CAESAREAN MYOMECTOMY - A CASE REPORT

Abstract

INTRODUCTION -30 yrs old Primigravida
with Fibroid complicating pregnancy
was admitted for safe confinement at 37
weeeks of gestation. Her cycles were
regular. She is married since one year
and conceived spontaneously after 3
months. She had regular antenatal visit.
She was diagnosed to have fibroid in the
1st trimester USG. In the subsequent follow
up USG, fibroid tend to increase in
size during 1st 2nd trimester, and there
was decrease in size thereafter. On examination,
her general condition was
good and vitals were stable. Per abdomen
shows Uterus term , Not acting,
Head high mobile, FH good. A firm mass
of size 8x6cm felt in suprapubic region.
Per vaginal examination shows Cervix
uneffaced, os closed, head felt through
fornices above brim, lower border of
mass felt through anterior lateral fornices,
pelvis gynaecoid, no showdraining
pv.Routine investigations were within
normal limits.
GESTATIONAL AGE 6 7 WEEKS 28 29
WEEKS 37 38 WEEKS SIZE 10.4 X 8.2
CMS 12.3 X 11.3 CMS 11 X 7 CMS SITE
ANTERIOR WALL ANTERIOR TO RIGHT
OFLEFT LATERAL WALL OF
UTERUSUTERUS AT CERVICOUTERINEjunction
She was prepared for
elective caesarean section. Intra operatively
a large 20 x 18 cms intramural fibroid
was found in the anterior wall at the upper
part of lower uterine segment. Lower segment
caesarean section could not proceeded,
hence myomectomy was done.
Enucleation of the fibroid is technically easier
in the gravid uterus owing to the greater
looseness of the capsule. In contrary to the
popular belief, blood loss during myomectomy
was very minimal. The myoma
weighed 2 kg. Then LSCS was done to deliever
an alive girl baby of 2.8 kg with APGAR
810, 910. Inj. Oxytocin 20 units was
added to drip. Placenta and membranes
delieved in toto. Uterus was found to be
firm and well contracted. Uterine wound
closed in layers.Blood loss during

surgery was minimal and hence patient does
not require any blood transfusions. Postoperative
period was uneventful. Sutures removed
on 7th postoperative day and she was discharged
next day.DISCUSSIONCaesarean
myomectomy was practically absent from the
obstetric literature until the last decade. This
was due to the high risk of haemorrhage associated
with this procedure and the need for
blood transfusion. However, some obstetricians
started performing selective myomectomy
at caesarean section for specific indications
like pedunculated uterine fibroid, anterior
subserous fibroid and fibroid in the lower uterine
segment.