However, in the presence of intractable symptoms, some patients have been offered termination of pregnancy [8]. A 37-year-old G3P0+1 lady was referred from a secondary level facility to our centre due to a huge uterine fibroid coexisting with pregnancy at 14 weeks gestation. Caesarean myomectomy was further adjudged to be safe in this case because the ultrasound scan showed a single, large, subserous fibroid nodule. stimulated by estrogens). Fibroids are very common. The effect of fibroids on the pregnancy. A. Mynbaev et al., “The surgical outcome of Intracapsular cesarean myomectomy. She was counselled for an elective caesarean section while on admission to which she gave her consent. This is the currently recommended technique for caesarean myomectomy [27, 28] which is safe, feasible, and reliable if correctly performed in carefully selected patients [27–29]. The process of fibroid degeneration may sometimes cause … 2. This is called cystic degeneration. The first line of management is conservative with counselling for myomectomy after delivery. Elective caesarean section was carried out under spinal anaesthesia at 35 weeks of gestation. B. Caughey, and V. Y. Fujimoto, “Fibroids and reproductive outcomes: a systematic literature review from conception to delivery,”, R. Zhao, X. Wang, L. Zou et al., “Adverse obstetric outcomes in pregnant women with uterine fibroids in China: a multicenter survey involving 112, 403 deliveries,”, G. N. Milazzo, A. Catalano, V. Badia, M. Mallozzi, and D. Caserta, “Myoma and myomectomy: poor evidence concern in pregnancy,”, C. Ezeama, J. I. Ikechebelu, N. J. Obiechina, and N. N. Ezeama, “Clinical presentation of uterine fibroids in Nnewi, Nigeria: a 5-year review,”, M. A. Adegbesan-Omilabu, K. S. Okunade, and A. Gbadegesin, “Knowledge of, perception of, and attitude towards uterine Fibroids among women with fibroids in Lagos, Nigeria,”, A. Ciavattini, N. Clemente, G. Deli-Carpini, J. Paracetamol and opiate-based analgesia are safe in pregnancy. She did not seek any medical advice or treatment for the abdominal swelling before she became pregnant. Extensive degeneration within fibroids can cause diagnostic dilemmas. A study investigated the frequency of red degeneration in fibroids during pregnancy using ultrasound scans. She eventually had a caesarean myomectomy at 35 weeks of gestation; the outcome was a live female baby with a birth weight of 2.3 kg and a large subserous fibroid weighing 9.5 kg. Mass was predominantly cystic with septations. Learn about our remote access options, ST7 Obstetrics and Gynaecology, Princess Alexandra Hospital, Harlow, Essex, CM20 1QX UK, Consultant in Obstetrics and Gynaecology with a special interest in Fertility, Ipswich Hospital, Ipswich, Suffolk, IP4 5PD UK. Uterine fibroid is the commonest benign tumour of the female reproductive tract. Following the delivery of the baby, the uterine incision was repaired. Thus, she was admitted and managed conservatively for eight weeks with significant relief of symptoms. Cystic degeneration is observed in about 4% of leiomyomas. Being rare in prepubertal females, they commonly accelerate in growth during pregnancy and involute with menopause 1. Degenerating Cystic Uterine Fibroid Mimics an Ovarian Cyst in a Pregnant Patient. Hyaline cystic degenerations of the uterine fibroids may be rare but not uncommon. The knowledge of differential diagnoses and respective US and MRI findings becomes indispensable, considering that fibroids with cystic degeneration may mimic a range of pelvic disorders. Copyright © 2020 Edu Eyong and Okon A. Okon. USG is helpful; More in fibroids >5cm and in 2nd / 3rd trimester; Mostly due to red degeneration (seen as cystic changes within fibroid on USG) or torsion (of padenculated); May need hospitalization & analgesics.Paracetamol & opiate-based → safe in pregnancy; Most effective analgesic → Ibuprofen (caution in 3rd trimester if used >48hrs) ** Degeneration is described as hyaline, myxomatous, calcific, cystic, fatty, red (usually only during pregnancy), or necrotic. The authors declare that there is no conflict of interests regarding the publication of this paper. Please check your email for instructions on resetting your password. In fact pain is the most common complication of fibroids during pregnancy. Our index patient noticed progressive abdominal swelling over seven years but did not present for treatment in any hospital before she got pregnant. A fibroid can undergo a different type of degeneration known as red degeneration, or necrobiosis. In some cases, it can lead to miscarriage. 1,2 On gross pathological examination, it is characterized by a red, hemorrhagic appearance of the leiomyoma if the surgery was performed during the acute phase of red degeneration. Occurrence. During the period of admission, the patient had a transfusion of one unit of packed cells. Working off-campus? It occurs in 20–40% of women, whereas the estimated incidence in pregnancy is 0.1–3.9%. On examination, the patient was not in respiratory distress, clinically pale, afebrile, anicteric, and no pedal oedema. The lead author undertook the major part in writing and researching this report, with the review, editing, and plagiarism verification done by the second author. Also, our women usually present late for treatment due to poor health-seeking behaviour, sociocultural and financial constraints, and the fear of surgery [16, 21, 22]. We decided to document this case of successful caesarean myomectomy done in our clinical setting of limited resources to encourage the broadening of counselling options in carefully selected cases. It can occur in pregnancy and non-pregnant state in the reproductive age. In pregnancy, fibroids can lead to complications such as placental abruption and increased caesarean section rates. In one study, only 40% of fibroids diagnosed during pregnancy were clinically detectable (17). Fibroids(leiomyomas)arethemostcommonpelvictumourin pregnancy, with a prevalence of 10.7% in the first trimester.1 Fibroidsare morecommonin womenoriginating from South Asian, African and Middle Eastern subcontinents. The complications which could be associated with uterine fibroids in pregnancy include degenerative changes which commonly cause abdominal pain, miscarriages, malposition/malpresentation, intrauterine growth restriction, antepartum haemorrhage, preterm labour, obstructed labour, postpartum haemorrhage, and high caesarean section rates [16–19, 24–26]. This type of degeneration typically occurs during pregnancy. Fibroids are uncommon before the onset of puberty and regress after menopause. Affect 40–80 % of all the symptoms of necrobiosis include severe abdominal pain swelling! Figure 3 showed areas of cystic spaces without epithelial linings spaces or coarse heterogeneous cystic degeneration of fibroid in pregnancy pattern cystic! The diagnosis could be single or multiple in number and present in varying sizes admission to which she gave consent... Thought to represent ~4 % of all women have uterine fibroids in uterus Pictures she! 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