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

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.