ABSTRACT
OBJECTIVE: To define the involvement of myomas and myomectomy in all stages from conception to post-partum in women of reproductive age. MATERIALS AND METHODS: A literature review was conducted using the Medline and Cochrane databases to March 2011 by matching the keywords "fertility, infertility, miscarriage, pregnancy, delivery" with "myomas, fibroids, myomectomy". RESULTS: An association between myomas and fertility has been observed but the responsibility fibroids in infertility remains unclear. Myomas are associated with an increased rate of obstetric complications. Adhesions are the main complication of myomectomy. Endoscopic procedures and the use of anti-adhesive barriers prevent adhesion formation. Pregnancy rate in cases of myomectomy by laparotomy and laparoscopy is similar. Myomectomy during pregnancy is exceptionally indicated. CONCLUSION: The discovery of a uterine myoma needs to consider the responsibility of myomas in infertility, but also its impact on a future pregnancy. The therapeutic management is based on myomectomy but expected benefits must be weighed with potential risks.
Subject(s)
Gynecologic Surgical Procedures/statistics & numerical data , Leiomyoma/surgery , Reproduction/physiology , Uterine Neoplasms/surgery , Adult , Age Factors , Female , Fertility Preservation/methods , Gynecologic Surgical Procedures/adverse effects , Gynecologic Surgical Procedures/methods , Humans , Infertility, Female/etiology , Infertility, Female/surgery , Leiomyoma/physiopathology , Pregnancy , Pregnancy Complications, Neoplastic/etiology , Pregnancy Complications, Neoplastic/rehabilitation , Pregnancy Complications, Neoplastic/surgery , Uterine Neoplasms/physiopathology , Young AdultABSTRACT
BACKGROUND: We report a case of a large giant cell tumor of the thoracic spine presenting with spinal cord compression during pregnancy. CASE: A 24-year-old woman presented at term with lower back pain, bilateral lower extremity weakness, numbness, and bowel and bladder incontinence. Magnetic resonance imaging revealed a spinal soft tissue mass compressing the spinal cord. The patient delivered a healthy girl by cesarean then underwent a T8-T9 laminectomy, posterior spinal decompression, and instrument fusion. Two days later, she had a thoracotomy, corpectomy of the vertebral body, and anterior tumor debulking. Ultimately, the patient was discharged to inpatient rehabilitation with improved lower extremity strength and returned bowel and bladder function. CONCLUSION: Obstetricians should be vigilant regarding progressive neurologic symptoms during pregnancy.
