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17.02.2015


A month after undergoing emergency surgery, it's clear the experience has had a sobering effect on Liz, 28, who's always dreamed of having a family. She is now planning to donate some of her eggs to help couples who cannot conceive naturally to have a baby.
Five weeks ago, Liz was in the middle of an interview when suddenly she felt extremely light-headed and unwell. This is when a fertilised egg becomes implanted outside the womb, most often in the fallopian tubes. If the pregnancy is not caught in time, the tube can burst, causing a huge loss of blood which can prove fatal. During the operation, it emerged that Liz was not pregnant - instead, her symptoms were the result of her fallopian tubes being stuck together. The main symptom is pain, as the band of tissue pulls on the fallopian tubes and twists them.
The symptoms can also worsen if a woman has a mild infection elsewhere in the body, because this can cause slight inflammation in the fallopian tubes. If this happens and the tubes become swollen, a scan can check whether or not there's an ectopic pregnancy. The problem is that if the tubes develop a kink or become blocked because of adhesions, it affects a woman's fertility and increases the risk of an ectopic pregnancy later. Although Liz was assured she'd be able to have children, her experience opened her eyes to those who cannot. AbstractBackgroundThe medical literature has reported an increase in myomectomy during caesarean section in the past decade.
As a busy clinician, balancing work life and home life and personal time generally means that something gives.
The former Atomic Kitten and winner of last year's Celebrity Masterchef is constantly on the go. At first this was thought to be an ectopic pregnancy, which can be life threatening - but it turned out that some of her fallopian tubes had glued themselves together.


She only managed to have my little brother Joe by having hormone injections to stop her body miscarrying the baby. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery.
We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy. Laparotomy revealed a 32 cm degenerating subserosal uterine fibroid co-existing with an intrauterine pregnancy.
The subsequent antenatal period was uneventful with a spontaneous vaginal delivery of a female baby at 38 weeks. The abdominal swelling started as a small lump but markedly increased in size in the preceding 3 months. It was associated with pain, severe epigastric discomfort, constipation, weakness and swelling of the legs. There was a massive central abdomino-pelvic mass which was firm and irregular, measuring 40 cm from the symphysis pubis. It also showed a 30 cm multi-loculated cystic tumor with a thick capsule located at the right posterior-superior aspect of the uterus and free fluid in the peritoneal cavity. The woman's blood group was 0 Rhesus positive and the hemoglobin genotype was AA.
Malaria treatment was started following a positive smear test and two units of sedimented cells were administered to correct the anaemia. Operative findings included ascites, normal liver, spleen, kidneys, diaphragm, ovaries and fallopian tubes. A cystic subserosal fibroid measuring 32 cm in diameter was situated at the right posterior superior aspect of the uterus.
It was removed and the myoma bed was quickly closed with 2-0 polyglactin suture and hemostasis was easily achieved.
The estimated blood loss was 600 mls and 2 units of whole blood were transfused intra-operatively.


The post-operative hematocrit was 30% and the woman was discharged from the hospital 10 days after the operation.
The histology report showed sections of interlacing bundles of smooth muscles with areas of hyaline degeneration with no evidence of malignancy. Repeat sonography during antenatal care visits showed a normally growing fetus and the remainder of the antenatal period was uneventful.
The woman went into spontaneous labor at 38 weeks gestation and delivered vaginally a female baby weighing 3.5 kg with Apgar scores of 8 and 10 at one and five minutes, respectively. Two days post partum the maternal hematocrit was 30% and mother and baby were discharged from the hospital. The 6 weeks post-natal visit was unremarkable.DiscussionTo the best of our knowledge this is the first report of antepartum myomectomy from Nigeria. The decision to remove the fibroid was justified by its size and the patient's symptoms. The benefit was the relief of symptoms and a tissue diagnosis of a very large, suspicious abdominal mass. Its subserosal location may have contributed to easy enucleation and closure of the myoma bed.
Hypercoagulability in pregnancy might have contributed to the ease in achieving hemostasis. The ease with which the fibroid was removed and the minimal measures used to obtain hemostasis contributed to the safety of the procedure.
This case illustrates that myomectomy during pregnancy can be safely performed in carefully selected cases. Both authors collaborated in the preparation of the manuscript, read and approved the final manuscript.Figure 1Uterus with massive subserosal fibroid.



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