Caesarean myomectomy of a large cervical fibroid

Excerpt

A 21-year-old second gravida with a previous second trimester loss presented at 10 weeks of gestation with pregnancy complicated by a large cervical fibroid measuring 135 × 120 mm (Fig. 1a, b). Serial ultrasound surveillance revealed an average-for-gestational-age fetus and central placenta praevia. Antepartum haemorrhage at 34 weeks of gestation prompted delivery of a 2680 g baby with good Apgar scores by classical caesarean section. The uterine incision was extended inferiorly to facilitate cervical myomectomy (Fig. 1c, d). This was deemed necessary to avoid post-partum retention of lochia and consequent development of pyometra and sepsis as the lower endometrial cavity was completely obliterated by the myoma. Postpartum haemorrhage of 2200 ml was controlled with medical measures and Hayman sutures (Fig. 1e), and four units of packed red cells were transfused. She made an uneventful recovery and was discharged on the sixth postoperative day. Histopathology of the 1760 g fibroid (Fig. 1f) was reported as benign leiomyoma. Follow-up pelvic ultrasonography a year later was unremarkable. Recent reports indicate myomectomy during Caesarean section to be a safe procedure. However, careful selection of cases and availability of requisite surgical expertise to deal with massive (and sometimes unavoidable) blood loss are paramount.

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