Unusual growth of a myoma during pregnancy

Abstract

A 29-year-old woman presented at our gynecology outpatient clinic after having tried to conceive for more than 12 months. Her medical history included a cesarean section performed 4 years before. Her gynecological examination revealed a uterus with an intramural myoma of 7 cm. It was proposed that the patient undergo myomectomy, but she became pregnant before admission.The patient was followed up every 3 weeks by ultrasound, and the size of the myoma was found to have increased from 7 to 22 cm. At 25 weeks of pregnancy, edema of the lower legs was noted and the patient was also suffering from slight dyspnea.Magnetic resonance imaging (MRI) (Fig. 1) revealed a myoma of more than 22 cm, showing compression between the pubic bone and the promontory, which explained the compression on the iliac veins and vena cava and the bladder.FIGURE 1MRI shows the uterus at 25 weeks of pregnancy. A myoma of more than 22 cm is clearly visible. The fetus is located in the upper portion of the peritoneal cavity, beneath the liver. The myoma is compressed between the pubic bone and the promontory, explaining the compression on the iliac veins and vena cava.Show full captionDonnez. Myoma during pregnancy. Fertil Steril 2002.View Large Image Figure ViewerDownload (PPT)The fetus was located in the upper portion of the peritoneal cavity. Because of the symptoms and the risk of intrauterine growth retardation, it was decided to perform a laparotomy for myomectomy. The myomectomy took 2 hours and required very careful dissection from the myometrium in the portion close to the amniotic membranes, which were visible over a length of 14 cm through a very thin layer of residual myometrium. The myometrium was sutured with stitches of vicryl 2-0. Histological analysis revealed the pathological characteristics of a benign myoma without signs of atypia. The myoma weighed 2.250 kg.The patient remained hospitalized and was free of symptoms. MRI (Fig. 2) at 32 weeks demonstrated the absence of dehiscence of the myomectomy scar and normal growth of the fetus. A cesarean section was planned between 34 and 35 weeks if the feto-maternal parameters remained good. The patient delivered a healthy female newborn weighing 2.280 kg by cesarean section at 35 weeks.FIGURE 2MRI performed at 32 weeks demonstrates the absence of dehiscence of the myomectomy scar.Show full captionDonnez. Myoma during pregnancy. Fertil Steril 2002.View Large Image Figure ViewerDownload (PPT) A 29-year-old woman presented at our gynecology outpatient clinic after having tried to conceive for more than 12 months. Her medical history included a cesarean section performed 4 years before. Her gynecological examination revealed a uterus with an intramural myoma of 7 cm. It was proposed that the patient undergo myomectomy, but she became pregnant before admission. The patient was followed up every 3 weeks by ultrasound, and the size of the myoma was found to have increased from 7 to 22 cm. At 25 weeks of pregnancy, edema of the lower legs was noted and the patient was also suffering from slight dyspnea. Magnetic resonance imaging (MRI) (Fig. 1) revealed a myoma of more than 22 cm, showing compression between the pubic bone and the promontory, which explained the compression on the iliac veins and vena cava and the bladder. Donnez. Myoma during pregnancy. Fertil Steril 2002. The fetus was located in the upper portion of the peritoneal cavity. Because of the symptoms and the risk of intrauterine growth retardation, it was decided to perform a laparotomy for myomectomy. The myomectomy took 2 hours and required very careful dissection from the myometrium in the portion close to the amniotic membranes, which were visible over a length of 14 cm through a very thin layer of residual myometrium. The myometrium was sutured with stitches of vicryl 2-0. Histological analysis revealed the pathological characteristics of a benign myoma without signs of atypia. The myoma weighed 2.250 kg. The patient remained hospitalized and was free of symptoms. MRI (Fig. 2) at 32 weeks demonstrated the absence of dehiscence of the myomectomy scar and normal growth of the fetus. A cesarean section was planned between 34 and 35 weeks if the feto-maternal parameters remained good. The patient delivered a healthy female newborn weighing 2.280 kg by cesarean section at 35 weeks. Donnez. Myoma during pregnancy. Fertil Steril 2002.