alexa Successful Pregnancy Outcome Following Abdominal Myomectomy: A Case Report | OMICS International
ISSN: 2161-0932
Gynecology & Obstetrics
Like us on:
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Successful Pregnancy Outcome Following Abdominal Myomectomy: A Case Report

Yogita Dogra1*, Rashmi Bagga2 and Subhas Saha2

1Department of Obstetrics and Gynecology, Kamla Nehru Hospital, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

2Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

*Corresponding Author:
Dr. Yogita Dogra
Senior Resident, Department of Obstetrics and Gynecology,
Kamla Nehru Hospital, Indira Gandhi Medical College,
Shimla, Himachal Pradesh, India,
E-mail: [email protected]

Received date: September 20, 2012; Accepted date: October 27, 2012; Published date: November 05, 2012

Citation: Dogra Y, Bagga R, Saha S (2012) Successful Pregnancy Outcome Following Abdominal Myomectomy: A Case Report. Gynecol Obstet 2:133. doi: 10.4172/2161-0932.1000133

Copyright: © 2012 Dogra Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Gynecology & Obstetrics

Abstract

Myomas are the benign tumors of uterus commonly affecting the female reproductive tract, especially in reproductive age group. They are often associated with recurrent abortions, excessive blood loss during menstruation and dysmenorrhoea. Less commonly myomas are also responsible for primary infertility in small but significant proportion of patients, as pregnancies do occur after myomectomy in number of patients suffering from myomas especially submucous and intramural. Hysterectomy is viewed as the definitive management of symptomatic uterine leiomyomas. Myomectomy is an alternative to hysterectomy for patients who desire childbearing, who are young, or who prefer that the uterus be retained.

Keywords

Myomas; Fibroids; Infertility; Myomectomy; Pregnancy

Introduction

Infertility is defined as 1 year of unprotected intercourse without conception [1,2]. It affects approximately 14% of couples and is a medical concern for 2.7 million women of reproductive age in the United States [2]. Infertility causes great distress to many couples, causing increasing numbers of them to seek specialist fertility care [3]. This condition may be further classified as primary infertility, in which no previous pregnancies have occurred and secondary infertility, in which a prior pregnancy, although not necessarily a live birth, has occurred. There are many causes of infertility including male and female factors [1,4]. Pathologies within uterine cavity are the cause of infertility in as many as 15% of couples seeking treatment and are diagnosed in greater than 50% of infertile patients. Uterine cavity abnormalities include endometrial polyps, endometrial hyperplasia, submucous myomas, intrauterine synechiae and congenital uterine anomalies. Leiomyomas, also called myomas or fibroids; are benign monoclonal uterine myometrial tumors that affect 25% to 45% of reproductive-age women. The mechanisms by which fibroids cause infertility are unknown, but may involve altered uterine contractility, impaired gamete transport or endometrial dysfunction [4]. Fibroids are a fairly frequent occurrence in the reproductive age group and are exclusively responsible for both infertility and pregnancy wastage in a small (5%) but significant proportion of patients [5]. Fibroids may be classified as submucous, intramural or subserous [6]. It is often assumed that fibroids cause infertility since pregnancies do occur after myomectomy and other treatments where the fibroids are removed [3]. We are presenting here a case of primary infertility which on infertility workup showed heterogeneous mass in uterus on ultrasonography and conceived after abdominal myomectomy.

Case Report

A 36 year old female patient attended the Gynecology Outpatient Department at PGIMER Chandigarh for first time with complaints of heavy menstrual flow for 5 years and primary infertility for 1.5 years. Her menses were regular, 2-3 days, soaking 6-7 pads per day followed by mild bleeding for up to 10-12 days with mild dysmenorrhoea. On her abdomen examination, firm, irregular, non-tender mobile abdominopelvic mass was felt (≈16 weeks). On ultrasonography, uterus was 16×7×12 cm; heterogeneous mass seen involving uterine body with anechoic areas in it, bilateral ovaries were normal, no free fluid was present in pelvic cavity.

Infertility work up was done including serum TSH, serum prolactin, Chest X-ray, semen analysis, which was within normal limits. Decision was taken for abdominal myomectomy under spinal anesthesia. Intraoperatively uterus was 16 week size, bilateral tubes and ovaries were normal. Multiple intramural and submucosal fibroids in anterior, posterior and fundal region were found. Largest fibroid was 4×5 cm. Bonney’s hood incision and midline vertical incisions were given over anterior wall of uterus and multiple fibroids were removed by tunneling. The Uterine cavity was opened and 8-10 submucosal fibroids were removed. Multiple intramural fibroids in posterior wall were removed by transcavitary approach. A total of >35 fibroids were removed.

Two months later, USG showed multiple 0.2-0.5 cm fibroids. She received Leuprolide depot 3.75 mg twice, one month apart. Ovarian stimulation with gonadotropins done for 2 cycles and patient conceived on 2nd attempt of ovarian stimulation. She was admitted at 35 weeks with transverse lie and planned for Caesarean section at 37 weeks. She went into spontaneous labour at 36+6 wks for which emergency caesarean section was done. Intraoperatively single submucosal fibroid of 3+4 cm on anterior wall of uterus was present. She delivered a live born girl, 2.75 kg in about 1 year of abdominal myomectomy.

