Resection of Degenerated Leiomyoma by Laparotomy during Second Trimester of Pregnancy with Favorable Outcome: A Case Report and Review of Literature Regarding Leiomyomas during Pregnancy

Abstract

Aims: We present a case of degenerated leiomyoma in pregnancy causing pain that deteriorated with conservative management and was successfully treated with myomectomy. Presentation of Case: A 37-year-old woman with a known asymptomatic subserosal leiomyoma was admitted to the obstetrics clinic of our hospital at the gestational age of 18+3 weeks due to gradually worsening constant right quadrant lower abdominal pain of acute onset. Clinical examination, laboratory investigation and abdominal ultrasonography led to the conclusion that the pain was due to the degeneration of the leiomyoma. The initial conservative approach was not effective so the subserous leiomyoma was resected by laparotomy. The pregnancy progressed normally until the delivery of a healthy neonate at 37+5 weeks gestational age by cesarean section due to the prior myomectomy. The pathologic examination revealed a nodular 6,5x5x3cm tumor with histological features of leiomyoma with regional hydropic and focal hyaline degeneration. Discussion: Prevalence of leiomyomas during pregnancy is reported as 0, 3-3, 9% according to epidemiologic studies. They usually remain asymptomatic but they can also cause complications in 10% of all cases. Management of uterine leiomyomas in pregnancy is based on conservative treatment, but there are cases where surgical intervention is necessary. Conclusion: We present data from relative literature, showing that myomectomy during pregnancy can under circumstances be an inevitable treatment choice to this medical condition, in favour of the best outcome for the ongoing gestation.