Unavoidable caesarean myomectomy: A case report

Abstract

Establishment of the feasibility and need to perform myomectomy during caesarean section when fibroid obstruct wound closure with associated hemorrhage has been presented. A case of a primigravida with a huge uterine fibroid located in the lower segment lifting up the uterine cavity leading to persistent transverse lie of the fetus at term is presented. An elective classical caesarean section was performed with difficulty in uterine wound closure and haemorrhage necessitating myomectomy. Haemorrhage was controlled with the use of Foley catheter tourniquet and high dose oxytocin infusion. Literature review was carried out. The mother and baby had satisfactory outcome. To conclude, life threatening situations of myomectomy with caesarean section ought to be, and can be safely performed using tourniquet and high dose oxytocin to reduce haemorrhage. The uterus in the immediate post partum period is better adapted physiologically to control haemorrhage than any other stage of a woman's life.

Key Words: Classical caesarean Section, Myomectomy, caesarean-myomectomy, Haemorrhage.  

doi:10.3126/njog.v2i2.1463

N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 81 - 83