Spontaneous Expulsion of Intramural Fibroid Six Weeks after Emergency Caesarean Section

Abstract

We present a thirty-six-year-old woman with a high risk pregnancy, complicated by multiple congenital anomalies, severe hyperemesis, a pulmonary embolus, and a large intramural fibroid. This fibroid grew in size during the pregnancy. At 34 + 5 weeks, there were reduced fetal movements and a pathological CTG. A live infant was delivered by an emergency cesarean section. Five weeks postpartum, she presented with abdominal pain, offensive vaginal discharge, and fevers. She was given antibiotics and ferrous sulphate. An abdominal ultrasound showed an 11 × 12 × 9 cm fibroid with a coarse degenerative appearance. Clinically, she showed signs of sepsis; a CT scan and laparotomy performed under general anesthetic did not find any collections as a source of sepsis. When stable, she was discharged. She re-presented two days later with a large mass (necrotic fibroid) in her vagina. This is the first case of spontaneous expulsion of fibroid six weeks after caesarean section. Presentation of pain and fever after the delivery may be due to red degeneration of the fibroid, caused by diminished blood supply, ischaemia, and necrosis. This case highlights the importance of considering fibroids as a cause for abdominal pain during and after pregnancy, even up to 6 weeks after delivery.

Developing a theoretical evolutionary framework to solve the mystery of parturition initiation

“…Interestingly, uterine emptying is not limited to parturition. Large uterine fibroids can be spontaneously expelled through a process that includes myometrial contraction and dilation of the cervix ( De Cure et al, 2013 ; Sagoo et al, 2015 ). In cases of uterine fibroid expulsion, the fibroid mass is necrotic and patients exhibit signs of intrauterine infection and inflammation.…”

Transvaginal postpartum manual removal of a prolapsed submucous leiomyoma, initially diagnosed hybrid predominantly intramural

“…The first one reports a case of an intramural myoma in pregnancy changing to a submucosal type which the authors attribute to a likely error in sonographic reporting 7. The second case reports an intramural myoma changing into a pedunculated subserosal type on a small stalk 10.…”

Puerperal Complications of a Retroplacental Uterine Leiomyoma

“…4 The primary mechanism of hemorrhage is attributed to either uncoordinated uterine contractions leading to uterine atony or retained products of conception. 5 Although spontaneous expulsion of a leiomyoma in the postpartum period after vaginal or cesarean delivery has been reported, [6][7][8][9] reports of delayed expulsion are rare, 10,11 and optimal management is based solely on clinical experience. The current case report describes the presentation and management of a retroplacental leiomyoma causing postpartum hemorrhage and degeneration with prolapse in the immediate and delayed postpartum period, respectively.…”