Successful Antepartum Myomectomy of a Large Pedunculated Fibroid

Uterine leiomyomas are generally asymptomatic during pregnancy, but in some cases can be associated with both maternal and fetal complications. The management of fibroids during pregnancy is largely expectant, and myomectomy is delayed until after delivery due to the risk of hemorrhage and postoperative morbidity. However, when there is severe pain, uncertain diagnosis, or massive size, expectant or medical management might not be adequate; thus, surgical intervention might be necessary. Antenatal myomectomy is controversial, and there is a paucity of literature describing the procedure. A 30-year-old primigravida was diagnosed with a large pedunculated fibroid during her dating ultrasound. A physical examination revealed that this fibroid filled her abdominal cavity. The fibroid was also viewed under magnetic resonance imaging to delineate the blood supply and rule out any concerning features. An abdominal myomectomy was performed at 12 weeks' gestational age without disrupting the pregnancy. Following surgery, the patient had an uncomplicated antenatal course and subsequently delivered a healthy female infant at 39 weeks. This report supports previous small case series and case reports describing successful antenatal abdominal myomectomy in carefully selected and appropriately counseled patients.