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Intramural leiomyoma during pregnancy becoming pedunculated postpartally. A case report
R D Haskins1, C J Haskins, R Gilmore
1Department of Obstetrics and Gynecology, St. John's Mercy Hospital, Washington, USA.
The Journal of Reproductive Medicine
|April 18, 2001
Summary
Large intramural uterine fibroids discovered during cesarean delivery can become pedunculated postpartum. This transformation can simplify and enhance the safety of a postpartum myomectomy compared to removal during cesarean birth.
Area of Science:
- Reproductive Medicine
- Gynecologic Surgery
Background:
- Uterine leiomyomas, commonly known as fibroids, are frequent in women of reproductive age.
- Their natural history during pregnancy is of significant clinical interest.
Observation:
- A case study details a 39-year-old primigravida with vaginal spotting at 10 weeks gestation.
- Ultrasonography identified a large intramural leiomyoma.
- Despite unsuccessful tocolysis, a cesarean section was performed at 25 weeks for breech presentation, with the intramural fibroid left in situ.
Findings:
- Postpartum, six months after cesarean delivery, the 10-cm intramural leiomyoma was observed to have transformed into a pedunculated fibroid on a 4-cm stalk.
- This change occurred spontaneously after delivery.
Implications:
- Intramural fibroids identified during cesarean delivery may pedunculate postpartum, facilitating safer and simpler postpartum myomectomy.
- Understanding this potential fibroid transformation aids in planning subsequent myomectomy procedures.
- Pre-pregnancy myomectomy is advisable for fibroids that have previously complicated a pregnancy.