Ultrasound-guided laparoscopy for conservative management of a massive degenerated uterine fibroid during pregnancy: A case report

Objective To outline the key steps in the management of a massive, degenerated fibroid during pregnancy. Design A video article demonstrating diagnostic imaging, laparoscopic anatomy, and innovative surgical technique. Setting This video demonstrates an unusual presentation of a uterine fibroid in pregnancy. Uterine fibroids are common, with an incidence of 40%–60% by the age of 35 with a possibility of growing in pregnancy and impacting the developing fetus. Interventions This case summarizes an innovative, safe, and efficient minimally invasive surgery approach to a patient with a 30-cm degenerated fibroid at 16 weeks gestational age of pregnancy, permitting ongoing development of the viable fetus. Review of imaging revealed a solid-cystic uterine mass, suspicious for degenerated fibroid, compressing the gestation into the right upper quadrant. The patient did not have a reported history of a uterine mass prior to pregnancy. Interdisciplinary care with maternal-fetal medicine and gynecologic oncology ensured thorough counselling and various treatment possibilities. The MIGS team performed ultrasound-guided laparoscopy involving drainage, biopsy, and insertion of a transient drain to prevent re-accumulation of fluid throughout the pregnancy. Pathology revealed fibroid degeneration with infarct-type necrosis. The patient continued successfully in pregnancy until undergoing a Cesarean section at 33 weeks after developing an abscess within the fibroid. Neonatal outcome was excellent. Conclusion Our case demonstrates degeneration with massive expansion of a fibroid, compromising the potential of the fetus. A solution was devised and implemented, allowing for pregnancy continuation until the third trimester.