1/118. Myomectomy in pregnancy: incarcerated pedunculated fibroid in an umbilical hernia sac.We describe a rare case of a 31-year-old woman at 28 weeks of pregnancy presenting with an incarcerated pedunculated fibroid in an umbilical hernia sac. She had a successful myomectomy and hernia repair and proceeded to have spontaneous vaginal delivery at term. Incarceration of a pedunculated fibroid presents a diagnostic puzzle which can be successfully treated by myomectomy.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/118. Twin delivery after myomectomy, in vitro fertilization, and embryo reduction in an infertile woman.A 28-year-old patient had metroplasty performed because of necrosis of a uterine fibroid. During follow-up, the left adnexa were removed because of a recurrent left ovarian cyst. The triplet gestation achieved by in vitro fertilization was reduced to twins. The living premature newborns were delivered abdominally.- - - - - - - - - - ranking = 0.032989877069096keywords = gestation (Clic here for more details about this article) |
3/118. Large lower segment myoma--myomectomy at lower segment caesarean section--a report of two cases.Uterine leiomyoma is found in approximately 2% of pregnant women. One in ten women will have complications related to myoma in pregnancy. Myomectomy during pregnancy especially at Caesarean section is much discouraged in the literature. We present here 2 cases of large uterine myoma, situated in the anterior aspect of the lower segment, complicating pregnancy at term. Myomectomy in both instances allowed delivery of the fetus through the lower segment, making vaginal delivery in subsequent pregnancies possible.- - - - - - - - - - ranking = 0.6keywords = pregnancy (Clic here for more details about this article) |
4/118. Transient rapid growth of uterine leiomyoma in a postmenopausal woman.We report a case of transient rapid growth of uterine leiomyoma in a postmenopausal woman. A 58-year old woman presented with a rapidly enlarging pelvic tumor, from a 14-week to a 20-week gestational size in the one month. Transcervical needle biopsy revealed a smooth muscle tumor with 5 mitotic figures per 10 high power fields. However, surgical specimen obtained 1 month later revealed less than 1 mitotic figure per 100 high power fields. This variation may influence the final histopathological diagnosis because mitotic index is believed to be one of the most reliable histopathological parameters for differentiating between uterine leiomyoma and leiomyosarcoma.- - - - - - - - - - ranking = 0.032989877069096keywords = gestation (Clic here for more details about this article) |
5/118. hemoperitoneum from spontaneous bleeding of a uterine leiomyoma: a case report.Bleeding from uterine leiomyoma is a rare cause of hemoperitoneum. In most cases bleeding is a result of trauma or torsion. Spontaneous rupture of a superficial vein is extremely rare. Fewer than 100 cases have been reported. Our patient is a 44-year-old black woman who presented in the emergency room with acute onset of epigastric pain. Past medical and surgical history was not contributory except for a uterine "fibroid." In the emergency room, the patient's abdomen became diffusely tender. Her pregnancy test was negative, and the abdominal ultrasound showed fluid in the peritoneal cavity. The patient became hemodynamically unstable, and there was a significant drop of the hemoglobin/hematocrit. A surgical consultation was requested, and the patient underwent exploratory laparotomy. A subserosal uterine leiomyoma was found, with an actively bleeding vein on its dome. The leiomyoma was excised and 3 liters of blood and blood clots were evacuated from the peritoneal cavity. The patient was premenopausal and had a known leiomyoma. The clinical course was similar to that of previously reported cases. Although extremely rare, when there is no history of trauma, pregnancy, or other findings, spontaneous bleeding from uterine leiomyoma should be in the differential diagnosis. Emergent surgical intervention is recommended to establish the diagnosis and stop the hemorrhage.- - - - - - - - - - ranking = 0.4keywords = pregnancy (Clic here for more details about this article) |
6/118. MR findings in degenerated ovarian leiomyoma.leiomyoma is one of the rarest solid tumours of the ovary. We report a case of a degenerated ovarian leiomyoma associated with pregnancy. MR findings are identical to those of degenerated uterine leiomyoma and it is difficult to differentiate between them. Ovarian leiomyoma should therefore be included in the differential diagnosis of subserosal uterine leiomyoma.- - - - - - - - - - ranking = 0.2keywords = pregnancy (Clic here for more details about this article) |
7/118. Myomectomy during early pregnancy.abdominal pain during early pregnancy may be caused by leiomyoma of the uterus. Inconsistency of uterine size and gestational dates in a pregnant patient with acute abdominal pain may be the first sign of leiomyoma. This 31-year-old primigravida presented with progressively worsening lower abdominal pain at 12 weeks gestational age. ultrasonography and magnetic resonance imaging demonstrated a large fundal heterogeneous mass and an intrauterine gestation compatible with her menstrual dates. Exploratory surgery and myomectomy confirmed a large leiomyoma showing benign degenerative changes. The operative procedure was successful, and the pregnancy progressed normally. An elective cesarean section was performed at 37 weeks gestation after confirming fetal maturity by amniocentesis and serial ultrasonography. abdominal pain in a pregnant patient with leiomyoma uteri may be attributable to degenerative changes in the myoma. Surgical intervention during pregnancy is occasionally necessary in uncommon cases of intractable pain.- - - - - - - - - - ranking = 1.5319595082764keywords = pregnancy, gestation (Clic here for more details about this article) |
