Caesarean myomectomy in a case of bad obstetric history and multiple fibroids: a case report

ABSTRACT

Uterine myomas are being observed in pregnancy more frequently now than in the past, because many women are delaying child bearing till their late thirties, which is the time for the greatest risk of the myoma growth. Traditionally, obstetricians are trained to avoid myomectomies during caesarean sections as severe haemorrhages can occur, which may often necessitate hysterectomies. Pedunculated fibroids which can be easily removed are an exception. A 38-year-old, elderly female, G3 A2, 37 weeks pregnancy with bad obstetric history and multiple fibroids was admitted in Apollo Hospitals, Ahmedabad. She underwent high risk caesarean section followed by myomectomy. Four large and one small fibroid were removed. One posterior wall intramural fibroid 6×5 cm was lower down, hence not removed. Histopathological examination showed leiomyomata with degenerative changes, infarct and calcification. She didn’t have any intraoperative haemorrhage or any postpartum complications. On follow up after 6 weeks, patient was healthy, had no complaints. Caesarean scar was healthy. Ultrasound scan showed normal uterus with one posterior wall intramural fibroid 3×3 cm. With the advent of better anaesthesia, easy availability of blood and blood components, caesarean myomectomy is a safe surgical procedure when performed by experienced obstetrician in carefully selected patients. Intraoperative assessment of fibroids is important in decision making for caesarean myomectomy.