Emergency inevitable caesarean myomectomy, challenge to obstetrician/ gynaecologist: a case report

Abstract

BACKGROUND Caesarean myomectomy is not routinely done by Obstetricians/Gynaecologists due to associated complications and increased risk of maternal morbidity/mortality. The incidence of fibroid in pregnancy varies from 1.6% to 10.7% globally.
AIM To present an uncommon management modality.
CASE REPORT Mrs BD is a 34-year-old unbooked G1 Para 0⁺⁰ at 38 weeks’ gestation who presented on self-referral from a maternity with complaints of increasing abdominal pain and breathlessness of 1day duration.  Examination at presentation revealed fundal height of 44cm, intra-abdominal mass consistent with huge uterine fibroid extending from the fundus to the lower segment, oblique-lying foetus with normal heart tones. Obstetric ultrasound done on admission were in keeping with above clinical findings with uterine fibroid measuring 22cm by 20cm. She was billed for elective caesarean section but went into labour which necessitated an emergency caesarean section with delivery of a live male baby, birth weight 3.2kg and myomectomy for uterine fibroid at the lower uterine. The estimated blood loss was 800mls, She had a unit of blood intra-operatively.  Her post-operative period was uneventful. She was counselled on the extent of the surgery including her future fertility and family planning. She was discharged home on her 7^th post-operative day in satisfactory clinical condition. 
CONCLUSION Caesarean myomectomy may be a hazardous surgical procedure to the attending Obstetrician/Gynaecologist. However, adequate pre-operative preparation, the skill and speed of the surgeon may help improve maternal /perinatal outcome.

Key Words: caesarean myomectomy, obstetrician/ gynaecologist, maternal morbidity/mortality.