Pyomyoma after abortion: Uterus conserving surgery is possible to maintain fertility. Case report

Pinton, Anne; Aubry, Gabrielle; Thoma, V.; Nisand, I.; Akladios, Chérif

doi:10.1016/j.ijscr.2016.05.020

Cited by 13 publications

(22 citation statements)

References 18 publications

(27 reference statements)

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“…A crucial issue is whether or not to myomectomy should be performed on large asymptomatic myomas. Myomectomy does not improve the obstetric or delivery outcomes, but removing large fibroids distorting the uterine cavity improves pregnancy rates and decreases miscarriage rates . Shavell et al stated that it is premature to make specific recommendations regarding the value of myomectomy prior to conception .…”

Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

“…A decrease in oxytocinase activity in the gravid fibroid uterus could increase the concentration of oxytocin, predisposing to premature contractions . Large uterine fibroids are significantly associated with pPROM and with delivery at an earlier gestational age . Others found an association with multiple intramural myomas .…”

Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

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Myoma and myomectomy: Poor evidence concern in pregnancy

Milazzo¹,

Catalano²,

Badia³

et al. 2017

J of Obstet and Gynaecol

103

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Aim: Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. Methods: Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. Results: Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. Conclusions: Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.

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Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

Section: Obstetric Complications Of Myomas During Pregnancymentioning

confidence: 99%

Myoma and myomectomy: Poor evidence concern in pregnancy

Milazzo¹,

Catalano²,

Badia³

et al. 2017

J of Obstet and Gynaecol

103

View full text Add to dashboard Cite

show abstract

“…When uterine evacuation in mid trimester pregnancy loss fails there is the potential for retained fetal bone as a result of distorted uterine anatomy caused by the fibroids. A septic miscarriage carries the potential risk of a pyomyomata formation [33].…”

Section: Uterine Fibroids and Pregnancymentioning

confidence: 99%

Uterine Fibroids and Pregnancy: A Review of the Challenges

Abam¹,

Kasso²

2017

Obstetrics

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Uterine fibroids are quite common in women of the reproductive age group and as such commonly encountered in pregnancy. Though majority of these cases are asymptomatic, some are prone to developing complications and may end up having adverse outcomes in pregnancy. Management of these women with uterine fibroids presents its own challenges, especially in low-resource setting as in sub-Saharan Africa, where the condition is rife. Adequate management of these women, be it pregnant or nonpregnant, improves their quality of life.

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“…Rupture is suggested on imaging by disruption of the wall of the pyomyoma, along with free intraperitoneal fluid and air [ 1 ]. Mortality rate estimates range from 6% to 21% in the era of antibiotics [ 5 , 8 , 14 , 16 ]. Prior to the development of antibiotics in 1945, the mortality rate was 29% according to case series [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Due to the nonspecific presentation of pyomyoma, initiation of appropriate treatment is frequently delayed [ 16 ]. Treatment of pyomyoma is almost always surgical.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature

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Mullins

2018

Case Reports in Obstetrics and Gynecology

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Introduction Pyomyoma, or suppurative leiomyoma, is a rare complication of uterine fibroids. It occurs most commonly in the setting of pregnancy, the immediate postpartum period, or postmenopausal status. It may also arise after recent uterine instrumentation, after uterine artery embolization, or in immunocompromised patients. The most likely cause of pyomyoma is vascular compromise followed by bacterial seeding from direct, hematogenous, or lymphatic spread. Diagnosis is difficult, as the condition is rare, presents with vague symptoms, and is difficult to identify on imaging. Definitive diagnosis is only possible with surgery. Pathology shows a degenerating fibroid with hemorrhage, necrosis, cystic degeneration, and/or inflammatory change. Cultures of the pus contained within often show polymicrobial infection. Case Presentation Our patient is a 24-year-old nulligravid female who presented with a surgical abdomen, fever, hypotension, and leukocytosis. She had no significant prior medical or surgical history, no history of uterine instrumentation, and no history of pelvic infection; she was not currently sexually active at the time of presentation. She was taken to the operating room, where she underwent diagnostic laparoscopy. This showed a ruptured pyomyoma originating in the left broad ligament. She then underwent laparoscopic myomectomy. She was transferred to the ICU intubated; she slowly recovered on IV antibiotics and was discharged home on postoperative day 10. Discussion Pyomyoma is a rare condition and is even rarer in premenopausal patients without recent history of pregnancy or uterine instrumentation. This demonstrates an unusual case of spontaneous pyomyoma in the absence of risk factors, other than a history of known fibroids. Pyomyoma should be considered as a diagnosis in patients with sepsis, history of fibroids, and no other identifiable source of infection.

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Pyomyoma after abortion: Uterus conserving surgery is possible to maintain fertility. Case report

Cited by 13 publications

References 18 publications

Myoma and myomectomy: Poor evidence concern in pregnancy

Myoma and myomectomy: Poor evidence concern in pregnancy

Uterine Fibroids and Pregnancy: A Review of the Challenges

Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature

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