Spontaneous Intra-leiomyoma Hemorrhage during Second Trimester of Pregnancy



Abstract Views
443

Downloads
484

Citations

Share

##plugins.themes.bootstrap3.article.sidebar##

Submitted Dec 15, 2020
Published Dec 31, 2020
10.24018/ejmed.2020.2.6.618

Abstract viewed = 443 times

Table of Contents

##plugins.themes.bootstrap3.article.main##

Uterine fibroid affects 0.3-2.6% of pregnant women and it is usually asymptomatic during pregnancy [1]. In about 10% of these patients will have complications such as miscarriage, fetal malpresentation, premature rupture of membranes, placenta abruptio, preterm delivery, abdominal pain due to fibroid torsion or degeneration [2]. Bleeding into the uterine fibroid is extremely rare and patient can present with acute abdomen [11]. Up to date, there were only two cases reported and both occur in postpartum period. We present a case of a pregnant woman with huge uterine fibroid with spontaneous intra-leiomyoma bleeding causing hypovolemic shock at 22 weeks of gestation. Because of failure of conservative management, we performed fibroid resection at 22 weeks of gestation with preservation of the pregnancy.

Keywords: Leiomyoma, pregnancy, intraleiomyoma haemorrhage, myomectomy, anemia

Downloads

Download data is not yet available.

