Challenging myomectomy of large cervical fibroid - successful fertility outcome: a case report

The cervical fibroids are rare and large cervical fibroids are rarer. Removing large cervical fibroids when a patient desires future fertility is a surgical challenge because of the risks of significant blood loss, bladder and ureteric injury, and unplanned hysterectomy. For women who desire future fertility, myomectomy can improve the chances of pregnancy by restoring normal anatomy. In this article, we describe a successful pregnancy following the restoration of the normal anatomy of the cervix by a challenging myomectomy in a sub-fertile patient with a large cervical fibroid. A 38-year-old nulliparous lady presented to the reproductive endocrinology and infertility (REI) department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with primary sub-fertility for five and half years, and dysmenorrhea for 2 years. She was a regularly menstruating woman with average flow and duration. Being a resident of Canada, she was diagnosed there as a case of large cervical fibroid (10×9 cm) by TVS extending up to the posterior wall of the uterus, cervix, and upper vagina impacted in the pouch of Douglas during infertility workup. For this reason, she was advised for in vitro fertilization (IVF) keeping the fibroid in situ. However, due to the failure of embryo transfer with this large cervical fibroid, she was advised for embryo transfer following myomectomy. Hysteroscopic myomectomy was tried first (in February 2019 in Canada) but was unable to be removed. Then Laparotomy was tried (in September 2019 in Canada) but failed again. Being a complicated case, she was counselled there for myomectomy by a multidisciplinary approach with the high risk of injury to the urinary bladder, ureter, bowel, and other pelvic structures. But she refused to do a myomectomy there after knowing the dreadful complications with the fear of injury to the pelvic organs. With this problem, she went to different institutions both in the country and abroad but couldn’t get the proper treatment. Finally, she visited the outpatient department (OPD) of the REI department, BSMMU, Dhaka, Bangladesh with the hope of getting the most appropriate treatment for her and she was reassured, counselled, and managed by a challenging myomectomy (in March 2022) through a combined approach of the vagina and abdominal route without any significant intra and post-operative complications. Her whole post-operative period was uneventful, the anatomy of the cervix was restored and detected by TVS, and trial transfer was done before embryo transfer with easy negotiation to the cervix. Finally, she conceived 1 year after myomectomy with easy frozen embryo transfer. Myomectomy in expert hand even for the large cervical fibroid can restore normal anatomy and can achieve successful pregnancy outcomes.

Fetomaternal outcome in patients with eclampsia: study in a territory care hospital in Bangladesh

Background: Eclampsia, a severe complication of preeclampsia, poses significant risks to both the mother and the fetus. Understanding the specific factors influencing these outcomes in the context of Bangladesh is crucial for improving maternal and neonatal healthcare in the region.Methods: A retrospective cohort study was conducted at department of gynaecology and obstetrics, Jashore Medical College Hospital, Jashore, Bangladesh reviewing medical records of 155 patients diagnosed with eclampsia over a January 2020 to December 2020. Data on maternal age, gestational age, clinical presentation, management strategies, and fetal outcomes were collected and analyzed.Results: Preliminary findings suggest that maternal age, gestational age at onset, and timely interventions play crucial roles in determining the fetomaternal outcomes in eclampsia cases. Maternal mortality rates, neonatal morbidity, and mortality rates were assessed in relation to these factors. Additionally, the study investigates the impact of various management approaches, including antihypertensive medications, and magnesium sulfate therapy on these outcomes.Conclusions: Eclampsia continues to pose significant risks to both mothers and infants in Bangladesh. Inadequate antenatal care appears to contribute to the severity of cases. The high rate of emergency cesarean sections underscores the need for vigilant monitoring of high-risk pregnancies. Efforts to improve antenatal care utilization and implement timely interventions are crucial to mitigate the adverse fetomaternal outcomes associated with eclampsia in this setting. Further prospective studies are warranted to explore preventive strategies and optimize management protocols for better outcomes.