Abstract

Background: Large uterine fibroids during pregnancy are associated with increased maternal and fetal complications. It can be a cause for arrest of labor and the need for cesarean delivery. Prior to the late 2000s, the reported prevalence ranged from 0.1 to 3.9%, with more recent data suggesting rates closer to 11%.1,2 The majority of these fibroids do not significantly change during pregnancy and frequently remain asymptomatic but if the fibroids grow in isthmic localization, vaginal delivery can be very difficult or impossible and many complications might also occur. Objectives: Uterine fibroids greater than 5 cm in diameter are more likely to grow during pregnancy and cause obstetrical complications. In this case,we report a case of a large 10 cm lower uterine fibroid presented to our hospital with obstructed labour and antepartum eclampsia resulting in cesarean delivery. Myomectomy was also done simultaneously. Methods: A 38 year-old gravida 3, para 2, pregnant woman was referred to our obstetrics emergency at SNMMCH, Dhanbad at 37 week gestation with diagnosis of antepartum eclampsia. Her pregnancy was further complicated by a presence of enlarged lower uterine segment fibroid with largest measuring 10.3 cm. Conclusion: Uterine fibroids are associated with an increased risk of caesarean delivery. The main factors for deciding the mode of delivery depends on the location, size and number of fibroids. Fibroids which are located in lower uterine segment present as case of obstructed labor and in these case caesarean delivery is preferred. Also caesarean myomectomy has been increasingly done now a days in order to avoid risk of reoperation in future.

• 1.   Laughlin S K, Baird D D, Savitz D A, Herring A HS, Hartmann K E. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet Gynecol. 2009;113(03):630–635. doi: 10.1097/ AOG.0b013e318197bbaf. [DOI] [PMC free article] [PubMed] [Google Scholar]
• 2.   Qidwai G I, Caughey A B, Jacoby A F.Obstetric outcomes in women with sonographically identified uterine leiomyomata Obstet Gynecol 2006107(2 Pt 1):376–382. [DOI] [PubMed] [Google Scholar]
• 3.   Mathews T J, Hamilton B E. Mean age of mothers is on the rise: United States, 2000–2014. NCHS Data Brief. 2016;(232):1–8. [PubMed] [Google Scholar]
• 4.   Stewart E A, Cookson C L, Gandolfo R A, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124(10):1501–1512. doi: 10.1111/1471- 0528.14640. [DOI] [PubMed] [Google Scholar]
• 5.   Rice J P, Kay H H, Mahony B S.The clinical significance of uterine leiomyomas in pregnancy Am J Obstet Gynecol 1989160(5 Pt 1):1212–1216. [DOI] [PubMed] [Google Scholar]
• 6.   Vergani P, Locatelli A, Ghidini A, Andreani M, Sala F, Pezzullo J C.Large uterine leiomyomata and risk of cesarean delivery Obstet Gynecol 2007109(2 Pt 1):410–414. [DOI] [PubMed] [Google Scholar]
• 7.   Kaymak O, Ustunyurt E, Okyay RE, et al. Myomectomy during cesarean section. Int J Gynaecol Obstet 2005;89:90-3. [Crossref] [PubMed]
• 8.   Gürsoy A, Atasayan K, Tekbaş ED, et al. The Dilemma of Cesarean Myomectomy: Is It Safe or Not. J Exp Clin Med 2021;38:410-5. [Crossref]
• 9.   Ramya T, Sabnis SS, Chitra TV, et al. Cesarean Myomectomy: An Experience from a Tertiary Care Teaching Hospital. J Obstet Gynaecol India 2019;69:426-30. [Crossref] [PubMed]
• 10.   Shields LE, Goffman D, Caughey AB. ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 2017;130:e168-86.
• 11.   NICE. Intrapartum care for healthy women and babies. Clinical Guideline [CG190]. NICE; 2014. Available online: https://www.nice.org.uk/guidance/cg190.

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