References

  1. Burton CA, Grimes DA, March CM. Surgical management of leiomyomata during pregnancy. Obstet Gynecol 1989;74:707–9.
     Google Scholar
  2. Phelan JP. Myomas and pregnancy. Obstet Gynecol Clin North Am 1995;22:801–5.
     Google Scholar
  3. Hasbargen U, Strauss A, Summerer-Moustaki M, et al. Myomectomy as a pregnancy-preserving option in the carefully selected patients. Fetal Diagn Ther 2002;17:101–3.
    DOI  |   Google Scholar
  4. Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol 2006; 107:376.
    DOI  |   Google Scholar
  5. Exacoustòs C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol 1993; 82:97.
     Google Scholar
  6. Strobelt N, Ghidini A, Cavallone M, et al. Natural history of uterine leiomyomas in pregnancy. J Ultrasound Med 1994; 13:399.
    DOI  |   Google Scholar
  7. Laughlin SK, Baird DD, Savitz DA, et al. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet Gynecol 2009; 113:630.
    DOI  |   Google Scholar
  8. Stout MJ, Odibo AO, Graseck AS, et al. Leiomyomas at routine second-trimester ultrasound examination and adverse obstetric outcomes. Obstet Gynecol 2010; 116:1056.
    DOI  |   Google Scholar
  9. E. Danzer, W. Holzgreve, C. Batukan, P. Miny, S. Tercanli, and I. Hoesli, “Myomectomy during the first trimester associated with fetal limb anomalies and hydrocephalus in a twin pregnancy,”Prenatal Diagnosis, vol. 21, no. 10, pp. 848–851, 2001.
    DOI  |   Google Scholar
  10. Michalas SP, Oreopoulou FV, Papageorgiou JS. Myomectomy during pregnancy and cesarean section. Hum Reprod. 1995;10:1869-70.
     Google Scholar
  11. .Exacoustos C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol 1993;82:97-101.
     Google Scholar
  12. Lev-Toaff AS, Coleman BG, Arger PH, et al. Leiomyomas in pregnancy: sonographic study. Radiology 1987; 164:375.
    DOI  |   Google Scholar
  13. Aharoni A, Reiter A, Golan D, et al. Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study. Br J Obstet Gynaecol 1988; 95:510.
    DOI  |   Google Scholar
  14. Rosati P, Exacoustòs C, Mancuso S. Longitudinal evaluation of uterine myoma growth during pregnancy. A sonographic study. J Ultrasound Med 1992; 11:511.
    DOI  |   Google Scholar
  15. Katz VL, Dotters DJ, Droegemeuller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol 1989; 73:593.
     Google Scholar
  16. De Carolis S, Fatigante G, Ferrazzani S, et al. Uterine myomectomy in pregnant women. Fetal Diagn Ther 2001; 16:116.
    DOI  |   Google Scholar
  17. Vergani P, Ghidini A, Strobelt N, et al. Do uterine leiomyomas influence pregnancy outcome? Am J Perinatol 1994; 11:356
    DOI  |   Google Scholar
  18. Buttram VC Jr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981; 36:433.
    DOI  |   Google Scholar
  19. Febo G, Tessarolo M, Leo L, et al. Surgical management of leiomyomata in pregnancy. Clin Exp Obstet Gynecol 1997; 24:76.
     Google Scholar
  20. Wittich AC, Salminen ER, Yancey MK, Markenson GR. Myomectomy during early pregnancy. Mil Med 2000; 165:162.
    DOI  |   Google Scholar
  21. Celik C, Acar A, Ciçek N, et al. Can myomectomy be performed during pregnancy? Gynecol Obstet Invest 2002; 53:79.
    DOI  |   Google Scholar
  22. Michalas SP, Oreopoulou FV, Papageorgiou JS. Myomectomy during pregnancy and caesarean section. Hum Reprod 1995; 10:1869.
    DOI  |   Google Scholar
  23. Glavind K, Palvio DH, Lauritsen JG. Uterine myoma in pregnancy. Acta Obstet Gynecol Scand 1990; 69:617.
     Google Scholar
  24. Mollica G, Pittini L, Minganti E, et al. Elective uterine myomectomy in pregnant women. Clin Exp Obstet Gynecol 1996; 23:168.
     Google Scholar
  25. Roberts WE, Fulp KS, Morrison JC, Martin JN Jr. The impact of leiomyomas on pregnancy. Aust N Z J Obstet Gynaecol 1999; 39:43.
    DOI  |   Google Scholar
  26. Phelan JP. Myomas and pregnancy. Obstet Gynecol Clin North Am 1995; 22:801.
    DOI  |   Google Scholar
  27. Hasan F, Arumugam K, Sivanesaratnam V. Uterine leiomyomata in pregnancy. Int J Gynaecol Obstet 1991; 34:45.
    DOI  |   Google Scholar
  28. Dildy GA 3rd, Moise KJ Jr, Smith LG Jr, et al. Indomethacin for the treatment of symptomatic leiomyoma uteri during pregnancy. Am J Perinatol 1992; 9:185.
    DOI  |   Google Scholar
  29. Niebyl JR, Witter FR. Neonatal outcome after indomethacin treatment for preterm labor. Am J Obstet Gynecol 1986; 155:747.
    DOI  |   Google Scholar
  30. Moise KJ Jr. Effect of advancing gestational age on the frequency of fetal ductal constriction in association with maternal indomethacin use. Am J Obstet Gynecol 1993; 168:1350.
    DOI  |   Google Scholar
  31. Vermillion ST, Scardo JA, Lashus AG, Wiles HB. The effect of indomethacin tocolysis on fetal ductus arteriosus constriction with advancing gestational age. Am J Obstet Gynecol 1997; 177:256.
