Overcoming Obstacles During Caesarean Section with a Fibroid in the Uterus, from Diagnosis to Decision: A Case Series.

BACKGROUND: We regularly face pregnancy with fibroid since pregnancy at advanced ages has been more prevalent and the prevalence of lower segment caesarean section (LSCS) has also increased over the previous three decades. Myomectomy with cesarean section has historically been avoided because of the danger of haemorrhage, but obstetricians now place more emphasis on it. Since fibroids can range widely in terms of location, size, and patient features, the intervention should be individualized. Under this article, we, therefore, provide a case series of seven pregnant women with uterine myomas who had delivery via LSCS.

METHOD: Seven pregnant patients who had uterine fibroid and undergone cesarean section were enrolled in this observational study done over the period of one year with consent and after taking ethical approval.  Results: The mean age was 27.7 years. Three of the cases were primigravida, while the remainder were multigravida. One patient had red degeneration and was hospitalized with abdominal discomfort at 29 weeks gestation. Four patients had a solitary fibroid, while the three had numerous. The biggest myoma size was 8×7 cm, while the smallest was 5×5 cm. Due to the presence of the fibroid in the lower segment of the uterus, three patients had a caesarean myomectomy, while in rest four cases it was not done. During cesarean myomectomy, two of them had uterine artery ligation to limit the moderate intraoperative haemorrhage.

CONCLUSION: If the patient is wisely chosen and the surgeon has the experience, a caesarean myomectomy can be performed safely and successfully during LSCS, especially if located in the lower uterine segment (LUS).