Unnoticed early pregnancy during myomectomy with favorable outcome: Case report

Uterine fibroids are a common cause of infertility, and myomectomy remains a key surgical intervention to improve reproductive outcomes. However, the occurrence of an undetected pregnancy during myomectomy is rare and poses significant clinical risks.

We report a 34-year-old woman, nulliparous with a history of secondary infertility and three first-trimester miscarriages. She had multiple fibroids and was managed for polycystic ovarian syndrome and hyperprolactinemia. Scheduled for abdominal myomectomy, the surgery proceeded uneventfully, with six fibroids removed and no breach of the endometrial cavity. Five weeks postoperatively, she presented with symptoms suggestive of early pregnancy. Ultrasound confirmed a viable intrauterine gestation of 8 weeks and 1 day. She later developed cervical shortening at 11 weeks and underwent cerclage. The pregnancy progressed without further complications, and she delivered a healthy infant via elective caesarean section at 36 weeks and 2 days.

This case underscores the importance of thorough preoperative assessment to exclude pregnancy. It also reflects emerging evidence suggesting that conception shortly after myomectomy does not necessarily increase obstetric risk, especially when the uterine cavity remains intact.

Although conception during or soon after myomectomy is generally avoided, favorable outcomes are possible with careful surgical technique and close antenatal monitoring. Individualized counseling may be more appropriate than rigid timing guidelines for conception post-myomectomy.