Discussion

Leiomyomas are an infrequent primary cause of infertility and have been reported as a sole cause in only a small percentage of infertile patients. Pregnancy loss or complications such as preterm labor, intrauterine growth restriction, and malpresentation can occur in women with leiomyomas, although most patients have uncomplicated pregnancies and deliveries [7]. The treatment of fibroids has historically been surgery, usually hysterectomy. Myomectomy is an option in women wishing to maintain fertility and for those desiring to keep their uterus [3]. The position of the uterine fibroid plays important role in infertility. The presence of submucous fibroid decreases the fertility rate. Subserosal fibroids do not affect the fertility rate but removing those does increase fertility. Intramural fibroid decreases fertility slightly but removal does not increase fertility. A metaanalysis of the effect of fibroids on fertility and the effect of myomectomy on fertility found that submucous fibroid that distort uterine cavity appear to decrease fertility, with ongoing pregnancy/ live birth rates decreased about 70%. Resection of submucous fibroids slightly increased fertility relative to infertile controls without fibroids [8]. Submucosal leiomyomas are a possible cause of infertility and are highly amenable to surgical treatment and subsequent restoration to fertility. 47% of women with primary infertility became pregnant and 63% of them did so in 11 months after surgery [9]. Subserosal fibroids do not appear to affect fertility while intramural (regardless of cavity distortion) and submucous myomas are associated with lower implantation and live birth rates. In women desiring fertility who require treatment of fibroids, myomectomy is the preferred approach. Removal of cavity-distorting intramural and submucous myomas is generally recommended prior to proceeding with the infertility treatment [4]. A retrospective study suggested that myomectomy for intramural and subserosal fibroids may significantly improve the reproductive performance of women presenting with infertility or pregnancy loss [10]. 65.2% of patients with otherwise unexplained infertility conceived after they underwent abdominal myomectomy for the removal of subserous or intramural myomata [11-13]. A submucous fibroid or an intramural fibroid distorting the uterine cavity, fibroids >5 cm and multiple fibroids are all indications for intervention in a women considering a pregnancy. Open myomectomy, i.e. removal of fibroid via laparotomy should be the route of choice when there are large subserosal or intramural fibroids (>7 cm), when multiple fibroids (>5 cm) are to be removed and when entry into the uterine cavity is to be expected [5].

A prospective, controlled study was performed in order to evaluate whether the location of uterine fibroids may influence reproductive function in women and whether removal of the fibroid prior to conception may improve pregnancy rate and pregnancy maintenance. Among the patients who underwent myomectomy, the pregnancy rates obtained were 43.3% in cases of submucosal, 56.5% in cases of intramural, 40.0% in cases of submucosal-intramural and 35.5% in cases of intramural-subserosal uterine fibroids, respectively. This study confirmed the important role of the position of the uterine fibroid in infertility as well as the importance of fibroids removal before the achievement of a pregnancy, to improve both the chances of fertilization and pregnancy maintenance [14]. Another retrospective study showed that abdominal myomectomy increases pregnancy and live birth rates and reduces the pregnancy loss. Conception rate was 25.7% before myomectomy and 68.5% after the surgery. The pregnancy loss and live birth rate was 71.4% and 28.6% pre myomectomy and 9.1% and 90.9% post myomectomy [15].

Conclusion

To conclude with, myomas affect the fertility especially the submucosal myomas. Myomectomy definitely improves the reproductive outcome in significant number of patients suffering from infertility and should be undertaken in infertile women with prior counseling, in whom other causes of infertility have been ruled out.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

  • 2nd World Congress on Embryology and In Vitro Fertilization March 30-31, 2018 Orlando, USA. Theme: Exploring the Novel Research & Techniques in Reproductive Health
    March 30-31, 2018 Orlando, USA
  • World Congress on Gynecology and Obstetrics
    April 16-17, 2018 Dubai, UAE
  • 7th International Conference on Clinical and Medical Case Reports June 01-02, 2018 Osaka, Japan Theme: Focusing the breakthroughs of case reports in Clinical & Medical Research
    June 01-02, 2018 Osaka, Japan
  • 7th International Conference and Exhibition on Surgery June 21-23, 2018 Dublin, Ireland Theme: Advancements and Endeavours in the Field of Surgery
    June 21-23, 2018 Dublin, Ireland Dublin, Ireland
  • Annual Congress on Research and Innovations in Medicine July 02-03, 2018 Bangkok, Thailand Theme: Current Research and Innovations in Medicine to Improve Human Health
    July 02-03, 2018 Bangkok, Thailand
  • International Conference on Medical and Health Science August 24-25, 2018 Tokyo, JAPAN Theme: Scrutinize the Modish of Medical and Health Science
    August 24-25, 2018 Tokyo, Japan
  • World Summit on Trauma and Reconstructive Surgery Sep 10-11, 2018 Singapore Theme: Expanding new horizons in Trauma and Surgery
    Sep 10-11, 2018 Singapore City, Singapore
  • 6th American Gynecological Surgery Conference September 28-29, 2018 San Antonio | Texas | USA
    September 28-29, 2018 San Antonio, USA
  • World Congress on Fetal and Maternal Medicine October 15-17, 2018 Osaka, Japan Theme: A New Beginning on Fetal, Maternal & Neonatal Medicine
    October 15-17, 2018 Osaka, Japan
  • International Conference on Reproduction and Fertility October 18-19, 2018 Abu Dhabi, UAE
    October 18-19, 2018 Abu Dhabi, UAE

Article Usage

  • Total views: 11799
  • [From(publication date):
    December-2012 - Feb 23, 2018]
  • Breakdown by view type
  • HTML page views : 8039
  • PDF downloads : 3760
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2018-19
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2018 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version