Advanced Biomedical Research

Successful Myomectomy in the Second Trimester of Pregnancy

Authors

Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

The prevalence of uterine myomas during pregnancy is estimated to be small. However, a significant fraction of these could lead to pregnancy complications. Myomectomy is rarely performed during pregnancy because of fear of miscarriage and the risk of uncontrolled hemorrhage necessitating hysterectomy. This article reports on a case of myomectomy of subserous leiomyoma that was causing septic necrosis, leukocytosis, rise of inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), and pressure symptom on the liver. Myomectomy was performed at 20 weeks of gestation. The pregnancy continued with no further problems, and at 39 weeks and 1 day of gestation, vaginal delivery resulted in a healthy baby. It is postulated that when myomectomy is performed in carefully selected patients, it prevents sepsis due to myoma torsion and necrosis and also protects surrounding organs against damage.

Keywords

1.
Jhalta P, Negi SG, Sharma V. Successful myomectomy in early pregnancy for a large asymptomatic uterine myoma: Case report. Pan Afr Med J 2016;24:228.  Back to cited text no. 1
    
2.
Domenici L, Di Donato V, Gasparri ML, Lecce F, Caccetta J, Panici PB. Laparotomic myomectomy in the 16th week of pregnancy: A case report. Case Rep Obstet Gynecol 2014;2014:154347.  Back to cited text no. 2
    
3.
Lolis DE, Kalantaridou SN, Makrydimas G, Sotiriadis A, Navrozoglou I, Zikopoulos K, et al. Successful myomectomy during pregnancy. Hum Reprod 2003;18:1699-702.  Back to cited text no. 3
    
4.
Pelissier-Komorek A, Hamm J, Bonneau S, Derniaux E, Hoeffel-Fornes C, Graesslin O, et al. Myoma and pregnancy: When medical treatment is not sufficient. J Gynecol Obstet Biol Reprod (Paris) 2012;41:307-10.  Back to cited text no. 4
    
5.
Vitale SG, Tropea A, Rossetti D, Carnelli M, Cianci A. Management of uterine leiomyomas in pregnancy: Review of literature. Updates Surg 2013;65:179-82.  Back to cited text no. 5
    
6.
Müller Vranjes A, Sijanović S, Vidosavljević D, Kasac Z, Abicic Zuljević K. Surgical treatment of large smooth muscle tumor of uncertain malignant potential during pregnancy. Med Glas (Zenica) 2011;8:290-2.  Back to cited text no. 6
    
7.
Basso A, Catalano MR, Loverro G, Nocera S, Di Naro E, Loverro M, et al. Uterine fibroid torsion during pregnancy: A case of laparotomic myomectomy at 18 weeks' gestation with systematic review of the literature. Case Rep Obstet Gynecol 2017;2017:4970802.  Back to cited text no. 7
    
8.
Suwandinata FS, Gruessner SE, Omwandho CO, Tinneberg HR. Pregnancy-preserving myomectomy: Preliminary report on a new surgical technique. Eur J Contracept Reprod Health Care 2008;13:323-6.  Back to cited text no. 8
    
9.
Michalas SP, Oreopoulou FV, Papageorgiou JS. Myomectomy during pregnancy and caesarean section. Hum Reprod 1995;10:1869-70.  Back to cited text no. 9
    
10.
Kasum M. Hemoperitoneum caused by a bleeding myoma in pregnancy. Acta Clin Croat 2010;49:197-200.  Back to cited text no. 10
    
11.
Exacoustòs C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol 1993;82:97-101.  Back to cited text no. 11
    
12.
Myerscough P. Pelvic Tumors; Other Surgical Complications. Munro Kerr's Operative Obstetrics. 10th ed.. London: Cassel and Collier Macmillan; 1987. p. 203-11.  Back to cited text no. 12
    
13.
Glavind K, Palvio DH, Lauritsen JG. Uterine myoma in pregnancy. Acta Obstet Gynecol Scand 1990;69:617-9.  Back to cited text no. 13
    
14.
Omar SZ, Sivanesaratnam V, Damodaran P. Large lower segment myoma – Myomectomy at lower segment caesarean section – A report of two cases. Singapore Med J 1999;40:109-10.  Back to cited text no. 14
    
15.
Mollica G, Pittini L, Minganti E, Perri G, Pansini F. Elective uterine myomectomy in pregnant women. Clin Exp Obstet Gynecol 1996;23:168-72.  Back to cited text no. 15
    
16.
Umezurike C, Feyi-Waboso P. Successful myomectomy during pregnancy: A case report. Reprod Health 2005;2:6.  Back to cited text no. 16
    
17.
Machado LS, Gowri V, Al-Riyami N, Al-Kharusi L. Caesarean myomectomy: Feasibility and safety. Sultan Qaboos Univ Med J 2012;12:190-6.  Back to cited text no. 17
    
18.
Vilos GA, Allaire C, Laberge PY, Leyland N; Special Contributors. The management of uterine leiomyomas. J Obstet Gynaecol Can 2015;37:157-78.  Back to cited text no. 18
    
Advanced Biomedical Research
Volume 2019, september
September 2019
Pages 1-4