1/6. Pregnancy after embolization of uterine myoma: report of 12 cases.OBJECTIVE: To treat uterine myomas with embolization, to look for pregnancy-induced myoma recurrences, and to assess pregnancy course and outcome after embolization. DESIGN: Observational clinical study. SETTING: University of paris VII hospital.Patient(s): Nine women had embolization for symptomatic myoma, with 12 pregnancies observed. INTERVENTION(s): Embolizations were highly selective and performed bilaterally through the uterine arteries with polyvinyl alcohol. MAIN OUTCOME MEASURE(s): pregnant women were evaluated by physical and sonographic examinations. RESULT(s): Before embolization, the mean uterine volume was 450 cm(3), and in six patients polymyomas were present. The median age at embolization was 40 years; the median delay before pregnancy was 9 months; and the median age at first pregnancy outcome was 41 years. Five early miscarriages occurred. The seven other pregnancies were uneventful, although three premature births and one case of late toxemia occurred unrelated to previous embolization. Three women delivered vaginally and four by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed. CONCLUSION(s): The results of this first series of 12 pregnancies after myoma embolization are promising. If these preliminary results are confirmed, embolization could be a major breakthrough in the management of myoma and could replace conventional medical and surgical treatments.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/6. sepsis in second trimester of pregnancy due to an infected myoma. A case report and a review of the literature.Considering the high incidence of uterine myomata in women in reproductive age, myomata are only found in 2% of all pregnancies. Although they frequently lead to complications in pregnancy, cases of pyomyomata during pregnancy are rarely reported. A 44-year-old gravida 1 in her 26th week of gestation was admitted to the hospital for septic temperatures of unknown cause. A 12-cm leiomyoma with solid structures of heterogenic sonographic pattern and cystic spaces had been documented on a prior first trimester sonogram. The myoma now appeared with the same size but an increased echogenicity of the liquid parts. Ultrasound guided aspiration of the fluid within the myoma showed an infection with klebsiella pneumoniae. A cesarian section with myo- mectomy confirmed the diagnosis of a pyomyoma.- - - - - - - - - - ranking = 1.5keywords = pregnancy (Clic here for more details about this article) |
3/6. A stepwise transcervical resection of a large uterine myoma after vaginal delivery.CASE REPORT: This study reported a stepwise (4-times) transcervical resection (TCR) performed on a patient with a large uterine myoma. The patient (36 years old) was at 6 weeks of pregnancy when at the first medical examination a uterine myoma, as large as the head of newborn infant, was discovered. After the delivery, myomectomy was performed by way of conserving the uterine. Since the myoma nodule was large, TCR was performed several times to completely resect it. CONCLUSION: TCR has been indicated only for small submucosal myoma; however, this study shows that TCR utilizing a stepwise technique can also be indicated for larger myoma.- - - - - - - - - - ranking = 0.25keywords = pregnancy (Clic here for more details about this article) |
4/6. Coexistence of a prolapsed, pedunculated cervical myoma and pregnancy complications: a case report.BACKGROUND: Different types of fibroids may affect reproductive outcome to a different extent, causing infertility and pregnancy wastage. Rectosigmoid compression, prolapse of a pedunculated submucous tumor through the cervix, venous stasis, polycythemia and ascites are infrequently associated with leiomyomas. Uterine leiomyomas arefound in approximately 2% of pregnant women; 1 in 10 causes complications during pregnancy. CASE: A 37-year-old woman, gravida 3, para 2, abortion 0, at 18 weeks of pregnancy, arrived at our outpatient clinic with a complaint of leaking vaginal fluid. On examination, a prolapsed, pedunculated myoma, measuring 5 x 6 x 7 cm, and pooling of amniotic fluid in the vaginal fornix were detected. Antibiotics were started, but the amniotic fluid leak continued, and the fetal heart beat became undetectable after 12 hours of hospitalization. We tried to excise the myoma from the vagina but because it was very large, we could not reach the proximal point it originatedfrom. We dissected the posterior cervical channel, removed the myoma and performed a total abdominal hysterectomy. CONCLUSION: Vaginal myomectomy is recommended as the initial treatment of choicefor a prolapsed, pedunculated submucous myoma except when other indications necessitate an abdominal approach. Use of laminaria and hysteroscopic resection has been mentioned as other treatment choices. In our case a prolapsed, pedunculated cervical myoma was detected along with pregnancy complications, preterm premature rupture of membranes and fetal death. The cause-and-effect relationship between the prolapsed myoma and membrane rupture is unknown. We were unable to perform a vaginal or abdominal myomectomy because the myoma originated in the posterior cervical region, so we had to perform an abdominal hysterectomy.- - - - - - - - - - ranking = 2keywords = pregnancy (Clic here for more details about this article) |
5/6. Submucous myoma induces uterine inversion.OBJECTIVE: Inversion of the uterus is indeed a rarity for a gynecologist. The puerperal variety is associated with pregnancy, including term pregnancy and abortion. The nonpuerperal condition may be tumor-induced or idiopathic. We present a nonpuerperal uterine inversion and discuss a reasonable plan for its management. CASE REPORT: A 42-year-old, unmarried woman without sexual experience and any systemic diseases noted a mass outside of the vaginal introitus combined with massive vaginal bleeding and abdominal pain of sudden onset after taking laxative agents for colonoscopic preparation. Then she had voiding difficulty with distended bladder. A suprapubic urinary catheter was inserted and 800 mL urine was drained out. The patient received emergency tumor resection and subtotal hysterectomy. The diagnosis of uterine inversion was confirmed during operation. The postoperative course was uneventful and she was discharged without complication. CONCLUSION: Nonpuerperal inversion of the uterus is rarely encountered by gynecologists. diagnosis of uterine inversion is often not easy and imaging studies might be helpful. Surgical treatment is the method of choice in nonpuerperal uterine inversion.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
6/6. Myomectomy during pregnancy: uncommon case report.A case of myomectomy during pregnancy is presented. Generally myomectomy is contraindicated during this period. On the 14th week of pregnancy our patient presented with progressive lower abdominal pain and a tender mass of nearly 12 centimeter diameter in the pouch of Douglas. Therefore an exploratory laparotomy was performed to exclude torsion of an adnexal mass or pedunculated subserous myoma. A dorsal degenerating myoma with short thick pedicle (4 cm diameter) was found. It was compressed between the promontory of the sacrum and the uterus. Myomectomy was performed and pregnancy progressed without complications.- - - - - - - - - - ranking = 1.75keywords = pregnancy (Clic here for more details about this article) |