Skip to main content
PMC home page
Case Reports in Obstetrics and Gynecology logoLink to Case Reports in Obstetrics and Gynecology
. 2017 Apr 24;2017:4970802. doi: 10.1155/2017/4970802

Uterine Fibroid Torsion during Pregnancy: A Case of Laparotomic Myomectomy at 18 Weeks' Gestation with Systematic Review of the Literature

Annachiara Basso 1, Mariana Rita Catalano 1, Giuseppe Loverro 1, Serena Nocera 1, Edoardo Di Naro 1, Matteo Loverro 1, Mariateresa Natrella 2, Salvatore Andrea Mastrolia 1,*
PMCID: PMC5421091  PMID: 28523198

Abstract

Uterine myomas are the most common benign growths affecting female reproductive system, occurring in 20–40% of women, whereas the incidence rate in pregnancy is estimated from 0.1 to 3.9%. The lower incidence in pregnancy is due to the association with infertility and low pregnancy rates and implantation rates after in vitro fertilization treatment. Uterine myomas, usually, are asymptomatic during pregnancy. However, occasionally, pedunculated fibroids torsion or other superimposed complications may cause acute abdominal pain. There are many controversies in performing myomectomy during cesarean section because of the risk of hemorrhage. Nevertheless, the majority of indication arises before labor and delivery due to acute symptoms leading to a discussion regarding the need for intervention during pregnancy. Therefore, we present a case of successful multiple laparotomic myomectomy at 17 + 2 weeks of gestational age and a systematic review of the literature in order to clarify the approach to this pathologic condition and its effect on pregnancy outcome.

1. Introduction

Uterine myomas are the most common benign growths affecting female reproductive system, occurring in 20–40% of women [1], whereas the incidence rate in pregnancy is estimated from 0.1 to 3.9%. The lower incidence in pregnancy is due to the association with infertility and low pregnancy rates and implantation rates after in vitro fertilization treatment [2]. Uterine myomas, usually, are asymptomatic during pregnancy. However, occasionally, pedunculated fibroids torsion or other superimposed complications may cause acute abdominal pain. Urinary and gastroenteric symptoms may occur due to the rapid increase in size in reason of hyperestrogenic environment and, consequently, compression and displacement of surrounding organs. Additionally, fibroids predispose to pregnancy complications, including early miscarriage, antepartum bleeding, preterm labor, premature rupture of membranes, fetal malpresentations, labor dystocia, and postpartum hemorrhage.

Conservative management with anti-inflammatory therapy is considered a gold standard, and surgery is generally avoided during pregnancy because of the risks of hysterectomy secondary to severe hemorrhage, pregnancy injury, and pregnancy loss [3]. The main conditions that induce inevitably the surgical procedure are the torsion of pedunculated fibroids or rare cases of necrosis, resultant inflammatory peritoneal reaction, and, finally, if symptoms persist after 72 hours of pharmacological therapy [4–7]. Therefore, the diagnosis needs a particular attention for the appropriate management choice. Surgical removal fibroids in pregnancy can be performed by laparotomy or laparoscopy technique taking into account the volume and location of nodules [1, 8].

Laparoscopy can be considered in selected cases such as small, subserous, pedunculated myomas.

There are many controversies in performing myomectomy during cesarean section because of the risk of hemorrhage [3]. Nevertheless, the majority of indication arises before labor and delivery due to acute symptoms leading to a discussion regarding the need for intervention during pregnancy.

Therefore, we present a case of successful multiple laparotomic myomectomy at 17 + 2 weeks of gestational age and a systematic review of the literature in order to clarify the approach to this pathologic condition and its effect on pregnancy outcome.

2. Case Report

Uterine myomas are usually asymptomatic during pregnancy. However, pedunculated fibroids torsion may occasionally cause acute abdominal pain [1].

Most cases of laparotomic myomectomy described in literature have been performed during a cesarean section due to the risk of managing them surgically at low gestational age [2–4]. We present a case of a successful multiple laparotomic myomectomy during the second trimester of pregnancy.

A 36-year-old, morbidly obese primigravida presented at our emergency room at 17 + 0 weeks of gestational age complaining of abdominal pain. At clinical examination, the uterus appeared to be of higher volume compared to the gestational age, the abdomen was painful but treatable, and the obstetrical examination was normal. The patient was then referred to US Unit of our Department for further evaluation. The sonographic assessment revealed the presence of three subserous uterine myomas located on anterior wall (maximum diameter: 13.2 cm), the right wall (maximum diameter: 12.6 cm), and the left wall (maximum diameter: 11.7 cm) of the uterus, respectively. All myomas were vacuolated inside as for suspected necrosis. The scan also showed other multiple myomas less than 3 cm in size. Vital signs were monitored (blood pressure 140/90 mmHg, maternal heart rate 124 bmp, SO2 94%, apyretic). Amniotic fluid was normal and fetal well-being was preserved. Thus, the patient was admitted to the High-Risk-Pregnancy Unit. When collecting the medical history, the first trimester ultrasound scan, performed at 11 weeks' gestation, revealed the presence of the same lesions with a size of 10.8 cm, 10.2 cm, and 6.14 cm, respectively.

