Delivery and organ-preserving surgery in a woman with high-risk uterine myoma

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Abstract

This study presents a clinical case from the practice of the State Budgetary Healthcare Institution of the Republic of Bashkortostan “CCPC” in Ufa regarding an organ-preserving operation in a woman with high-risk uterine myoma of isthmus localization that shifted to the posterior wall of the uterus. In May 2023, at 39 weeks of gestation, patient T. was scheduled for a planned operative delivery by cesarean section, followed by conservative myomectomy (removal of uterine fibroids). The indication for surgery was uterine fibroids of isthmus localization with transition to the posterior wall of the uterus, which made vaginal delivery impossible. In this patient, uterine fibroids were discovered during pregnancy. Ultrasonography and magnetic resonance imaging (MRI) were performed. At routine ultrasound screenings, uterine fibroids of isthmus localization measuring 123×99×112 mm without malnutrition of the node were noted. MRI confirmed the diagnosis of large uterine fibroids. A transverse suprapubic laparotomy was performed. The first stage of the combined operation was a cesarean section in the lower segment, and a live full-term boy (weight, 3,480 g; height, 53 cm; Apgar score, 7–8–9 points) was extracted. During the revision of the pelvic organs, a myomatous node was found in the isthmus with a transition to the posterior wall of the uterus, measuring 100×120 mm, without signs of necrosis. Conservative myomectomy without penetration into the uterine cavity was performed. The bed was sutured using separate sutures, and hemostasis was achieved. The myomatous node weighed 570 g. In this clinical case, a favorable full-term pregnancy was possible despite the high-risk uterine fibroids, large sizes, and atypical localization. Combined organ-preserving operations are currently being carried out, which enable a woman to preserve the organ and further realize her reproductive potential.

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About the authors

Alfiya G. Yashchuk

Bashkir State Medical University

Email: alfiya_galimovna@mail.ru
ORCID iD: 0000-0003-2645-1662
SPIN-code: 2607-9150

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Ufa

Aliya R. Iskandarova

City Clinical Perinatal Centre, Ufa

Email: aliya-i@yandex.ru
ORCID iD: 0000-0002-1985-6402
SPIN-code: 3035-0483

Deputy Chief Physician

Russian Federation, Ufa

Zuhra G. Gurova

City Clinical Perinatal Centre, Ufa

Email: zgurova16@yandex.ru
ORCID iD: 0000-0002-9535-3014
SPIN-code: 6801-8087

MD, Cand. Sci. (Medicine); 

Russian Federation, Ufa

Ilnur I. Musin

Bashkir State Medical University

Email: ilnur-musin@yandex.ru
ORCID iD: 0000-0001-5520-5845
SPIN-code: 4829-1179

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Ufa

Maria Y. Klyavlina

City Clinical Perinatal Centre, Ufa

Author for correspondence.
Email: gradusova.maria@mail.ru
ORCID iD: 0009-0001-1751-7482
SPIN-code: 3967-0537

Obstetrician-gynecologist

Russian Federation, Ufa

References

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  4. Sobel M, Hobson S, Chan C. Uterine fibroids in pregnancy. Canadian Medical Association Journal. 2022;194(22):E775. doi: 10.1503/cmaj.211530
  5. Sundermann AC, Aldridge TD, Hartmann KE, et al. Uterine fibroids and risk of preterm birth by clinical subtypes: a prospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):560. doi: 10.1186/s12884-021-03968-2
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  10. Buyanova SN, Logutova LS, Schukina NA., et al. Parasitic myomas and adenomyomas after myomectomy. Akusherstvo i Ginekologiya. 2020;(9):241–247. EDN: RRZKYA doi: 10.18565/aig.2020.9.241-247
  11. Khan AT, Shehmar M, Gupta JK. Uterine broids: current perspectives. International Journal of Women’s Health. 2014;6:95–114. doi: 10.2147/IJWH.S51083

Supplementary files

Supplementary Files
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2. Fig. 1. Magnetic resonance image of patient T’s uterine myoma in the transversal plane during pregnancy.

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3. Fig. 2. Magnetic resonance image of patient T’s uterine myoma in the frontal plane during pregnancy.

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4. Fig. 3. Magnetic resonance image of patient T’s uterine myoma in the sagittal plane during pregnancy.

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5. Fig. 4. Macropreparation of the myomatous node after removal.

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6. Fig. 5. Macropreparation of the myomatous node after sectional removal.

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7. Fig. 6. Myomatous node in transvaginal access before conservative myomectomy.

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8. Fig. 7. Sutured myoma bed after conservative myomectomy by transvaginal access.

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