Inevitable Caesarean Myomectomy: A Case Report.

Abstract

The traditional teaching in obstetrics is to avoid myomectomy during caesarean section because of increased risk of hemorrhage. When a lower segment uterine fibroid is present, a classical incision is prescribed.We present a 32year old booked nullipara who had an emergency classical caesarean section for huge lower segment fibroids, transverse lie and premature rupture of fetal membranes at 37 weeks of gestation and was delivered of a live male baby who weighed 3.6kg with good APGAR scores. The intramural fibroids, enchroaching into the uterine incision, made closure impossible, necessitating a caesarean myomectomy under a high dose oxytocin infusion before successfully closing the incision. She did remarkably well and was discharged home on the 7th post-operative day. Caesarean myomectomy can safely be done in situations where fibroid nodules enchroach on the incision line or in cases of pedunculated subserous fibroids, using good surgical technique and high dose oxytocin infusion.

Key words: uterine fibroids, classical incision, inevitable, caesarean myomectomy.