Laboratory studies demonstrated rising inflammatory markers (C-reactive protein: 354 mg/L; WBC: 16.92 × 103 μL).

Due to the persistence of the symptoms, despite of two days of analgesic, antispastic, and antibiotic therapy, after multidisciplinary discussion, and a thorough counseling to inform the parents of the surgical and postoperative risks connected with uterine surgery during the gestation, the patient underwent surgery. Laparotomy approach by longitudinal skin incision, considering the volume and the position of the myomas, was performed under general anesthesia. Three huge bulky subserous pedunculated myomas were evidenced, the largest located at the uterine fundus, with a maximum diameter of 15 cm and a torsion of its pedicle (Figure 1). Furthermore, intra-abdominal adhesions were found within peritoneal cavity. Blunt dissection was undertaken to free the omentum and look for the appendix, which was normal. The three large myomas evidenced by ultrasound were removed and sent for pathologic examination. A pelvic drainage was left and removed 24 hours postoperatively. Pathology showed widespread phenomena of necrosis, especially in the myoma with torsion of its pedicle.

Figure 1.

Figure 1

Open in a new tab

Myoma of the uterine fundus with evidence of torsion of its pedicle.

During the following nine days, the patient received antibiotics, low molecular heparin, and progesterone, and fetal heartbeat was checked daily. Considering the improvement in clinical condition, the patient was discharged with an indication to treatment with progesterone and low molecular heparin.

Three weeks later, at 21 weeks' gestation, the patient was admitted again due to abdominal pain. Obstetrical evaluation revealed cervical effacement and the transvaginal ultrasound scan showed a reduction of cervical length (18 mm), funneling, and sludge. An ultrasound scan was performed showing good fetal variables. Consequently, the therapy with progesterone was increased. The patient had a positive vaginal culture for Staphylococcus haemolyticus, urine culture was negative, and C-reactive protein resulted to be positive. Therefore, antibiotic therapy with macrolides was given, according to antibiogram result. A cervical cerclage was proposed to the patient, but she refused to undergo the procedure.

Hospitalization lasted for seven days; then the woman was discharged due to an improvement of her clinical condition. The patient underwent obstetric evaluation every two weeks until she presented in labor and delivered vaginally at 38 + 1 weeks' gestation a healthy female newborn of 2940 g, appropriate for gestational age according to national growth curves [9]. Apgar score was 9/10 at 1′ and 5′ respectively.

3. Data Source and Literature Search

To identify potentially eligible studies, we searched PubMed, Scopus, and Cochrane Library (all from inception to 16 March 2017). No language restrictions were initially applied. We used a combination of key words and text words represented by “myomectomy,” “myoma,” and “pregnancy.”

Two reviewers (Annachiara Basso and Mariana Rita Catalano) independently screened the titles and abstracts of records retrieved through database searches. Both reviewers recommended studies for the full-text review. The screen of full-text articles recommended by at least one reviewer was done independently by the same two reviewers and assessed for inclusion in the systematic review. Disagreements between reviewers were resolved by consensus. For all full-text manuscripts, reference lists were analyzed in order to find additional eligible studies.

4. Results

The electronic database search provided a total of 1855 results. After duplicate exclusion, there were 1611 citations left. Of these, 1508 were not relevant to the review based on title and abstract screening. 103 studies were considered for full-text assessment, of which 40 were excluded for the following reasons: we could not translate 31 articles, while nine papers could not be retrieved even after international librarian search.

Overall, 63 [3–6, 10–67] articles were incorporated for further assessment. The study selection process is shown in Figure 2. The main characteristics of the selected studies are included in Table 1.

Figure 2.

Figure 2

Open in a new tab

Study selection process.

Table 1.

Characteristics of the relevant studies.

