We report a case of successful myomectomy performed at the time of an emergency cesarean section, with an intent to disintegrate the long-established belief of avoiding it due to fear of complications. Pregnancy with fibroid is a high-risk situation. Although the majority of such cases are asymptomatic or have mild symptoms, 10–40% of cases can present with antenatal complications in the form of pregnancy loss, degenerative changes, malpresentation, abruption placenta, preterm labor, dysfunctional labor or uterine inertia, and increased chances of operative delivery, thus increasing maternal and fetal morbidity and mortality [
3]. Treatment is usually conservative during the antenatal period in the form of bed rest, adequate hydration, and analgesics. Myomectomy is rarely required in the case of intractable abdominal pain due to twisting of pedunculated sub-serosal fibroid, red degeneration unresponsive to conservative treatment, or massively enlarged myoma causing abdominal discomfort to the patient [
1]. In a recent study, a successful myomectomy was performed during the first trimester at 11 weeks for a large myoma of 14 cm that was a cause of severe discomfort to the patient [
4]. The patient continued with pregnancy to term and delivered a healthy baby. Another uneventful myomectomy was performed in the second trimester by Bhatla
et al. without any adverse impact on pregnancy [
5]. Myomectomy during cesarean section is still a topic of debate in the modern era. Until the last decade, it was considered a dreadful surgery except for pedunculated sub-serosal fibroids. However, many researches have concluded that the procedure is not dangerous and does not lead to complications in the hands of an experienced obstetrician [
6]. Kwawukume performed cesarean myomectomies on 12 patients and reported that enucleation was much easier in pregnancy due to increased softness of the tissue [
7]. A retrospective case–control study, comparing 40 women with fibroids who underwent cesarean myomectomy with 80 women with fibroids forming the control group who underwent cesarean section alone, reported no significant difference in the incidence of hemorrhage between the two groups (12.5% and 11.3%, respectively) [
8]. Similar findings were reported in another study, with no significant differences in hemoglobin levels, incidence of blood transfusions, or postoperative pyrexia. However, not all myomas need to be removed, but only those causing difficulty in delivery of the fetus or wound closure and sub-serosal fibroids. In our case, myomectomy was inevitable as the myoma was in the incision line, making wound closure impossible. Every possible effort should be made to reduce the blood loss. Bilateral ligation of uterine arteries immediately after delivery of the fetus significantly reduces both intraoperative and postoperative blood loss and risk of peripartum hysterectomy [
9]. It also reduces the recurrence of myomas and minimizes the need for future surgery, with no apparent effect on fertility [
10]. This was a key step in our case which prevented the dreaded complications. Also, the postpartum uterus is better adapted physiologically to control bleeding than in any other phase of a woman’s lifetime. The patient and relatives should be properly counseled and informed that removal of myoma is possible, and a final decision can be taken at the time of cesarean based upon the size, number, and location of the fibroid.