Uterine myomas complicating pregnancy can be a risk factor for cervical insufficiency, preterm birth, and cesarean delivery. Cervical insufficiency is a risk factor for preterm premature rupture of membranes (PPROM) and preterm births. A classic cesarean section (CS) is an incision made through the upper, thicker muscular segment of the uterus using a vertical uterine muscular incision and is at risk for postoperative infectious morbidity. This report presents the case of a 32-year-old gravida 2 para 0 female who presented at 23 weeks and 5 days of gestation, 2 cm dilated, with PPROM. Prior to arrival, all of her prenatal care had been outside the United States and included an Arabin pessary. After a 15-day latency period from PPROM to the onset of labor, an emergency classic CS was performed, obtaining an 800-gram male infant with Apgar scores of 1 at 1 minute and 5 at 5 minutes. The infant expired on day of life 1. Over the next 52 days, she was admitted three times for clinical and radiologic findings consistent with recurrent infection and myoma degeneration. Her laboratory values remained stable as parenteral antibiotics were adjusted regularly. The patient requested maintaining her fertility throughout her care until her final admission. A total abdominal hysterectomy and bilateral salpingectomy were ultimately performed, and an intrauterine abscess, including the surgical site and degenerating myomas, was found. Serial imaging with both CT and ultrasound confirmed abnormal fluid density collections, but interventional radiology was unsuccessful in therapeutic drainage. A preterm classic CS with myomas is associated with less favorable neonatal outcomes, higher complication rates, increased perioperative risk, and delayed recovery. Postoperative imaging could not differentiate between infectious causes and myoma degeneration in this case.
Karmarker et al. (Mon,) studied this question.