Reference Number of patients Gestational age at diagnosis 
(weeks)		 Gestational age at myomectomy (weeks) Type of surgery Fibroid maximum volume (cm) Mode of delivery Gestational age at delivery Neonatal outcome
(Apgar, birthweight, pH)
De Carolis et al., 2001 18 nd 13 LPT 8 CS 39 8/8, 3150 g
nd 23 LPT 40 CS 38 8/8, 2670 g
nd 19 LPT 14 VD 36 8/9, 3080 g
nd 17 LPT 21 CS 38 8/9, 3060 g
nd 19 LPT 15 Fetal demise at 19 weeks
nd 20 LPT 6 VD 41 9/9, 2970 g
nd 19 LPT 12 CS 39 7/9, 3180 g
nd 8 LPT 9 CS 40 9/9, 3300 g
nd 12 LPT 8 CS 38 9/10, 2780 g
nd 17 LPT 24 CS 38 9/9, 3900 g
nd 15 LPT 10 CS 40 8/10, 3170 g
nd 17 LPT 13 CS 39 9/10, 3100 g
nd 6 LPT 15 nd nd nd
nd 20 LPT 8 CS 39 9/10, 2860 g
nd 10 LPT 16 CS 40 9/10, 3500 g
nd 16 LPT 10 CS 39 9/10, 3930 g
nd 13 LPT 14 CS 39 9/9, 3180 g
nd 7 LPT 15 CS 38 9/10 - 2550 g
Domenici et al., 2014 1 16 16 LPT 20 CS 38 8/9 - 3250 g
Michalas et al., 1995 1 14 15 LPT 20 CS 39 2800 g
Danzer et al., 2001 1 12 12 LPT 10 CS 37 9/10, 3235 g;
9/10, 2810 g
Lozza et al., 2011 1 12 16 LPT 18 CS 36 9/9, 2280 g
Joó et al., 2001 1 8 25 LPT 12 CS 40 3600 g
Çelik et al., 2002 5 nd 22 LPT 13 CS 38.6 +/− 1.1 10, 3200 g
nd 18 LPT 10 CS 38.6 +/− 1.1 9, 3400 g
nd 20 LPT 12 CS 38.6 +/− 1.1 10, 3600 g
nd 16 LPT 15 CS 38.6 +/− 1.1 8, 3100 g
nd 13 LPT 20 CS 38.6 +/− 1.1 9, 2800 g
Hasbargen et al., 2002 1 18 18 LPT 15 CS 36 8/9, 2495 g
Umezurike and Feyi-Waboso, 2005 1 19 19 LPT 32 VD 38 8/10, 3500 g
Usifo et al., 2007 1 13 13 LPT 17 CS 38 3990 g
Suwandinata et al., 2009 1 nd 18 LPT nd CS 37 8/9, 2950 g
Bhatla et al., 2009 1 8 19 LPT 28 VD 38 2740 g
Leite et al., 2009 1 1st trimester 17 LPT 10 CS 39 9/10, 3315 g
Isabu et al., 2010 1 14 14 LPT nd CS 37 2700 g
Leach et al., 2011 1 11 11 LPT 14 CS 40 9/9, 4356 g
Doerga-Bachasingh et al., 2012 1 9 10 LPT 15 CS 37 nd
Jhalta et al., 2016 1 13 13 LPT 16 VD 39 8/10, 3000 g
Kosmidis et al., 2015 1 10 10 LPS 8 nd nd nd
Saccardi et al., 2015 1 9 15 LPS 24 CS 41 4460 g, 7.2
Obara et al., 2014 1 6 13 VAG 6 VD 40 2775 g
Currie et al., 2013 1 11 11 LPS 8 nd nd nd
Kobayashi et al., 2013 1 21 21 LPT 8 CS 37 2730 g
MacCiò et al., 2012 3 8 19 LPS 11 CS 39 3150 g
20 20 LPS 10 VD 40 3310 g
20 20 LPS nd CS 39 3050 g
Shafiee et al., 2012 1 15 21 LPS 15 CS 38 nd
Ardovino et al., 2011 1 14 14 LPS 6 VD 40 3216 g
Müller Vranjes et al. 1 14 18 LPT 35 CS 33 10/10, 1750 g, 7.28
Son et al., 2011 1 18 18 LPS 9 VD 39 3740 g
Kasum 2010 1 15 15 LPT 9 VD 38 nd
Fanfani et al., 2010 1 25 25 LPS 9 VD 40 2950 g
Adeyemi et al., 2007 1 19 19 LPT 30 VD 39 7/10, 3500 g
Okonkwo and Udigwe, 2007 1 19 24 LPT nd CS nd nd
Dracea and Codreanu, 2006 1 12 13 LPT 24 VD nd nd
Melgrati et al., 2005 1 24 24 LPS 7 VD 39 9/9
Sentilhes et al., 2003 1 17 17 LPS 5 CS 37 3530 g
Lolis et al., 2003 13 nd 16 LPT nd CS 37 3340 g
nd 15 LPT nd CS 39 3600 g
nd 19 LPT nd CS 37 2970 g
nd 16 LPT nd CS 36 3000 g
nd 15 LPT nd Fetal demise at 15 weeks
nd 15 LPT nd CS 37 2740 g