    DOI  |   Google Scholar
  32. Vitale SG, Tropea A, Rossetti D, et al. Management of uterine leiomyomas in pregnancy: review of literature. Updates Surg 2013; 65:179.
    DOI  |   Google Scholar
  33. Tower AM, Cronin B. Myomectomy after a vaginal delivery to treat postpartum hemorrhage resulting from an intracavitary leiomyoma. Obstet Gynecol 2015; 125:1110.
    DOI  |   Google Scholar
  34. Treissman DA, Bate JT, Randall PT. Epidural use of morphine in managing the pain of carneous degeneration of a uterine leiomyoma during pregnancy. Can Med Assoc J 1982; 126:505.
     Google Scholar
  35. Kwon SY, Lee G, Kim YS. Management of severely painful uterine leiomyoma in a pregnant woman with epidural block using a subcutaneous injection port. Acta Obstet Gynecol Scand 2014; 93:839.
    DOI  |   Google Scholar
  36. D. E. Lolis, S. N. Kalantaridou, G. Makrydimas et al., “Successful myomectomy during pregnancy,” Human Reproduction, vol. 18, no. 8, pp. 1699–1702, 2003.
    DOI  |   Google Scholar
  37. N. Bhatla, B. B. Dash, A. Kriplani, and N. Agarwal, “Myomectomy during pregnancy: a feasible option,” Journal of Obstetrics and Gynaecology Research, vol. 35, no. 1, pp. 173–175, 2009.
    DOI  |   Google Scholar
  38. G. Mollica, L. Pittini, E. Minganti, G. Perri, and F. Pansini, “Elective uterine myomectomy in pregnant women,” Clinical and Experimental Obstetrics and Gynecology, vol. 23, no. 3, pp. 168–172, 1996.
     Google Scholar
  39. Danikas D, Theodorou SJ, Kotrotsios J, Sills C, Cordero PE. Hemoperitoneum from spontaneous bleeding of a uterine leiomyoma: A case report. Am Surg 1999; 65: 1180–1182.
    DOI  |   Google Scholar
  40. V. Lozza, A. Pieralli, S. Corioni, M. Longinotti, and C. Penna, “Multiple laparotomic myomectomy during pregnancy: a case report,” Archives of Gynecology and Obstetrics, vol. 284, no. 3, pp. 613–616, 2011.
    DOI  |   Google Scholar
  41. Salih H.A.M, Sarsam RI, Abed MF, et al. Uterine fibroid causing intestinal obstruction: report of a case. J Young Pharmacists. 2015;7(4):399-402.
    DOI  |   Google Scholar
  42. Domenici L, Donato VDI, Gasparri ML, et al. Laparotomic myoomectomy in the 16th week of pregnancy: a case report. Case reports in Obst and Gynecology. Hindawi Publishing Corporation. 2014:154347:1-5.
    DOI  |   Google Scholar
  43. Glavind K, Palvio DH, Lauritsen JG. Uterine myoma in pregnancy. Acta obstetrician et gynecologica Scandinavica. 1990 Jan 1;69(7-8):617–9.
    DOI  |   Google Scholar
  44. Day Baird D, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomy- oma in black and white women: Ultrasound evidence. American Journal of Obstetrics and Gynecology. 2003;188:100-107.
    DOI  |   Google Scholar
  45. Manopunya, Manatsawee & Tongprasert, Fuanglada & Sukpan, Kornkanok & Tongsong, Theera. (2012). Intra-leiomyoma massive hemorrhage after delivery. The journal of obstetrics and gynaecology research. 39. 10.1111/j.1447-0756.2012.01932.x.
    DOI  |   Google Scholar
  46. Koide, K., Sekizawa, A., Nakamura, M., Matsuoka, R. and Okai, T. (2009), Hypovolemic shock due to massive edema of a pedunculated uterine myoma after delivery. Journal of Obstetrics and Gynaecology Research, 35: 794-796.
    DOI  |   Google Scholar
  47. Frederick J. Mccann. Pregnancy complicated by a fibroid tumour showing "Red Degeneration." Proc R Soc Med.t908 ;1 (ObstetGynaecol Sect): 315-320.
    DOI  |   Google Scholar
  48. Milazzo, Giusi & Catalano, Angelica & Badia, Valentina & Mallozzi, Maddalena & Caserta, Donatella. (2017). Myoma and myomectomy: Poor evidence concern in pregnancy. Journal of Obstetrics and Gynaecology Research.
    DOI  |   Google Scholar
  49. Deveer M, Deveer R, Engin-Ustun Y et al. Comparison of preg- nancy outcomes in different localizations of uterine fibroids. Clin Exp Obstet Gyneco 2012; 39: 516–518.
     Google Scholar
  50. CookH,EzzaliM,SegarsJH,McCarthyD.Theimpactofuter- ine leiomyomas on reproductive outcomes. Minerva Ginecol 2010; 62: 225–236.
     Google Scholar
  51. Parker WH. Laparoscopic myomectomy and abdominal myo- mectomy. Clin Obstet Gynecol 2006; 49: 789–797.
    DOI  |   Google Scholar
  52. Parker WH, Einarsson J, Istre O, Dubuisson JB. Risk factor for uterine rupture after laparoscopic myomectomy. J Minim Inva- sive Gynecol 2010; 17: 551–554.
    DOI  |   Google Scholar
  53. Zhang Y, Hua K. Patients’ age, myoma size, myoma location and interval between myomectomy and pregnancy may influ- ence the pregnancy rate and live birth rate after myomectomy. J Laparoendosc Adv Surg Tech A 2014; 24: 95–99.
    DOI  |   Google Scholar
  54. Claeys J, Hellendoorn I, Hamerlynck T, Bosteels J, Weyers S. The risk of uterine rupture after myomectomy: A systematic review of the literature and metanalysis. Gynecol Surg 2014; 11: 197–206.
    DOI  |   Google Scholar