2200 g-Weight-Fibroid: Abdominal Mymectomy in the Twentieth Week of Pregnancy
Authors:
L. Bartošová; Z. Žižka; Z. Hájek; D. Kužel
Authors‘ workplace:
Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc.
Published in:
Ceska Gynekol 2008; 73(5): 289-293
Category:
Original Article
Overview
Objective:
To present our clinical experience with a case of myomectomy of very big myoma during the second trimestr of pregnancy and to analyse current articles with this topics. Two myomectomies in one pregnancy (in the second trimestr and during the cesarian section) are presented.
Design:
Review article, case report.
Results:
A case report of 36-years-old nulliparous woman with 2 big fibroids in pregnancy is presented. The pregnancy was troubleless until 20th week, than she was hospitalized with suddenly appeared pain in epigastrium. A big necrotisis of fibroid was found during the examination. The clinical situation of the pacient rapidly deteriorated – in 24 hours the pain increased and ileus appeared. The operation due to vital indication was carried out with maximal effort to preserve the pregnancy. The 2200g-weigh-myoma was removed abdominally and the pregnancy continued without another complication. The cesarian section was done in 38-week-old pregnancy and a healthy child was delivered. The second big fibroid on the back of the uterus was found during the cesarian section, myomectomy and large adhesiolysis was done. The pacient was hospitalized during the puerperium again with reapperance of ileus. The therapy of ileus was conservative. A case report presents a rare ocurence of big myomectomy during the second trimestr of pregnancy which was complicated by recidivans ileus due to large adhesive process in abdominal cavity.
Conclusion:
The prevalence of fibroids in pregnancy is between 2 and 4%, only 10 procents of this pregnancies are complicated, the necrosis of fibroid during the pregnancy is one of the most difficult cases.
Key words:
myomectomy in pregnancy, ileus, fibroid.
Sources
1. Benson, CB, Chow, JS., Chang-Lee, W., et al. Outcome of pregnancies in women with uterine leiomyomas identified by sonography in th first trimestr. J Clin Ultrasound, 2001, 29, 5, p. 261-264.
2. Brown, D., Fletcher, HM., Myrie, MO., et al. Cesarean myomectomy – a safe procedure. A retrospective case controlled study. J Obst Gynaecol, 1999, 19, 2, p. 139-141.
3. Carta, G., Cerrone, L., Iovenitti, P. Postoperative adhesion prevetion in gynecologic surgery with hyaluronic acid. Clin Ecp Obstet Gynecol, 2004, 31, 1, p. 39-41.
4. Celik, C., Acar, A., Cicek, N., et. al. Can myomectomy be performed during pregnancy? Gynecol Obstet Invest, 2002, 53, 2, p. 79-83.
5. Cooper, NP., Okolo, S. Fibroids in pregnancy- common but poorly understood. Obstet Gynecol Surv, 2005, 60, 2, p. 132-138.
6. Danzer, E., Holzgreve, W., Batukan, C., et al. Myomectomy during the first trimestr associated with fetal limb anomalies and hydrocephalus in twin pregnancy. Prenat Diagn, 2001, 21, p. 848-851.
7. De Carolis, S., Fatingante, G., Ferrazzani, S., et al. Uterine myomectomy in pregnant women. Fetal Diagn Ther, 2001, 16, 2, p. 116-119.
8. Dracea, L., Condreanu, D. Vaginal birth after extensive myomectomy during pregnancy in a 39-year-old nulliparous woman. J Obstet Gyanecol, 2006, 26, 4, p. 374-375.
9. Dubuisson, JB., Fauconnier, A., Chapron, C., et al. Second look after laparoscopic myomectomy. Hum Reprod, 1998, 13, 8, p. 2102-2106.
10. Exacoustos, C., Rosati, P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol, 2003, 82, 1, p. 97-101.
11. Farquhar, C., Vandekerckhove, P., Watson, A. Barrier agents for preventing adhesions after surgery for subfertility. Cochrane Database Syst Rev, 2000, , 2), CD000475.
12. Gojnic, M., Pervulov, M., Mostic, T., Petkovic, S. Doppler ultrasound as an additional parametr for the evaluation of myomas and the indication of myomectomy during pregnancy. Fetal Diagn Ther, 2004, 19, 5, p. 462-464.
13. Gojnic, M., Pervulov, M., Petkovic, S., et al. Indication of myomectomy during pregnancy from Doppler ultrasonography. Clin Exp Obstet Gynecol, 2004, 1, 3, p. 197-198.
14. Hassiakos, D., Christopoulos, P., Vitoratos, N., et al. Myomectomy during cesarean section: a safe procedure? Ann NY Acad Sci, 2006, 1092, p. 408-413.
