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 [2–4]. 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, 8–10]. 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
References
[1]
N. P. Cooper and S. Okolo, “Fibroids in pregnancy—common but poorly understood,” Obstetrical and Gynecological Survey, vol. 60, no. 2, pp. 132–138, 2005.
[2]
J. P. Phelan, “Myomas and pregnancy,” Obstetrics and Gynecology Clinics of North America, vol. 22, no. 4, pp. 801–805, 1995.
[3]
C. A. Burton, D. A. Grimes, and C. M. March, “Surgical management of leiomyomata during pregnancy,” Obstetrics and Gynecology, vol. 74, no. 5, pp. 707–709, 1989.
[4]
F. S. Suwandinata, S. E. Gruessner, C. O. Omwandho, and H. R. Tinneberg, “Pregnancy-preserving myomectomy: preliminary report on a new surgical technique,” European Journal of Contraception and Reproductive Health Care, vol. 13, no. 3, pp. 323–326, 2008, Erratum in: European Journal of Contraception and Reproductive Health Care, vol. 13, no. 4, p. 438, 2008.
[5]
K. Leach, L. Khatain, and K. Tocce, “First trimester myomectomy as an alternative to termination of pregnancy in a woman with a symptomatic uterine leiomyoma: a case report,” Journal of Medical Case Reports, vol. 5, no. 1, article 571, 2011.
[6]
D. E. Lolis, S. N. Kalantaridou, G. Makrydimas et al., “Successful myomectomy during pregnancy,” Human Reproduction, vol. 18, no. 8, pp. 1699–1702, 2003.
[7]
M. Bonito, L. Gulemì, R. Basili, and D. Roselli, “Myomectomy during the first and second trimester of pregnancy,” Clinical and Experimental Obstetrics and Gynecology, vol. 34, no. 3, pp. 149–150, 2007.
[8]
M. Ardovino, I. Ardovino, M. A. Castaldi, A. Monteverde, N. Colacurci, and L. Cobellis, “Laparoscopic myomectomy of a subserous pedunculated fibroid at 14 weeks of pregnancy: a case report,” Journal of Medical Case Reports, vol. 5, no. 5, article 545, 2011.
[9]
S. Doerga-Bachasingh, V. Karsdorp, G. Yo, R. van der Weiden, and M. van Hooff, “Successful myomectomy of a bleeding myoma in a twin pregnancy,” JRSM Short Reports, vol. 3, no. 2, p. 13, 2012.
[10]
G. Mollica, L. Pittini, E. Minganti, G. Perri, and F. Pansini, “Elective uterine myomectomy in pregnant women,” Clinical and Experimental Obstetrics and Gynecology, vol. 23, no. 3, pp. 168–172, 1996.
[11]
G. D. Coronado, L. M. Marshall, and S. M. Schwartz, “Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study,” Obstetrics and Gynecology, vol. 95, no. 5, pp. 764–769, 2000.
[12]
S. de Carolis, G. Fatigante, S. Ferrazzani et al., “Uterine myomectomy in pregnant women,” Fetal Diagnosis and Therapy, vol. 16, no. 2, pp. 116–119, 2001.
[13]
N. Bhatla, B. B. Dash, A. Kriplani, and N. Agarwal, “Myomectomy during pregnancy: a feasible option,” Journal of Obstetrics and Gynaecology Research, vol. 35, no. 1, pp. 173–175, 2009.
[14]
C. Celik, A. Acar, N. Ci？ek, K. Gezginc, and C. Akyürek, “Can myomectomy be performed during pregnancy?” Gynecologic and Obstetric Investigation, vol. 53, no. 2, pp. 79–83, 2002.
[15]
V. Lozza, A. Pieralli, S. Corioni, M. Longinotti, and C. Penna, “Multiple laparotomic myomectomy during pregnancy: a case report,” Archives of Gynecology and Obstetrics, vol. 284, no. 3, pp. 613–616, 2011.
[16]
C. C. Kilpatrick, M. T. Adler, and L. Chohan, “Vaginal myomectomy in pregnancy: a report of two cases,” Southern Medical Journal, vol. 103, no. 10, pp. 1058–1060, 2010.
[17]
S. P. Michalas, F. V. Oreopoulou, and J. S. Papageorgiou, “Myomectomy during pregnancy and Caesarean section,” Human Reproduction, vol. 10, no. 7, pp. 1869–1870, 1995.
[18]
E. Danzer, W. Holzgreve, C. Batukan, P. Miny, S. Tercanli, and I. Hoesli, “Myomectomy during the first trimester associated with fetal limb anomalies and hydrocephalus in a twin pregnancy,” Prenatal Diagnosis, vol. 21, no. 10, pp. 848–851, 2001.
[19]
J. G. Joó, J. Inovay, M. Silhavy, and Z. Papp, “Successful enucleation of a necrotizing fibroid causing oligohydramnios and fetal postural deformity in the 25th week of gestation: a case report,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 46, no. 10, pp. 923–925, 2001.
[20]
U. Hasbargen, A. Strauss, M. Summerer-Moustaki et al., “Myomectomy as a pregnancy-preserving option in the carefully selected patient,” Fetal Diagnosis and Therapy, vol. 17, no. 2, pp. 101–103, 2002.
[21]
C. Umezurike and P. Feyi-Waboso, “Successful myomectomy during pregnancy: a case report,” Reproductive Health, vol. 2, article 6, 2005.
[22]
F. Usifo, R. Macrae, R. Sharma, I. O. Opemuyi, and B. Onwuzurike, “Successful myomectomy in early second trimester of pregnancy,” Journal of Obstetrics and Gynaecology, vol. 27, no. 2, pp. 196–197, 2007.
[23]
G. K. C. Leite, H. A. Korkes, T. Viana Ade, A. Pitorri, G. Kenj, and N. Sass, “Myomectomy in the second trimester of pregnancy: case report,” Revista Brasileira de Ginecologia e Obstetricia, vol. 32, no. 4, pp. 198–201, 2010.
[24]
P. Isabu, J. Eigbefoh, F. Okogbo, S. Okunsanya, and R. Eifediyi, “Myomectomy during second trimester pregnancy: a case report,” The Nigerian Postgraduate Medical Journal, vol. 17, no. 4, pp. 324–326, 2010.
