Prolapsed Fibroid in Pregnancy

Article Information

Title: Prolapsed Fibroid in Pregnancy

Authors: Mussarat Batool, Ayesha Ahmed, Sidra Rauf, Shirza Sharafat, Shabnum Rasheed

Journal: Journal of Islamabad Medical and Dental College (JIMDC)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2022-07-01	2023-06-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30

Publisher: Healers Educational Society

Country: Pakistan

Year: 2023

Volume: 12

Issue: 3

Language: English

DOI: 10.35787/jimdc.v12i3.999

Keywords: PregnancyFibroidmyomectomy

Abstract

Uterine fibroids are commonly encountered in clinical practice. Majority of the fibroids are usually asymptomatic during pregnancy, however they may lead to complications in all three trimesters of pregnancy and even in the post natal period, causing a management dilemma. Vaginal prolapse of uterine fibroids is a rare phenomenon during pregnancy, delivery or puerperium. While most of the fibroids are managed conservatively, a few require surgical intervention Despite of multiple publications in the medical literature on the gynecological aspects of fibroids, scanty data is available on management during pregnancy and labor, posing a therapeutic dilemma. We present a case of a G4P3, presenting at 30weeks gestation with large degenerated prolapsed uterine fibroid which was successfully managed by vaginal myomectomy concurrently with cesarean section.

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Research Objective

To present a case of a G4P3, presenting at 30 weeks gestation with a large degenerated prolapsed uterine fibroid, and describe its successful management.

Methodology

Case report detailing the presentation, investigation, and management of a pregnant patient with a prolapsed uterine fibroid. The management involved a vaginal myomectomy concurrently with a cesarean section.

Methodology Flowchart

                        graph TD;
    A["Patient Presentation with Prolapsed Fibroid"] --> B["Investigations: Ultrasound, Hemoglobin"];
    B --> C["Decision for Management"];
    C --> D["Cesarean Section"];
    D --> E["Vaginal Myomectomy"];
    E --> F["Post-operative Care"];
    F --> G["Successful Outcome"];

Discussion

Uterine fibroids are common in pregnancy, but prolapse is rare. Management of fibroids during pregnancy is challenging due to potential complications. While conservative management is often preferred, surgical intervention may be necessary. Simultaneous myomectomy during cesarean section can be a viable option in selected cases, though it carries risks of hemorrhage.

Key Findings

A 38-year-old pregnant woman at 30+3 weeks gestation presented with a large, degenerated, and infected prolapsed uterine fibroid. She successfully underwent a cesarean section for delivery of a live baby, followed by a vaginal myomectomy to remove the fibroid.

Conclusion

The case demonstrates that a large, degenerated prolapsed uterine fibroid in pregnancy can be successfully managed by a combined approach of cesarean section and vaginal myomectomy, highlighting the importance of careful case selection and experienced surgical management.

Fact Check

* The patient was 30+3 weeks gestation at presentation.
* The prolapsed fibroid measured 16x16cm on examination.
* The delivered baby weighed 1.1kg.

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