EC Gynaecology

Background: Leiomyoma or uterine fibroids are the commonest benign tumors of the uterus. Fibroids co-exist with pregnancy and a prevalence of 20% - 30% has been reported in Nigeria. With increasing incidence of delayed child bearing in advancing age, there have been rising trends of pregnancy complicated by fibroids.

Cesarean myomectomy is the surgical removal of fibroids during cesarean section. It was previously a dreaded surgery, because of associated complications like excessive hemorrhage, potential hysterectomy, prolonged surgery time and increased post-op morbidity.

Currently, many studies have noted successful cesarean myomectomies, in carefully selected patients and being done by experienced obstetricians.

Case Report: This is the case report of a 34 years old primigravida, who had a huge co-existing uterine fibroid. She had a cesarean myomectomy at 37 weeks gestation. She was delivered of a live female baby, birth weight 2.5 kg, Apgar score 8 in one minute. The huge sub serous fibroid that was also removed had a dimension of 22 cm X 18 cm X 8 cm and weighed 4.5 kg.

The associated complication was acute kidney injury, secondary to massive blood loss, that was not replaced immediately. Other complications were prolonged surgery time and increased post-operative morbidity.

The Nephrologist co-managed her. She had 3 sessions of dialysis, a total of six units of blood transfusions. She was also co-managed by the anaesthetic and haematology teams.

She was discharged home twelve days later in good condition with her baby.

Conclusion: Cesarean myomectomy is feasible and can be done successfully by experienced obstetricians. Case selection is important, with multidisciplinary management.

Acute kidney injury can occur as a result of massive bleeding, following cesarean myomectomy.

 Keywords: Cesarean; Myomectomy; Complications; Kidney Injury; Multidisciplinary

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