Obstetrics and Gynaecology

OBGYN Online Case Records

Case 1 - December 2006

Leiomyoma With Pregnancy
Shashank V. Parulekar

Case report

Mrs. S.K. a 27 years old second gravida first para presented for antenatal care at 28 weeks of amenorrhea. She had had a normal delivery 2 years ago. That child was alive and well. Her menstrual cycles prior to the first pregnancy and in between the two pregnancies were regular, every 28 days, painful, and with moderate flow. Her last menstrual period was on 5th July 2005 and her expected date of delivery was 11th April 2006. There was no significant past history. Her obstetric examination revealed a single live fetus of 28 weeks' gestational size in vertex presentation. No abnormality of the uterine contour was detected. Systemic examination shoed no abnormality. Her hemogram and urinalysis reports were normal. Obstetric ultrasonography showed a single live fetus of gestational age of 28 weeks in vertex presentation. The placenta was fundal, and there was a single leiomyoma measuring 5 cm in diameter under the decidua deep to the site of placental implantation. She progressed normally, and had a normal delivery at term. After delivery of the placenta and membranes, the leiomyoma got expelled spontaneously (figure 1). The uterus contracted and retracted well, and there was no postpartum hemorrhage. She made an uneventful recovery and was discharged on the 3rd day after delivery. She was asymptomatic at follow up examinations 15 days and 42 days after delivery.

Fig 1. Leiomyoma.

Discussion

Leiomyomas can coexist with a pregnancy. They can develop complications like cystic degeneration and red degeneration. They can cause obstetric complications like malpresentation, placenta previa, placental abruption, and obstructed labor. In case the leiomyoma is subserous, pedunculated and lies in the pouch of Douglas obstructing labor, it may get detached under the pressure of the advancing presenting part, and deliver vaginally through a tear in the floor of the pouch of Douglas. This is the first case in the English world literature showing spontaneous detachment and expulsion of the leiomyoma after the delivery of the baby. If it is retained after detachment, it can cause atonic postpartum hemorrhage.

Conclusion

A submucous pedunculated leiomyoma may detach spontaneously and expel after the birth of the fetus, placenta and membranes. If it is retained after detachment, it can cause atonic postpartum hemorrhage, which should be watched for.

References

1. Dystocia due to soft tissue abnormalities of the reproductive tract. In Williams Obstetrics Ed. Cunningham FG, MacDonald PC, Leveno KJ, Gant NF, Gilstrap LC. 19th Ed 1993, Prentice Hall International Inc. pp 533-7.
2. Parulekar SV Pelvic or abdominopelvic lump in pregnancy. In Differential diagnosis and management options in gynecology and obstetrics, 2nd Ed Popular Prakashan, 2005 pp. 237-8.