finding.

Rupture of the gravid uterus.

Rupture of the gravid uterus, the most tragic obstetric emergence, is said to occur infrequently nowadays due to efficient antenatal and intranatal intensive care. Forty-six incidents of uterine rupture were reviewed among 197, 254 deliveries during 1978-1987, that is 1 per 4288 deliveries. There were 20 cases of previous scarred rupture, 18 traumatic, and 8 cases of spontaneous ruptures. A rupture of a previously scarred uterus had an approximately equal number of classical and low transverse scars. Maternal and fetal prognoses were much better with low transverse scars. A rupture of the previously unscarred uterus was a more dramatic event. It tended to be longitudinal and complete, and fetal prognoses were relative poor. About 28% of the ruptures were diagnosed prior to delivery, 33% were noticed at operation, and 39% were observed only after delivery and diagnosed by manual uterine exploration. The majority of cases were managed by hysterectomy rather than repair. Under special circumstances, the uterus may be repaired for subsequent reproduction. Maternal mortality was 2.2% and fetal loss 42.6%, 37% suffering from asphyxia at birth. Preventative measures, early diagnosis, and prompt treatment are emphasized.