Caesarean hysterectomy in a nullipara with multiple uterine fibroids
Background:· There are various reports in literature of successful surgical intervention of leiomyoma in pregnancy mainly, in the second trimester, with a few in the first trimester. These surgeries were undertaken when conservative management of leiomyoma symptoms failed.Almost all reported cases were carefully selected pendunculated leiomyoma masses. Early pregnancy termination with interval myomectomy is an alternative option explored by both surgeons and patients.Caesarean hysterectomy in a first pregnancy is not a frequently reported case.
Case Report :-A 35-year-old primigravida was referred by a private health facility with huge uterine fibroid co-existing with pregnancy of 12 weeks. The largest mass measured 17.7cm. There were several others distributed throughout the uterus. She declined second trimester myomectomy. Worsening symptoms unresponsive to conservative measures resulted in caesarean delivery at 32 weeks of gestation. She had subtotalhysterectomy because of life threatening haemorrhage.
Conclusion:-Adequate counselling on all available options of management of symptomatic leiomyoma co-existing with pregnancy need to be provided by the surgeon in an unbiased manner. The final decision should be clearly documented as this may reduce litigation arising from interventions in the management of the pregnancy.
Keywords: Leiomyoma, Primary postpanum haemorrhage, Caesarean Hysterectomy.