Caesarean Myomectomy in a Nullipara Following In Vitro Fertilization Pregnancy: A Case Report

Background: Caesarean myomectomy is the surgical removal of a leiomyoma during a caesarean section. The surgical removal of leiomyoma during caesarean section is controversial and is often avoided because of increased vascularity of the gravid uterus which leads to significant blood loss, needless hysterectomy and increased perioperative morbidity and mortality. Case Presentation: A 41-year-old gravida 3 para 0 + 2 with in vitro fertilization pregnancy who presented at 34 weeks + 1 day gestation for elective caesarean section. She has a history of myomectomy. Abdominopelvic ultrasound scan showed active twin gestation with a submucous fibroid measuring 4 × 3 cm located anteroinferiorly. Patient had anemia which was corrected and subsequently had caesarean section. During the procedure the submucous myoma was encountered at the line of incision at left lateral side and was removed. She developed post-partum preeclampsia and was managed. She also received 2 units of blood post-surgery following a post-surgery packed cell volume of 20%. She was subsequently discharged after 3 days post-surgery and sutures were removed on day 10 post-surgery. There were no complications. Conclusion: Caesarean myomectomy remains debatable. However, following careful surgical planning, selected cases can be done by experienced surgeons equipped to handle peri-operative complications should they arise.