Management of Cesarean Myomectomy in a Patient with Multiple Fibroids and an Obstructing Lower Uterine Segment Fibroid

Background and Objective: Management of caesarean myomectomy (CM) in lower uterine segment obstruction is a hard process. Here I present a pregnant woman with multiple fibroid pregnancy and an obstructing intramural fibroid in the lower segment. The CM procedure was modified here with initially excision of obstructing myoma and delivery of baby. Case Presentation:  A primigravida woman visited emergency room with abdominal pain at 22 week gestation, receiving antenatal care elsewhere. The emergency abdomen USG showed multiple fibroids in pregnancy with a huge obstructing fibroid in lower segment and a breech presentation with no anomalies. Comparing earlier USG reports exposed that the multiple fibroids were growing across the gestation weeks along the developing fetus. The mother was followed for watchful expectancy till 37 weeks gestation and delivery was planned as elective LSCS. Cesarean myomectomy was carried out through initial excision of lower uterine segment myoma to remove the obstruction, and then deliver the baby through the same incision. Conclusion: Here the cesarean myomectomy procedure was altered from a regular one, featuring preliminary myomectomy of uterine fibroid in the lower segment, and then delivering the baby and myomectomies again. The outcome was delivering a live baby with hemostasis in a case, with multiple and large fibroids.

Keywords:

Altered Caesarean Myomectomy , Breech presentation , Multiple myomas , Obstructing large myoma , Uterine Fibroid growth , Uterine lower segment obstruction