Miomectomy in early pregnancy

Abstract

Myomas or leiomyomas are benign monoclonal tumors that histologically arise from proliferation of smooth muscle and connective tissue of the uterus. They are slow growing and malignant degeneration is less than 1% and as low as 0.2%. Worldwide prevalence varies from 5-21%, increasing with age; 1.8% in women aged 20-29 years and 14.1% in women over 40 years.
A reduction in clinical pregnancy is reported in patients with uterine myomatosis greater than 4 cms (29 vs. 52%, p=0.025), compared to women without uterine myomatosis. If pregnancy is achieved as such, fibroids during pregnancy may cause: increased rate of miscarriage (due to distortion of the uterine cavity), premature contractions, premature rupture of membranes, placenta previa, placental abruption, abnormal fetal presentation, or postpartum hemorrhage and increased rate of cesarean section. We describe the clinical case of a 36-year-old female patient, primigravida, with a history of primary infertility and diagnosis of uterine myomatosis of large elements with a pregnancy of 11 weeks, in whom myomectomy was decided during pregnancy because she presented several clinical symptoms of threatened abortion and constant pelvic pain, as well as respiratory difficulty due to uterine volume, which evolved satisfactorily and in whom pregnancy was resolved by means of a programmed cesarean section plus hysterectomy, obtaining a female newborn at term.