A Rare Surgery: Myomectomy on Pregnant Uterus

Abstract

BACKGROUND: Leiomyomas also called myomas or fibroids; are benign monoclonal uterine myometrial tumors. Uterine fibroids are the commonest benign tumours of female genital tract with a prevalence of 20 to 50% in women of reproductive age. Fibroids may be classified as submucous, intramural or sub-serous. It is often assumed that fibroids cause infertility since pregnancies do occur after myomectomy and other treatments where the fibroids are removed. The treatment of fibroids has historically been surgery, usually hysterectomy. Myomectomy is an option in women wishing to maintain fertility and for those desiring to keep their uterus. The position of the uterine fibroid plays important role in infertility. The presence of sub-mucous fibroid decreases the fertility rate. Subserosal fibroids do not affect the fertility rate but removing those does increase fertility. Surgical management is limited to non-pregnant uterus. Fibroid coexisting pregnancy, prevalence is 0.3-2.6%, can be associated with complication in 10 to 30% cases which are managed conservatively. We present a case of multiple fibroid complicating pregnancy with one huge sub-serosal pedunculated fibroid extending up to xiphisternum that necessitated myomectomy at 18 to 20 weeks of gestation.