Successful myomectomy during pregnancy : A case report

BACKGROUND: The medical literature has reported an increase in myomectomy during caesarean section in the past decade. However, myomectomy performed during pregnancy remains a rarity. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery. We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy. CASE PRESENTATION: A 30 year old woman presented with a one year history of abdominal swelling, amenorrhea and severe epigastric discomfort of 19 weeks duration. The abdomen was grossly distended and tense. A sonographic diagnosis of ovarian tumor in pregnancy was made. Laparotomy revealed a 32 cm degenerating subserosal uterine fibroid co-existing with an intrauterine pregnancy. Myomectomy was successfully performed. The subsequent antenatal period was uneventful with a spontaneous vaginal delivery of a female baby at 38 weeks. CONCLUSION: This report supports other studies and case series that have demonstrated the safety of myomectomy during pregnancy in selected circumstances

OUTCOME OF PREGNANCY IN WOMEN WITH UTERINE MALFORMATION - EVALUATION OF 62 CASES

A retrospective analysis of the outcome of pregnancy in 62 women seen between 1971 and 1988, with a uterine malformation was carried out. Fifty-seven out of 62 cases with a uterine malformation conceived and there was a total of 127 pregnancies. On the other hand five women have an unexplained infertility of more than 2 years duration. The abortion rate among these 127 pregnancies was 36%, premature delivery rate 22% and term delivery rate 42%. Cases with a complete septate uterus had the higher abortion rate. Metroplasty was done in three patients with a uterus bicornis and in six cases with a septate uterus. Cervical cerclage was done in 23 cases. Breech presentation was very frequent (46%). The cesarean section rate in the 81 cases whose pregnancy continued beyond the 28th week of pregnancy was 63%. Perinatal mortality rate was 37% and fetal survival rate 61%

MYOMECTOMY DURING PREGNANCY AND CESAREAN-SECTION

Myomectomy was performed on a 31 year old primigravida during the 15th week of pregnancy due to a large myoma which was 23 cm in diameter, At the 39th week of pregnancy, during the Caesarean section, eight fibroids obstructing the lower part of the uterus were removed, There were no maternal or fetal complications

Cervico-isthmic pregnancy: an extremely rare case diagnosed during labour

This case report describes a cervico-isthmic pregnancy ending in a live vaginal birth at 37 + 2 weeks’ gestation. The case remained undiagnosed throughout pregnancy when after a fairly normal tabour a massive haemorrhage occurred. After an unsuccessful effort to control the bleeding conservatively, a total abdominal hysterectomy was carried out. During the operation the diagnosis of cervico-isthmic pregnancy was confirmed, which was in accordance with the pathology report. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved

Laparoscopic treatment of hydrosalpinx: Factors affecting pregnancy rate

Study Objective, To evaluate the efficacy of laparoscopic surgery in a series of women with hydrosalpinx. Design. Prospective, observational study (Canadian Task Force classification IL-2). Setting. University-affiliated hospital. Patients. Sixty-one women undergoing bilateral neosalpingostomy and restoration of tubal ovarian anatomy laparoscopically, and followed for 24 months. Intervention. Video-controlled operative laparoscopy using standard four-puncture technique. Measurements and Main Results. During 24-month follow-up, cumulative intrauterine pregnancy rates at 6-month intervals were 6.8%, 13.6%, 20.5%, and 20.5% for patients with only distal tubal obstruction and 12%, 23%, 29%, and 29% For those with mild degree of tubal disease and periadnexal adhesions. Miscarriage rate for intrauterine pregnancies was zero in both groups. Conclusion. Operative laparoscopy seems to be an effective treatment for hydrosalpinx in terms of pregnancy outcome

Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise?

Objective: To investigate the incidence of gynecological malignancy in menopausal women who develop tubo-ovarian abscesses (TOAs), and to address the differences in presentation and underlying pathology between premenopausal and postmenopausal women with TOAs. Study design: In a retrospective study we included 93 patients with a diagnosis of a TOA and compared a premenopausal group (group 1) with a postmenopausal group (group 2). Results: Group 1 included 76 (82%), and group 2 17 (18%) patients. Abdominal pain and pyrexia >38 degreesC were present in 93 and 74% cases of group 1, and in 71 and 41% cases of group 2 (P = 0.016 and 0.019, respectively). Irregular vaginal bleeding and gross ascites were significantly more frequent in group 2. With respect to benign additional pathology we found no differences between the two groups. On the contrary a significant association between TOAs in menopause and malignancy was established. In 8 (47%) postmenopausal cases a concomitant gynecological malignancy was found including a variety of cancers. Conclusion: Postmenopausal women presenting with TOAs, should be thoroughly investigated to exclude a concomitant pelvic malignancy. Conservative treatment of TOAs has no place during the menopause. (C) 2003 Elsevier Ireland Ltd. All rights reserved