8/118. Spontaneous uterine rupture in the early third trimester after laparoscopically assisted myomectomy. A case report.BACKGROUND: The development of new and innovative laparoscopic instruments has allowed a greater number of gynecologic surgeons to laparoscopically remove large, intramural leiomyomata. Cases of both successful pregnancy and uterine rupture following laparoscopic myomectomy have been reported. This is the first report of uterine rupture in pregnancy following a laparoscopically assisted myomectomy. CASE: A 26-year-old, nulligravid woman underwent a laparoscopically assisted myomectomy. While the myomectomy had been performed laparoscopically, the uterine incision had been repaired in layers through a minilaparotomy incision. Two years later she became pregnant and, at 29 weeks' gestation, presented to labor and delivery with contractions and uterine tenderness. Over the next several hours, a nonreassuring fetal heart rate developed, and a cesarean section was performed, revealing hemoperitoneum and uterine rupture at the site of the prior myomectomy. CONCLUSION: The ultimate integrity of a uterine incision may depend not only on how the incision is repaired but also on how it is made. Laparoscopically created uterine incisions may not be as strong as those made at laparotomy, regardless of the method of closure.- - - - - - - - - - ranking = 0.4329898770691keywords = pregnancy, gestation (Clic here for more details about this article) |
9/118. Major hemorrhage in a patient with multiple submucous leiomyomata during the treatment of long-acting gonadotropin-releasing hormone agonist.Gonadotropin releasing hormone agonist (GnRH-agonist) therapy has been useful as an adjunct before myomectomy or hysterectomy for uterine myoma but the concealed risk is often overlooked. We report an extremely rare clinical presentation of a patient with multiple submucosal myomata during the treatment of long-acting gonadotropin-releasing hormone agonist (GnRH-agonist) in a 23-year-old, virgin woman. This patient exhibited heavy menstruation and severe anemia for half of a year. Ultrasound demonstrated multiple submucous myomata and intramural myomata. She received a conservative medical treatment by GnRH-agonist. The patient showed marked suppression of serum estradiol concentrations throughout treatment (< 20 pg/ml since first dose injection). The volume of the uterus decreased 21% and the total volume of the uterine myomata decreased 27% at the end of the second dose injection. However, a sudden onset of major hemorrhage occurred at the 65th day without "add-back" hormonal replacement therapy after initial therapy of GnRH-agonist. Hypovolemic shock followed soon and immediately resuscitation was performed. After resuscitation, the patient was treated with hysteroscopic myomectomy, followed by 30 ml balloon Foley catheter placement for compressing the intrauterine rough surface and hormonal replacement therapy. When uterus returned to the normal size at the end of the first week, intrauterine device was positioned and maintained for three months. The patient married four months later and got pregnant soon. Now she has a pregnancy of 22 gestational weeks. The phenomenon suggests presence of concealed and potential risk of GnRH-agonist for managing a patient with multiple submucous myomata, even though GnRH-agonist is a well-documented transient treatment for uterine myomata not only by its effect on tumor shrinkage and decreasing blood loss during the myomectomy but also by providing a time for hematological recovery. This unexpected and unwanted clinical presentation should be alerted.- - - - - - - - - - ranking = 0.2329898770691keywords = pregnancy, gestation (Clic here for more details about this article) |
10/118. Prenatal magnetic resonance imaging assisting in differentiating between large degenerating intramural leiomyoma and complex adnexal mass during pregnancy.We present an unusual case in which a 36-year-old patient was referred due to increasing upper left quadrant abdominal pain and a possible left adnexal mass at 22 weeks' gestation. ultrasonography demonstrated a multiseptated cystic mass, with solid components measuring 12 cm in diameter. A thin sonolucency was thought to separate the mass from the uterus and thus the mass was considered consistent with an adnexal mass, possibly a mucinous cystadenoma. A large degenerating leiomyoma could not be ruled out with certainty and magnetic resonance (MR) imaging was performed which depicted a thin band of myometrium encompassing the complex mass and was therefore diagnostic of a degenerating uterine leiomyoma. We discuss the contribution of MR imaging in the noninvasive diagnosis of undetermined solid pelvic masses visualized ultrasonographically.- - - - - - - - - - ranking = 0.8329898770691keywords = pregnancy, gestation (Clic here for more details about this article) |
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