Uterine fibroids associated with pregnancy. Is myomectomy during pregnancy a feasible method?

Uterine myomas affects 2 10 % of pregnant women. They are hormone dependent tumors, and 30% of them will increase in response to hormonal changes of pregnancy, therefore a significant growth in the first trimester is expected. Usually, they are asymptomatic, but they may be associated with severe abdominal pain and adverse pregnancy outcomes. Conservative management is the first option. If the conservative treatment fails and the symptoms are severe, a myomectomy can be per formed, with serious risks such as severe hemorrhage, uterine rupture, miscarriage and preterm labor. We present the case of a 31 year old primigravida, presenting in our service for severe abdominal pain, pollakiuria and constipation. The ultrasound examination revealed a 14 week pregnancy, with no signs of fetal structural abnormalities and two large fibroids, one developed intramural and subserous, in the lower uterine segment and on the left parametrium, with a diameter of 100/95/87 mm, and the other one developed also intramural, into the right parametrium, with a diameter of 50/25/27 mm, in contact with the previous one. The placenta was developed on the anterior uterine wall and no signs of placental insufficiency were noted. The severe symptoms maintained during the following weeks, and the fibroids volume increased. At 17 weeks of pregnancy, due to severe abdominal pain, we decided to perform a my omectomy. The surgery was uneventful. The patient was monitored weekly. A detailed second trimester anomaly scan was performed at 22 weeks and confirmed no signs of fetal structural abnormalities, an estimated fetal weight at percentile 30, and a pulsatility index within normal ranges for both uterine arteries and umbilical artery. One of the characteristics that contributed to the absence of fetal complications in our case was the fact that fibroids predominantly had a significant subserous and intramural component, without being in contact with the uterine cavity or placenta. Myomectomy during pregnancy in cases of symptomatic uterine fibroids not responding to conservative management may be considered, following appropriate counseling regarding the associated risks. [ABSTRACT FROM AUTHOR]