Delivery and organ-preserving surgery in a woman with high-risk uterine myoma

Abstract

This article presents a clinical case from the practice of the State Budgetary Healthcare Institution of the Republic of Belarus "GKPTs" in Ufa regarding organ-conserving surgery in a woman with high-risk uterine fibroids of isthmus localization with transition to the posterior wall of the uterus. In May 2023, at 39 weeks of pregnancy, patient T. was scheduled for planned surgical delivery by cesarean section, with subsequent expansion of the scope of the operation to conservative myomectomy. The indication for surgery was uterine fibroids of gigantic size and isthmus localization with transition to the posterior wall of the uterus, as a result of which delivery through the natural birth canal is impossible. Uterine fibroids in this patient were discovered during pregnancy. Instrumental research methods used during the examination: ultrasound, magnetic resonance imaging (MRI). During routine ultrasound screenings, uterine fibroids of isthmus localization measuring 123x99x112 mm without disruption of the node's nutrition were diagnosed. According to MRI, the diagnosis of large uterine fibroids was confirmed. A transverse suprapubic laparotomy was performed. The first stage of the combined operation was a cesarean section in the lower segment. As a result, a live full-term boy weighing 3480 g, 53 cm, with 7-8-9 points on the Apgar scale was recovered. Then, during an inspection of the pelvic organs, a myomatous node was discovered in the isthmus area with a transition to the posterior wall of the uterus measuring 10x12 cm, without signs of necrosis. A conservative myomectomy was performed without penetration into the uterine cavity. The bed is sutured with separate sutures. Hemostasis has been achieved. The weight of the myomatous node will be 570 grams. Our clinical case shows that a favorable full-term pregnancy with high-risk, large size, atypical localization uterine fibroids is possible. Also, organ-preserving, combined operations are currently being carried out, which enable a woman to preserve the organ and further realize her reproductive potential.