Acute Complications of Leiomyoma During Pregnancy: Report of Three (3) Cases that Required Antepartum Myomectomy

Abstract

Introduction: Some women with uterine leiomyoma can experience life threatening complications during pregnancy. These leiomyomas are usually large and their associated symptoms were either neglected before the onset of the pregnancy or surgical treatment may have been rejected earlier by the patient.

Case Presentation: Three cases of antepartum myomectomy are reported in this paper. They had severe abdominal pains not responding to medical treatment with gross abdominal distention. Additionally, they had severe life-threatening symptoms including right hypochondria pain and shallow breath in case no.2 and intestinal obstruction in case no.3, an acute surgical complication which could not be resolved by conservative management. All three patients had successful antepartum myomectomy using a new flap techinique not previously described in the literature on reported cases of myomectomy during pregnancy. All the patients recovered successfully from the operation and their pregnancies continued to delivery of their babies at term by caesarean section. Cases no.1 and 2 presented in this report were managed in health facilities in Tamale, Northern Region in 2019. Case no.3 was managed in Accra at the Greater Accra Regional Hospital in 2022.

Conclusion: Pregnant women may present with life threatening complications of leiomyomas, antepartum myomectomy can be considered and successfully performed to improve quality of life or prevent maternal mortality. The procedure for the myomectomy in such situation may not be routine but a special approach is required to avoid fatal complications for both mother and foetus.