15. Ikeda, M., Ishida, H., Naito, Y., et al. A patient who was found to be pregnant unexpectedly during hysteromyomectomy. Int J Obstet Anesth, 1999, 8, 3, p. 189-189.
16. Joó, JG., Inovay, J., Silhavy, M., et al. Successful enucleation of a necrotizing fibroid causing oligohydramnios and fetal postural deformity in the 25th week of gestation. A case report. J Reprod Med, 2001, 46, 10, p. 923-925.
17. Katz, VL., Dotters, DJ., Droegemeuller, W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol, 1989, 73, 4, p. 593-596.
18. Kaymak, O., Ustunyurt, E., Okyay, RE. Myomectomy during cesarean section. Int J Gynaecol Obstet, 2005, 89, 2, p. 90-93.
19. Kempf-Haber, M., et al. Laparoscopic management during pregnancy- own material (1996-2002). Ginecol Pol, 2003, 74, 4, p. 520-524.
20. Kwawukume, EY. Caesarean myomectomy. Afr J Reprod Health, 2002, 6, 3, p. 38-43.
21. Lee, WL., Chiu, LM., Wang, PH., et al. Fever of unknown origin in puerperium. A case report. J Reprod Med, 1998, 43, 2, p. 149-152.
22. Liu, W., Wang, P., Tang, W., et al. Uterine artery ligation for treatment od pregnant women with uterine leiomyomas who are undergoing cesarean section. Fertil Steril, 2006, 86, 2, p. 423-428.
23. Lolis, DE., Kalantaridou, SN., Makrydimas, G., et al. Successful myomectomy during pregrancy. Human Reprod, 2003, 8, 18, p. 699-1702.
24. Malartic, C., Morel, O., Akerman, G., et. al. Laparoscopic myomectomy in 2007: state of the art. J Gynecol Obstet Biol Reprod, (Paris) 2007, 36, 6, p. 567-576.
25. Mettler, L., Audebert, A., Lehmann-Willenbrock, E., et al. New adhesion prevention concept in gynecological surgery. J S L S, 2003, 7, 3, p. 207-209.
26. Pelosi, MA., Pelosi, MA. 3rd, Giblin, S. Laparoskopic removal od a 1500-g symptomatic myoma during the second trimestr of pregnancy. J Am Assoc Gynecol Laparoscopy, 1995, 2, 4, p. 457-462.
27. Phelan, JP. Myomas and pregnancy. , 1995, 22, 4, p. 801-805.
28. Rich, DA., Stokes, IM. Uterine torsion due to a fibroid, emergency myomectomy and trnsverse upper segment cesarean section. Int J Obstet Gynaecol, 2002, 109, p. 105-106.
29. Roberts, WE., Fulp, KS., Morrison, JC., et al. The impact of leiomyomas on pregnancy. Aust N Z J Obstet Gynaecol, 1999, 39, 1, p. 43-47.
30. Roman, AS., Tabsh, K. Myomectomy at time of cesarean delivery: a retrospective cohort study. BMC Pregnancy Childbirth, 2004, 16, 4, 1, p. 14.
31. Sapmaz, E., Celik, H., Altunggul, A. Bilateral ascending uterine artery ligation v.s. tourniquet use for hemostasis in cesarean myomectomy. A comparisation. J Reprod Med, 2003, 48, 12, p. 950-954.
32. Sentilhes, L., Sergent, F., Verspyck, E., et al. Laparoscopic myomectomy during pregnancy resulting in septic necrosis od the myometrium. Int J Obstet Gynaecol, 2003, 110, p. 876-878.
33. Umezurike, C., Feyi–Waboso, P. Successful myomectomy during pregnancy: a case report. Reprod Health, 2005, 2, 1, p. 6.
34. Vergani, P., Ghidini, A., Strobelt, N. Do uterine leiomyomas infuence pregnancy outcome? Am J Perinatol, 1994, 11, 5, p. 356-358.
35. Vergani, P., Locatelli, A., Ghidinni, A., et al. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol, 2007, 109(2Pt1), p .410-414.
36. Watson, A., Vandekerckhove, P., Lilford, R. Liquid and fluid agents for preventing adhesions after surgery for subfertility. Cochran database Syst Rev, 2000, 3), CD001298.
37. Wittich, AC., Salminen, ER., Yancey, MK., et al. Myomectomy during early pregnancy. Mill Med, 2000, 165, 2, p. 162-164.
38. Wong, C. A uterine fibroid presenting as an incarcerated umbilical hernia during pregnancy. Hernia, 2005, 9, 3, p. 298-299.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2008 Issue 5
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