Abstract
Background: Submucous fibroids can lead to menorrhgia, infertility, recurrent pregnancy loss, and obstetric complications. The management of multiple submucous fibroids in patients who would like to preserve their reproductive function can be a challenge. The aim of this report is to discuss the management dilemma of a patient who presented with multiple (more than 20) submucous fibroids. Case: The patient was a 33-year-old Caucasian woman who had an initial complaint of menometrorrhagia and secondary infertility, which led to a diagnostic hysteroscopy. Multiple submucosal fibroids were noted; no other etiology for infertility was identified. She subsequently underwent hysteroscopic resection of several fibroids. Postoperative hyterosalpingogram demonstrated intrauterine scarring, unilateral tubal blockage, and several remaining fibroids. She did, however, conceive with intrauterine insemination. Unfortunately, this pregnancy ended in an early spontaneous abortion of twins. After being counseled on her options, including the possibility of needing a surrogate uterus, she elected to have an abdominal resection of the remaining fibroids. During this procedure, several steps were taken to restore the uterine cavity to a normal shape. After allowing her uterus to heal, she achieved pregnancy through in vitro fertilization. At 29 weeks of gestation, she had preterm premature rupture of membranes and, subsequently, had a cesarean section at 34 weeks of gestation. She had a viable 6 pound 1 ounce baby boy. At the time of her cesarean section, only one submucosal fibroid was identified. Conclusion: We present a unique case of multiple sub-mucous fibroids that failed hysteroscopic management and were subsequently treated successfully with hysterotomy, myomectomy, and uterine reconstructive surgery. Based on our experience with this case, we recommend hysterotomy and myomectomy for management of multiple sub-mucous fibroids from the outset. (J GYNECOL SURG 31:274)
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