Coexistente of a prolapsed, pedunculated cervical myoma and pregnancy complications: A case report
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Date
2004
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Abstract
BACKGROUND: Different types of fibroids may affect reproductive outcome to a different extent, causing infertility and pregnancy wastage. Rectosigmoid compression, prolapse of a pedunculated submucous tumor through the cervix, venous stasis, polycythemia and ascites are infrequently associated with leiomyomas. Uterine leiomyomas are found in approximately 2% of pregnant women; 1 in 10 causes complications during pregnancy. CASE: A 37-year-old woman, gravida 3, para 2, abortion 0, at 18 weeks of pregnancy, arrived at our outpatient clinic with a complaint of leaking vaginal fluid. On examination, a prolapsed, pedunculated myoma, measuring 5 × 6 × 7 cm, and pooling of amniotic fluid in the vaginal fornix were detected. Antibiotics were started, but the amniotic fluid leak continued, and the fetal heart beat became undetectable after 12 hours of hospitalization. We tried to excise the myoma from the vagina but because it was very large, we could not reach the proximal point it originated from. We dissected the posterior cervical channel, removed the myoma and performed a total abdominal hysterectomy. CONCLUSION: Vaginal myomectomy is recommended as the initial treatment of choice for a prolapsed, pedunculated submucous myoma except when other indications necessitate an abdominal approach. Use of Laminaria and hysteroscopic resection has been mentioned as other treatment choices. In our case a prolapsed, pedunculated cervical myoma was detected along with pregnancy complications, preterm premature rupture of membranes and fetal death. The cause-and-effect relationship between the prolapsed myoma and membrane rupture is unknown. We were unable to perform a vaginal or abdominal myomectomy because the myoma originated in the posterior cervical region, so we had to perform an abdominal hysterectomy.
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Abortion, Induced , Adult , Female , Fetal Death , Fetal Membranes, Premature Rupture , Humans , Hysterectomy , Myoma , Pregnancy , Pregnancy Complications, Neoplastic , Prolapse , Uterine Cervical Neoplasms , antibiotic agent , abdominal hysterectomy , adult , amnion fluid , antibiotic therapy , article , case report , clinical examination , female , female infertility , fetus death , fetus monitoring , fetus wastage , gestational age , human , myoma , myomectomy , pregnancy complication , premature fetus membrane rupture , priority journal , surgical approach , surgical technique , treatment indication , uterus myoma , uterus prolapse , vagina discharge , fetus death , hysterectomy , induced abortion , methodology , myoma , pregnancy , pregnancy complication , premature fetus membrane rupture , tissue injury , uterine cervix tumor