Approach to Termination of Pregnancy in a Woman with Uterine Leiomyomas

Abstract

Abstract

Background:

Women with enlarged leiomyomatous uteri often have limited options for termination of pregnancy (TOP) and are referred to tertiary-care centers for management. This article presents a unique surgical approach to TOP in such women that has not been previously described in the literature.

Case:

A 35-year-old gravida 6, para 2032, at 9 weeks and 3 days of pregnancy, presented with a 30-week-sized leiomyomatous uterus displacing the pregnancy to the fundus with distortion of the cervix and endometrial cavity. This patient desired future fertility and declined medical management of her condition. She underwent a transfundal suction curettage via laparotomy at 13 weeks and 2 days of her pregnancy.

Results:

The patient's estimated blood loss was 300 cc. She had an uncomplicated postoperative course and underwent a myomectomy 12 weeks after a surgical abortion.

Conclusions:

A literature review revealed several case reports of medical management, and 1 reported use of an endotracheal tube for surgical termination. However, no other reports were found to guide surgical management in women with enlarged leiomyomatous uteri. When conventional suction curettage or dilation and extraction are not technically feasible in pregnant women, due to distortion of the cervix and endometrial cavity secondary to the leiomyomas, transfundal suction curettage via laparotomy may be considered. This approach is an alternative to medical management in women with enlarged leiomyomatous uteri who desire termination of their pregnancies.