nd 16 LPT nd CS 38 3180 g
nd 16 LPT nd CS 39 3515 g
nd 16 LPT nd CS 39 3190 g
nd 19 LPT nd CS 38 2920 g
nd 17 LPT nd CS 38 3520 g
nd 16 LPT nd CS 38 3000 g
nd 15 LPT nd CS 29 1606 g
Donnez et al., 2002 1 Before pregnancy 25 LPT 22 CS 35 2280 g
Williamson, 1908 1 22 22 LPT 32 VD 23 Neonatal death
Stewart, 1906 1 20 20 LPT 24 VD 40 nd
Wittich et al., 2000 1 12 15 LPT 20 CS 37 9/9, 3275 g
Majid et al., 1997 1 17 18 LPT 24 Fetal demise 19 weeks
Algara et al., 2015 1 18 18 LPS 7 VD 24 nd
Lockyer, 1914 1 21 21 LPT nd VD 40 2300 g
von Hoffmann, 1911 3 16 16 LPT nd VD 40 3630 g
22 25 LPT nd Fetal demise at 25 weeks
14 15 LPT nd VD 40 nd
Andrews, 1910 1 Before pregnancy 9 LPT nd VD 40 nd
Swayne, 1908 2 20 20 LPT nd nd nd nd
16 16 LPT nd VD 24 nd
Doran, 1906 1 20 21 LPT 10 VD 40 nd
Evans, 1899 1 20 20 LPT 7 nd nd nd
Exacoustòs and Rosati, 1993 13 nd <26 nd nd N.G 40 (8), preterm > 32 (5) nd
Burton et al., 1989 8 nd 13 LPT 18 VD 40 nd
nd 15 LPT 14 Fetal demise 15 weeks
nd nd LPT 5 VD 40 nd
nd nd LPT 5 VD 40 nd
nd nd LPT 5 VD 40 nd
nd nd LPT 5 VD 40 nd
nd nd LPT 5 VD 40 nd
nd nd LPT 5 nd nd nd
Rella et al., 1980 1 10 12 LPT nd VD 27 Neonatal death
Pelosi et al., 1995 1 13 15 LPS 6 CS 39 nd
Pelissier-Komorek et al., 2012 1 10 13 LPT 22 VD 35 2280 g
Mollica et al., 1996 18 8–17 10–19 LPT >10 CS (17), VD (1) nd >7 (18), >2500 g (17), <2500 g (1)
Febo et al., 1997 3 nd 12–19 LPT N.G. CS (2), abortion (1) 37-38 nd
Bonito et al., 2007 5 nd 9–15 LPT 3.5–14.5 CS (2), VD (3) 38.2 9 +/− 0.83, 3200–4072 g
Vázquez Camacho et al., 2009 1 7 16 LPT 6.2 VD 40 9/9
Makar et al., 1989 1 12 17 LPT 13,500 g CS 38 9/9, 3950 g
Horno Liria, 1962 1 16 16 LPT nd VD 40 3600 g
Alanis et al., 2008 1 7 12 LPT 30 VD 38 2330 g
Ardizzone, 1955 27 8 8 LPT nd nd nd nd
8 8 LPT nd nd nd nd
8 8 LPT nd Miscarriage at 9 weeks
24 24 LPT nd Fetal demise at 25 weeks
8 8 LPT nd Miscarriage at 8 weeks
16 16 LPT nd nd nd nd
8 8 LPT nd nd nd nd
8 8 LPT nd nd nd nd
12 12 LPT nd Fetal demise at 14 weeks
20 20 LPT nd nd nd nd
16 16 LPT nd nd nd nd
20 20 LPT nd nd nd nd
20 20 LPT nd nd nd nd
12 12 LPT nd nd nd nd
12 12 LPT nd Fetal demise at 13 weeks
8 8 LPT nd nd nd nd
8 8 LPT nd nd nd nd
12 12 LPT nd Fetal demise at 13 weeks
12 12 LPT nd nd nd nd
16 16 LPT nd Fetal demise at 17 weeks
8 8 LPT nd nd nd nd
12 12 LPT nd nd nd nd
12 12 LPT nd nd nd nd
12 12 LPT nd nd nd nd
8 8 LPT nd nd nd nd
12 12 LPT nd Fetal demise at 12 weeks
12 12 LPT nd nd nd nd
Cozzi, 1967 16 nd 12 LPT nd VD 40 nd
nd 12 LPT nd VD 40 nd
nd 8 LPT nd VD 40 nd
nd 8 LPT nd VD 40 nd
nd 16 LPT nd VD 38 nd
nd 8 LPT nd VD 40 nd
nd 12 LPT nd VD 38 nd
nd 8 LPT nd VD 40 nd
nd 16 LPT nd VD 40 nd
nd 20 LPT nd VD 36 nd
nd 8 LPT nd VD 40 nd
nd 12 LPT nd VD 40 nd
nd 12 LPT nd VD 40 nd
nd 12 LPT nd VD 40 nd
nd 16 LPT nd VD 40 nd
nd 8 LPT nd VD 40 nd
Rochet et al., 1964 14 nd nd LPT 10 nd nd nd
Sciannameo et al., 1996 1 20 20 LPT 4 nd nd nd
Open in a new tab

