Our Summary

This research paper is about a woman in her 20s who was pregnant and experienced abdominal pain 10 weeks into her pregnancy. It was discovered that she had a fibroid (a non-cancerous growth in the uterus) that had grown significantly in size from 17 cm to 29 cm within a year. There were concerns that the fibroid would cause various complications during her pregnancy, including blood clotting, reduced blood flow, miscarriage, twisting of the fibroid, tissue death in the fibroid, premature labor, and even uterine rupture. A group of medical professionals including obstetricians, neonatologists, gynecologists, and radiologists reviewed her case and discussed the best course of action. The woman decided to go ahead with a surgical procedure called an open myomectomy at 14 weeks into her pregnancy. This procedure was successful and she was able to carry on with her pregnancy without any further issues. She delivered a healthy baby girl at almost 39 weeks through a planned caesarean section.

FAQs

  1. What potential risks are associated with an increase in fibroid size during pregnancy?
  2. How is an open myomectomy performed during pregnancy, and at what stage of gestation is it typically done?
  3. What specialists are typically involved in the decision to proceed with an open myomectomy during pregnancy?

Doctor’s Tip

A helpful tip a doctor might give a patient about myomectomy is to discuss all potential risks and benefits of the procedure, especially in the context of pregnancy. It is important to have a thorough discussion with your healthcare team to make an informed decision about the best course of action for your specific situation.

Suitable For

Patients who are typically recommended myomectomy are those who have symptomatic fibroids that are causing significant pain, heavy menstrual bleeding, or fertility issues. Additionally, myomectomy may be recommended for patients with fibroids that are rapidly growing, large in size, or causing complications during pregnancy. In the case of the patient mentioned above, the decision to proceed with a myomectomy during pregnancy was made due to the significant increase in size of the fibroid and the potential risks it posed to both the patient and the developing fetus. Consulting with a multidisciplinary team of healthcare providers can help determine the best course of action for patients with fibroids.

Timeline

  • Patient presents with abdominal pain at 10 weeks of pregnancy
  • Known to have a 17-cm fibroid a year ago, which has increased in size to 29 cm
  • Concerns about potential risks during pregnancy due to fibroid growth
  • Multidisciplinary team review with obstetricians, neonatologists, gynaecologists, and radiologists
  • Patient opts for open myomectomy at 14 weeks gestation
  • Successful myomectomy performed
  • Pregnancy continues uneventfully until term
  • Patient delivers a healthy girl infant at 38+2 weeks via elective caesarean section.

What to Ask Your Doctor

  1. What are the risks and benefits of a myomectomy during pregnancy?
  2. How will the myomectomy impact the pregnancy and delivery process?
  3. What is the success rate of a myomectomy during pregnancy?
  4. What type of anesthesia will be used during the procedure?
  5. How long is the recovery period after a myomectomy during pregnancy?
  6. Will future pregnancies be affected by having a myomectomy?
  7. Are there any potential complications or long-term effects of having a myomectomy during pregnancy?
  8. What alternative treatment options are available for managing fibroids during pregnancy?
  9. How will the fibroid be monitored during the remainder of the pregnancy?
  10. What is the likelihood of the fibroid growing back after the myomectomy?

Reference

Authors: Parton JR, Arshad I. Journal: BMJ Case Rep. 2024 Jan 24;17(1):e257980. doi: 10.1136/bcr-2023-257980. PMID: 38272528