Lower Uterine Segment Fibroid Complicating

Case Report
Lower Uterine Segment Fibroid Complicating
Pregnancy: A Case Report
C Jothikala1, Jamila Hameed2, S Radhika2, S Haseena3, Mouhamed Nazar4
1
Post-graduate, Department of Obstetrics and Gynaecology, Vinayaka Mission’s Medical College and Hospitals, Karaikal, Puducherry, India, 2Professor,
Department of Obstetrics and Gynaecology, Vinayaka Mission’s Medical College and Hospitals, Karaikal, Puducherry, India, 3Assistant Professor,
Department of Obstetrics and Gynaecology, Vinayaka Mission’s Medical College and Hospitals, Karaikal, Puducherry, India, 4Intern, Department of
Obstetrics and Gynaecology, Vinayaka Mission’s Medical College and Hospitals, Karaikal, Puducherry, India
The uterine fibroids are very common in the reproductive age group. During pregnancy, it may undergo rapid growth and red degeneration.
It may get infected during puerperium. Most of the fibroids are asymptomatic. Women with fibroids may have infertility, a tendency for
miscarriage, pre-term labor, placental abruption, placenta previa, fetal growth restrictions, fetal anomalies, postpartum hemorrhage, uterine
dystocia, malpresentations and increased risk of caesarean. Here, we present 26-year-old primigravida who was admitted with 9 months of
amenorrhea and anterior lower uterine segment intramural fibroid of size 7.2 cm × 7.1 cm on the right side. She conceived immediately after
marriage. All Investigations were normal. She was delivered by a cesarean section. An alive female baby of 2.5 kg with good Apgar score. The
indication was lower uterine segment fibroid. The liquor was meconium stained. There was no sign of intrauterine growth restriction of the
baby. The Doppler study, cardio-topography was normal before section. The post-operative period was uneventful. The patient was discharged
and came for follow-up after a month and was found to be alright.
Keywords: Caesarean section, Leiomyoma, Pregnancy complications
INTRODUCTION
Leiomyoma is the most common estrogen dependent
benign tumor of the uterus occurring in the reproductive
age. Asymptomatic myomas can be present in 50% of
cases.1 During pregnancy, fibroid may grow in size due
to hormones and undergo red degeneration. Growth
of leiomyoma is dependent on estrogen production,
growth factors and clonal expansion.2 The tumor thrives
during the period of greatest ovarian activity. Continuous
estrogen secretion, especially when uninterrupted by
pregnancy and lactation are thought to be the most
important risk factor in the development of myoma. It
causes mainly menstrual problems such as menorrhagia,
metrorrhagia, dysmenorrhea, and also infertility. Incidence
of women suffering infertility is 12-25%.3 In spite of several
complications of fibroid in pregnancy, this case had come
out successfully with a live baby.
CASE REPORT
A 26-year-old primigravida, a booked case, got admi ed for
safe confinement. She has been a ending ante-natal clinics
from the first trimester. She had a dating ultrasound scan
done. She had repeated admissions for pain, impending
pre-term labor during her antenatal visits. At term, she
got admi ed. On clinical examination, nil abnormality
was found out, except transverse lie. Medical and surgical
history was not significant. Ultrasonography was done.
The impression was that of an “anterior lower segment
uterine myoma” of size 7.2 cm × 7.1 cm on the right side.
Patient was not anemic. Blood pressure was normal.
The uterus was term on palpation. It was a transverse
lie, fetal heart rate was good. The liquor was diminished
(oligohydramnios, amniotic fluid index - 4 cm). The routine
blood investigations were normal. Patient was taken up
for elective lower segment caesarean section (LSCS) and
delivered an alive female baby weighing 2.5 kg and there
was huge intramural fibroid 7 cm × 7 cm on the right side
of lower segment of the uterus (Figure 1). The uterine cavity
closed in two layers without disturbing the intramural
fibroid (Figure 2). Patient went in for mild postpartum
hemorrhage and managed with uterotonics and blood.
Post-operative period was uneventful. She was discharged
home on the 8th post-operative day. She came for review
with her baby.
DISCUSSION
Fibroids are usually estrogen dependent benign tumors
found in women of reproductive age group, which cause
symptoms likes infertility, menstrual problems, pressure
symptoms, pain, recurrent miscarriages. Complications
in pregnancy are red degeneration, sudden increase in
Corresponding Author:
Dr. Jamila Hameed, Vinayaka Mission’s Medical College & Hospitals, Karaikal, Puducherry, India. Phone: +91-9444611107.
E-mail: [email protected]
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IJSS Case Reports & Reviews | November 2014 | Vol 1 | Issue 6
Jothikala, et al.: Lower Uterine Fibroid
in women with fibroids.8 According to a study in contrast
to the usual fact, it shows that women with leiomyomas
are at no longer at risk for obstetric complications when
compared with women without fibroids.9 Sometimes a
huge fibroid in early pregnancy with complication may
require myomectomy.10
CONCLUSION
Figure 1: Huge intramural fibroid 7 cm × 7 cm on the right side of lower segment
of the uterus
This lady with the fibroid complicating pregnancy in spite
of repeated admissions for threatened abortion, pain, and
impending preterm delivery was treated with tocolytics.
LSCS was done and had a good fetal outcome. This
encourages the obstetrician and gives hope for the patient
in an ordinary set up in developing countries. With the
discovery of the myomas in the antenatal period, need not
alarm the obstetrician and does not usually appear to have
an adverse impact on the outcome of the pregnancy.
REFERENCES
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Figure 2: Closing of uterine cavity in two layers without disturbing the intramural
fibroid
growth, malpresentation, premature labour, premature
rupture of membranes, intra-uterine growth restriction,
abruption of placenta, placenta previa, retained placenta,
postpartum haemorrhage, sub-involution of uterus,
decreased perinatal outcome and increased caesarean
section rate. Asymptomatic fibroids constitute around
50%. The magnetic resonance imaging, computed
tomography and ultrasound are helpful in diagnosis. The
submucous fibroids are outlined by hysterosalpingogram.
Hysteroscopy and laparoscopy are additional tools in
diagnosis in non-pregnant uterus. Fibroid in pregnancy,
when the dating scan is done if the fibroid is more than
4 cm and more in number and also the location namely the
lower body intramural myoma causes more complications
in pregnancy. The rate of spontaneous pregnancy loss
is double in fibroid complicating pregnancy, especially
is higher with multiple fibroids than single fibroid.
Cesarean section rate is also higher in patients with
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position of the fibroid plays an important role in fertility,
especially the submucous and the intramural. Hence, a
myomectomy in these cases improves the chance of fertility
and maintenance of pregnancy.7 The complications during
ante-partum, intrapartum and postpartum are increased
IJSS Case Reports & Reviews | November 2014 | Vol 1 | Issue 6
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How to cite this article: Jothikala, Hameed J, Radhika, Haseena S, Nazar M.
Lower uterine segment fibroid complicating pregnancy: A case report. IJSS
Case Reports & Reviews 2014;1(6):18-19.
Source of Support: Nil. Conflict of Interest: None declared.
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