nd, not determined; CS, cesarean section; VD, vaginal delivery; LPT, laparotomy; LPS, laparoscopy; VAG, vaginal surgery.

5. Discussion

Our review included 197 women undergoing myomectomy during pregnancy. The procedure was successful in 184 women, while in the remaining 13 cases a miscarriage or fetal demise happened after the myomectomy.

In 14 cases, a laparoscopic approach was chosen; in one case there was a vaginal surgery, while all the other cases for which the surgical information was available underwent laparotomy. These data confirm that the most used surgical intervention for myomas during pregnancy is the laparotomy route.

Maternal outcomes were favorable after myomectomy, with only two episodes of hemoperitoneum [33, 67], one uterine abscess [39], and only one woman requiring perioperative blood transfusion [61].

Moreover, the analysis of all reports was limited by two factors: (1) the heterogeneity of diagnostic information as well as descriptive data connected to operation and pathology examination which did not allow clear categorization of the pathology preoperatively and postoperatively and (2) the large amount of missing or unreported data.

6. Conclusion

Myomectomy is a feasible procedure if performed during pregnancy. Candidates need to be chosen carefully among those with symptomatic myomas, since abdominal surgery during pregnancy can be associated with an increased risk for the development of the great obstetrical syndromes, especially preterm labor and delivery.

Disclosure

This paper has been presented in part at the 19th National Congress of the Italian Society of Perinatal Medicine (Società Italiana di Medicina Perinatale, SIMP), Naples (Italy), 19–21 January 2017.

Conflicts of Interest

The authors declare that there are no conflicts of interest.

