%0 Journal Article
%T Laparotomic Myomectomy in the 16th Week of Pregnancy: A Case Report
%A Lavinia Domenici
%A Violante Di Donato
%A Maria Luisa Gasparri
%A Francesca Lecce
%A Jlenia Caccetta
%A Pierluigi Benedetti Panici
%J Case Reports in Obstetrics and Gynecology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/154347
%X Myomectomy is rarely performed during an ongoing pregnancy because of fear of miscarriage and the risk of an uncontrolled haemorrhage necessitating a hysterectomy. In cases where myomectomy is undertaken, most are performed at the time of cesarean section or with a laparoscopic approach. We report a case of a successful laparotomic myomectomy in the 16th week of pregnancy. A 35-year-old primigravida was admitted to our department with acute abdominal pain and hydronephrosis (serum creatinine 1.6£¿mg/dL). Imaging revealed a large implant myoma compressing the bladder, ureters, rectus, and gestational chamber and causing hydronephrosis. Laparotomic myomectomy was successfully performed and pregnancy continued uneventfully until the 38th week when a cesarean section was performed. Surgical management of myomas during pregnancy is worth evaluating in well-selected and highly symptomatic cases. 1. Introduction The estimated prevalence of uterine myomas during pregnancy varies from 0.3 to 15% [1]. Most uterine myomas remain asymptomatic during pregnancy but may result in obstetrical complications in about 10% of cases depending on their size, location, and number [2¨C4]. Pain is the main symptom reported in pregnancies with uterine myoma; however, in 2% of patients conservative medical therapy fails. In extreme cases some authors have advocated the interruption of pregnancy to relieve pain [5]. Myomectomy is generally avoided during pregnancy due to the high risk of haemorrhagic or obstetrical complications and no clear unanimous consensus exists, with a surgical approach reserved for cases of intractable abdominal pain and degeneration or rapid growth of myoma [6, 7]. Only a few cases of myomectomy in pregnancy have been reported in the literature [6, 8¨C10]. In this paper we report a case of myomectomy of subserous myoma with large base of implant causing hydronephrosis in the 16th week of pregnancy. 2. Case Presentation In January 2013, a 35-year-old primigravid Caucasian woman (BMI: 22) was referred to our university hospital in the 16th week of gestation for intractable pelvic pain. The medical history was uneventful. The patient reported a sense of pelvic heaviness, changes in urinary habits, lower abdominal discomfort, and unexplained back pain that had worsened over time. She had a normal white blood cell count but an increased value of serum creatinine (1.6£¿mg/dL). Obstetrical examination showed a large mass at the level of the posterior fornix. Abdominal ultrasound confirmed a viable fetus and a subserous large implant myoma (diameter of 20£¿cm; Figure
%U http://www.hindawi.com/journals/criog/2014/154347/