Myomectomy in the 14th week of pregnancy - case report

Abstract

Uterine leiomyomas are the most common benign tumours in women. During the pregnancy, their prevalence is 2%. The management of leiomyomas in this period is eminently clinical, except in special situations. The decision by the indication of concomitant surgery pregnancy is complicated because in addition to the anaesthetic risks, studies show worse fetal prognosis. In this study, a rare case of myomectomy was reported in a 14-week gestation due to acute abdomen with intense pain. A 36-year-old primigravida was admitted to the Maternity emergency room, with severe abdominal pain, especially in the right hypochondrium and right flank, for 3 days. Ultrasonography showed leiomyoma measuring 15×11.4 cm. Exploratory laparotomy was performed with myomectomy. After surgery, pregnancy progressed normally until the 37th week, when the patient developed pre-eclampsia. At the opportunity, a caesarean section was performed. The new born was born healthy, weighing 3031g and Apgar 9 and 10. The decision to perform myomectomy is complicated and controversial. Its accomplishment is considered especially when all the other non-surgical therapies have failed, persisting or increasing pain. However, it should be considered the choice of surgery because of possible abdominal surgical complications in pregnancy.