References

  • 1.Vitale S. G., Tropea A., Rossetti D., Carnelli M., Cianci A. Management of uterine leiomyomas in pregnancy: review of literature. Updates in Surgery. 2013;65(3):179–182. doi: 10.1007/s13304-013-0198-z. [DOI] [PubMed] [Google Scholar]
  • 2.Sunkara S. K., Khairy M., El-Toukhy T., Khalaf Y., Coomarasamy A. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Human Reproduction. 2010;25(2):418–429. doi: 10.1093/humrep/dep396. [DOI] [PubMed] [Google Scholar]
  • 3.Lozza V., Pieralli A., Corioni S., Longinotti M., Penna C. Multiple laparotomic myomectomy during pregnancy: a case report. Archives of Gynecology and Obstetrics. 2011;284(3):613–616. doi: 10.1007/s00404-011-1939-1. [DOI] [PubMed] [Google Scholar]
  • 4.Domenici L., Di Donato V., Gasparri M. L., Lecce F., Caccetta J., Panici P. B. Laparotomic myomectomy in the 16th week of pregnancy: a case report. Case Reports in Obstetrics and Gynecology. 2014:5. doi: 10.1155/2014/154347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Lolis D. E., Kalantaridou S. N., Makrydimas G., et al. Successful myomectomy during pregnancy. Human Reproduction. 2003;18(8):1699–1702. doi: 10.1093/humrep/deg318. [DOI] [PubMed] [Google Scholar]
  • 6.De Carolis S., Fatigante G., Ferrazzani S., et al. Uterine myomectomy in pregnant women. Fetal Diagnosis and Therapy. 2001;16(2):116–119. doi: 10.1159/000053893. [DOI] [PubMed] [Google Scholar]
  • 7.Bhatla N., Dash B. B., Kriplani A., Agarwal N. Myomectomy during pregnancy: a feasible option. Journal of Obstetrics and Gynaecology Research. 2009;35(1):173–175. doi: 10.1111/j.1447-0756.2008.00873.x. [DOI] [PubMed] [Google Scholar]
  • 8.Cagnacci A., Pirillo D., Malmusi S., Arangino S., Alessandrini C., Volpe A. Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study. Human Reproduction. 2003;18(12):2590–2594. doi: 10.1093/humrep/deg478. [DOI] [PubMed] [Google Scholar]
  • 9.Parazzini F., Cipriani S., Bulfoni G., et al. Centiles of weight at term birth according to maternal nationality in a northern Italian region. Italian Journal of Gynaecology and Obstetrics. 2016;28(2):52–56. doi: 10.14660/2385-0868-44. [DOI] [Google Scholar]
  • 10.Michalas S. P., Oreopoulou F. V., Papageorgiou J. S. Myomectomy during pregnancy and caesarean section. Human Reproduction. 1995;10(7):1869–1870. doi: 10.1093/oxfordjournals.humrep.a136195. [DOI] [PubMed] [Google Scholar]
  • 11.Danzer E., Holzgreve W., Batukan C., Miny P., Tercanli S., Hoesli I. Myomectomy during the first trimester associated with fetal limb anomalies and hydrocephalus in a twin pregnancy. Prenatal Diagnosis. 2001;21(10):848–851. doi: 10.1002/pd.155. [DOI] [PubMed] [Google Scholar]
  • 12.Joó J. G., Inovay J., Silhavy M., Papp Z. Successful enucleation of a necrotizing fibroid causing oligohydramnios and fetal postural deformity in the 25th week of gestation. A case report. Journal of Reproductive Medicine. 2001;46(10):923–925. [PubMed] [Google Scholar]
  • 13.Çelik Ç., Acar A., Çiçek N., Gezginc K., Akyürek C. Can myomectomy be performed during pregnancy? Gynecologic and Obstetric Investigation. 2002;53(2):79–83. doi: 10.1159/000052997. [DOI] [PubMed] [Google Scholar]
  • 14.Hasbargen U., Strauss A., Summerer-Moustaki M., et al. Myomectomy as a pregnancy-preserving option in the carefully selected patient. Fetal Diagnosis and Therapy. 2002;17(2):101–103. doi: 10.1159/000048017. [DOI] [PubMed] [Google Scholar]
  • 15.Umezurike C., Feyi-Waboso P. Successful myomectomy during pregnancy: a case report. Reproductive Health. 2005;2(1) doi: 10.1186/1742-4755-2-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Usifo F., Macrae R., Sharma R., Opemuyi I. O., Onwuzurike B. Successful myomectomy in early second trimester of pregnancy. Journal of Obstetrics and Gynaecology. 2007;27(2):196–197. doi: 10.1080/01443610601137911. [DOI] [PubMed] [Google Scholar]
  • 17.Suwandinata F. S., Gruessner S. E., Omwandho C. O., Tinneberg H. R. Pregnancy-preserving myomectomy: preliminary report on a new surgical technique. European Journal of Contraception and Reproductive Health Care. 2008;13(3):323–326. doi: 10.1080/13625180802586501. Erratum in: European Journal of Contraception and Reproductive Health Care, vol. 13, no. 4, article 438, 2008. [DOI] [PubMed] [Google Scholar]
  • 18.Leite G. K., Korkes H. A., Viana Ade T., Pitorri A., Kenj G., Sass N. Myomectomy in the second trimester of pregnancy: case report. Revista Brasileira De Ginecologia E Obstetricia. 2010;32(4):198–201. doi: 10.1590/s0100-72032010000400008. [DOI] [PubMed] [Google Scholar]
  • 19.Isabu P., Eigbefoh J., Okogbo F., Okunsanya S., Eifediyi R. Myomectomy during second trimester pregnancy: a case report. The Nigerian Postgraduate Medical Journal. 2010;17(4):324–326. [PubMed] [Google Scholar]
