Caesarean Myomectomy- A Rare Case

Abstract

Introduction: Uterine leiomyomas (fibroids) represent the most prevalent benign neoplasms of the female reproductive system.  Their presence during pregnancy may impair maternal and foetal outcomes, especially when situated in the lower uterine section.  Historically, myomectomy after caesarean delivery has been eschewed due to the potential for haemorrhage; yet, emerging research endorses its safety in specific instances.

Case report: We present the case of a 27-year-old woman, G2P1L1, who arrived at 38 weeks and 3 days of gestation with abdominal pain and backache lasting one day. Upon inspection, she exhibited haemodynamic stability, a cephalic presentation, and a reassuring foetal heart rate. Continuous Category II cardiotocography necessitated an urgent lower segment caesarean surgery. During the operation, a 5 × 5 cm intramural fibroid was located in the lower uterine section, blocking the incision site. A myomectomy was conducted utilising a myoma screw, succeeded by a transverse uterine incision, amniotomy, and the delivery of a healthy newborn. The placenta and membranes were entirely evacuated, and haemostasis was achieved using numerous haemostatic sutures and intramuscular carboprost. Histopathological analysis showed the presence of leiomyoma. Both the mother and the infant experienced a smooth recovery and were released in satisfactory condition.

Conclusion: This case demonstrates that caesarean myomectomy, despite being conventionally advised against, can be executed safely in carefully chosen patients with suitable intraoperative methods and surgical proficiency. The excision of obstructive fibroids during caesarean section not only aids in delivery but also mitigates the necessity for further surgical intervention.