Multiple myomectomy in pregnancy and at caesarean section: a case report of a patient managed at the Hospital des Oliviers in Lubumbashi. Democratic Republic of Congo

Abstract

Myomectomy during pregnancy is rarely performed because of the risks of premature interruption of the pregnancy, infection and uncontrollable uterine haemorrhage. We report here a case of myomectomy performed at 19 weeks of gestation in a 27-year old primigravida. Surgical intervention was necessary due to intense and refractory abdominal pain as a result of a rapid increase in size of a subserosal myoma. Under adequate analgesia and tocolytic therapy, the operation resulted in the ablation of three subserosal myomas. A sessile subserosal myoma was left untouched. Post-operative recovery was uneventful and the pregnancy progressed without any complications. At 38 weeks, the patient delivered a male baby weighing 3050 grams via elective caesarean section due to breech presentation. APGAR score was 9 and 10 at 1 and 5 minutes respectively. At caesarean section, we also proceeded without any trouble, to the resection not only of the intramural and subserosal myoma previously left untouched but also of nine other subserosal myomas discovered intra-operatively. When performed under certain circumstances, myomectomy during pregnancy may lead to a favourable obstetric outcome, especially by controlling pain and the prevention of complications of the myomas on the pregnancy and vice-versa. On the other hand, myomectomy during caesarean section can be performed without complications especially in the presence of subserosal myomas of less than 5 cm in diameter.