  • 20.Leach K., Khatain L., Tocce K. First trimester myomectomy as an alternative to termination of pregnancy in a woman with a symptomatic uterine leiomyoma: a case report. Journal of Medical Case Reports. 2011;5, article 571 doi: 10.1186/1752-1947-5-571. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Doerga-Bachasingh S., Karsdorp V., Yo G., Van Der Weiden R., Van Hooff M. Successful myomectomy of a bleeding myoma in a twin pregnancy. JRSM Short Reports. 2012;3(2, article 13) doi: 10.1258/shorts.2011.011087. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Jhalta P., Negi S. G., Sharma V. Successful myomectomy in early pregnancy for a large asymptomatic uterine myoma: case report. Pan African Medical Journal. 2016;13(24, article 228) doi: 10.11604/pamj.2016.24.228.9890.228 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Kosmidis C., Pantos G., Efthimiadis C., Gkoutziomitrou I., Georgakoudi E., Anthimidis G. Laparoscopic excision of a pedunculated uterine leiomyoma in torsion as a cause of acute abdomen at 10 weeks of pregnancy. American Journal of Case Reports. 2015;16:505–508. doi: 10.12659/AJCR.893382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Saccardi C., Visentin S., Noventa M., Cosmi E., Litta P., Gizzo S. Uncertainties about laparoscopic myomectomy during pregnancy: a lack of evidence or an inherited misconception? A critical literature review starting from a peculiar case. Minimally Invasive Therapy and Allied Technologies. 2015;24(4):189–194. doi: 10.3109/13645706.2014.987678. [DOI] [PubMed] [Google Scholar]
  • 25.Obara M., Hatakeyama Y., Shimizu Y. Vaginal myomectomy for semipedunculated cervical myoma during pregnancy. American Journal of Perinatology Reports. 2014;4(1):37–40. doi: 10.1055/s-0034-1370352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Currie A., Bradley E., McEwen M., Al-Shabibi N., Willson P. D. Laparoscopic approach to fibroid torsion presenting as an acute abdomen in pregnancy. Journal of the Society of Laparoendoscopic Surgeons. 2013;17(4):665–667. doi: 10.4293/108680813X13794522666400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Kobayashi F., Kondoh E., Hamanishi J., Kawamura Y., Tatsumi K., Konishi I. Pyomayoma during pregnancy: a case report and review of the literature. Journal of Obstetrics and Gynaecology Research. 2013;39(1):383–389. doi: 10.1111/j.1447-0756.2012.01947.x. [DOI] [PubMed] [Google Scholar]
  • 28.MacCiò A., Madeddu C., Kotsonis P., et al. Three cases of laparoscopic myomectomy performed during pregnancy for pedunculated uterine myomas. Archives of Gynecology and Obstetrics. 2012;286(5):1209–1214. doi: 10.1007/s00404-012-2441-0. [DOI] [PubMed] [Google Scholar]
  • 29.Shafiee M., Nor Azlin M., Arifuddin D. A successful antenatal myomectomy. Malaysian Family Physician. 2012;31(7(2-3)):42–45. [PMC free article] [PubMed] [Google Scholar]
  • 30.Ardovino M., Ardovino I., Castaldi M. A., Monteverde A., Colacurci N., Cobellis L. Laparoscopic myomectomy of a subserous pedunculated fibroid at 14 weeks of pregnancy: a case report. Journal of Medical Case Reports. 2011;5, article 545 doi: 10.1186/1752-1947-5-545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Müller Vranjes A., Sijanović S., Vidosavljević D., Kasac Z., Abicic Zuljević K. Surgical treatment of large smooth muscle tumor of uncertain malignant potential during pregnancy. Medicinski Glasnik Journal. 2011;8(2):290–292. [PubMed] [Google Scholar]
  • 32.Son C. E., Choi J. S., Lee J. H., Jeon S. W., Bae J. W., S. Seo S. A case of laparoscopic myomectomy performed during pregnancy for subserosal uterine myoma. Journal of Obstetrics and Gynaecology. 2011;31(2):180–181. doi: 10.3109/01443615.2010.538774. [DOI] [PubMed] [Google Scholar]
  • 33.Kasum M. Hemoperitoneum caused by a bleeding myoma in pregnancy. Acta Clinica Croatica. 2010;49(2):197–200. [PubMed] [Google Scholar]
  • 34.Fanfani F., Rossitto C., Fagotti A., Rosati P., Gallotta V., Scambia G. Laparoscopic myomectomy at 25 weeks of pregnancy: case report. Journal of Minimally Invasive Gynecology. 2010;17(1):91–93. doi: 10.1016/j.jmig.2009.08.004. [DOI] [PubMed] [Google Scholar]
  • 35.Adeyemi A. S., Akinola S. E., Isawumi A. I. Antepartum myomectomy with a live term delivery—a case report. Nigerian Journal of Clinical Practice. 2007;10(4):346–348. [PubMed] [Google Scholar]
  • 36.Okonkwo J. E. N., Udigwe G. O. Myomectomy in pregnancy. Journal of Obstetrics and Gynaecology. 2007;27(6):628–630. doi: 10.1080/01443610701538372. [DOI] [PubMed] [Google Scholar]
  • 37.Dracea L., Codreanu D. Vaginal birth after extensive myomectomy during pregnancy in a 39-year-old nulliparous woman. Journal of Obstetrics and Gynaecology. 2006;26(4):374–375. doi: 10.1080/01443610600618648. [DOI] [PubMed] [Google Scholar]
  • 38.Melgrati L., Damiani A., Franzoni G., Marziali M., Sesti F. Isobaric (gasless) laparoscopic myomectomy during pregnancy. Journal of Minimally Invasive Gynecology. 2005;12(4):379–381. doi: 10.1016/j.jmig.2005.05.012. [DOI] [PubMed] [Google Scholar]
  • 39.Sentilhes L., Sergent F., Verspyck E., Gravier A., Roman H., Marpeau L. Laparoscopic myomectomy during pregnancy resulting in septic necrosis of the myometrium. BJOG: An International Journal of Obstetrics and Gynaecology. 2003;110(9):876–878. doi: 10.1111/j.1471-0528.2003.03045.x. [DOI] [PubMed] [Google Scholar]
  • 40.Donnez J., Pirard C., Smets M., Polet R., Feger C., Squifflet J. Unusual growth of a myoma during pregnancy. Fertility and Sterility. 2002;78(3):632–633. doi: 10.1016/S0015-0282(02)03297-1. [DOI] [PubMed] [Google Scholar]
  • 41.Williamson H. Enucleation during the seventh lunar month of pregnancy of a uterine fibro-myoma. Proceedings of the Royal Society of Medicine. 1908;1:73–78. [PMC free article] [PubMed] [Google Scholar]
  • 42.Stewart J. Enucleation of fibro-myoma of uterus during pregnancy. British Medical Journal. 1906;1(2358):548–549. doi: 10.1136/bmj.1.2358.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Wittich A. C., Salminen E. R., Yancey M. K., Markenson G. R. Myomectomy during early pregnancy. Military Medicine. 2000;165(2):162–164. [PubMed] [Google Scholar]
  • 44.Majid M., Khan G. Q., Wei L. M. Inevitable myomectomy in pregnancy. Journal of Obstetrics and Gynaecology. 1997;17(4):377–378. doi: 10.1080/01443619750112925. [DOI] [PubMed] [Google Scholar]
  • 45.Algara A. C., Rodríguez A. G., Vázquez A. C., et al. Laparoscopic approach for fibroid removal at 18 weeks of pregnancy. Surgical Technology International. 2015;27:195–197. [PubMed] [Google Scholar]
  • 46.Lockyer C. Multiple myomectomy in the sixth month of pregnancy; labour at term. Proceedings of the Royal Society of Medicine. 1914;7:221–225. [PMC free article] [PubMed] [Google Scholar]
  • 47.von Hoffmann C. A. Abdominal myomectomy during pregnancy. California State Journal of Medicine. 1911;9(5):197–200. [PMC free article] [PubMed] [Google Scholar]
  • 48.Andrews H. R. Myomectomy during pregnancy. Proceedings of the Royal Society of Medicine. 1910;3:164–166. [PMC free article] [PubMed] [Google Scholar]
  • 49.Swayne WC. Abdominal myomectomy during pregnancy. Proceedings of the Royal Society of Medicine. 1908;1:129–132. [PMC free article] [PubMed] [Google Scholar]
  • 50.Doran A. Myomectomy during pregnancy and labour at term in an elderly primipara: with notes on similar cases. British Medical Journal. 1906;2(2395):1446–1447. doi: 10.1136/bmj.2.2395.1446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Evans H. M. A case of myomectomy for subperitoneal myoma complicating pregnancy. British Medical Journal. 1899;2(2033):p. 1673. doi: 10.1136/bmj.2.2033.1673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Exacoustòs C., Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstetrics and Gynecology. 1993;82(1):97–101. [PubMed] [Google Scholar]
  • 53.Burton C. A., Grimes D. A., March C. M. Surgical management of leiomyomata during pregnancy. Obstetrics and Gynecology. 1989;74(5):707–709. [PubMed] [Google Scholar]
  • 54.Rella R., Bonfadini Bossi E., Fagnani D. Myomectomy in pregnancy. Description of an interesting clinical case. Minerva Ginecologica. 1980;32(4):267–269. [PubMed] [Google Scholar]
  • 55.Pelosi M. A., Pelosi M. A., III, Giblin S. Laparoscopic removal of a 1500-g symptomatic myoma during the second trimester of pregnancy. American Association of Gynecologic Laparoscopists. 1995;2(4):457–462. doi: 10.1016/S1074-3804(05)80070-2. [DOI] [PubMed] [Google Scholar]
  • 56.Pelissier-Komorek A., Hamm J., Bonneau S., Derniaux E., Hoeffel-Fornes C., Graesslin O. Myoma and pregnancy: when medical treatment is not sufficient. Journal de Gynecologie Obstetrique et Biologie de la Reproduction. 2012;41(3):307–310. doi: 10.1016/j.jgyn.2011.10.002. [DOI] [PubMed] [Google Scholar]
  • 57.Mollica G., Pittini L., Minganti E., Perri G., Pansini F. Elective uterine myomectomy in pregnant women. Clinical and Experimental Obstetrics and Gynecology. 1996;23(3):168–172. [PubMed] [Google Scholar]
  • 58.Febo G., Tessarolo M., Leo L., Arduino S., Wierdis T., Lanza L. Surgical management of leiomyomata in pregnancy. Clinical and Experimental Obstetrics and Gynecology. 1997;24(2):76–78. [PubMed] [Google Scholar]
  • 59.Bonito M., Gulemì L., Basili R., Roselli D. Myomectomy during the first and second trimester of pregnancy. Clinical and Experimental Obstetrics and Gynecology. 2007;34(3):149–150. [PubMed] [Google Scholar]
  • 60.Vázquez Camacho E. E., Cabrera Carranco E., Sánchez Herrera R. G. Pedunculated twisted myoma and pregnancy. Case report. Ginecologia y Obstetricia de Mexico. 2009;77(9):441–444. [PubMed] [Google Scholar]
  • 61.Makar A. P., Schatteman E. A., Vergote I. B., Desmedt E. Myomectomy during pregnancy: uncommon case report. Acta Chirurgica Belgica. 1989;89(4):212–214. [PubMed] [Google Scholar]
  • 62.Horno Liria R. Myomectomy and pregnancy. Rev Esp Obstet Ginecol. 1962;19:214–218. [PubMed] [Google Scholar]
  • 63.Alanis M. C., Mitra A., Koklanaris N. Preoperative magnetic resonance imaging and antepartum myomectomy of a giant pedunculated leiomyoma. Obstetrics and Gynecology. 2008;111(2, part 2):577–579. doi: 10.1097/01.AOG.0000297314.62914.f7. [DOI] [PubMed] [Google Scholar]
  • 64.Ardizzone G. Clinical and statistical considerations of 27 cases of myomectomy in pregnancy. Rivista di Ostetricia e Ginecologia. 1955;10(12):848–860. [PubMed] [Google Scholar]
  • 65.Cozzi M. Myomectomy in pregnancy. Quaderni di Clinica Ostetrica e Ginecologica. 1967;22(3):171–180. [PubMed] [Google Scholar]
  • 66.Rochet Y., Cognat M., Dargent D., Pollosson E. On myomectomy during pregnance (apropos of 14 observations) Bulletin de la Fèdèration des Sociètès de Gynècologie et Dòbstètrique de Langue Francaise. 1964;16:462–463. [PubMed] [Google Scholar]
  • 67.Sciannameo F., Madami G., Madami C., et al. Torsion of uterine fibroma associated with inguinal incarcerated hernia in pregnancy. Case report. Minerva Ginecologica. 1996;48(11):501–504. [PubMed] [Google Scholar]

Articles from Case Reports in Obstetrics and Gynecology are provided here courtesy of Wiley

RESOURCES