Management guidelines for incidental uterine surgery in early pregnancy: a case report of a robotic myomectomy at 4 weeks gestation after a false-negative pregnancy test

Objective: To share our case and offer guidance to practitioners on management of incidental uterine surgery in early pregnancy.While elective uterine surgery should be avoided during pregnancy, there is always a chance of undetected pregnancy at time of surgery even after all precautions have been taken.There is currently minimal literature on the management and outcomes of uterine surgery during pregnancy.Design: Case report Subject: 42-year-old G1P1 female with symptomatic fibroids desiring fertility sparing surgery retroactively found to be 4 weeks pregnant at time of surgery even after negative pregnancy test and low suspicion for pregnancy under CDC guidelines.Intervention: Robotic assisted laparoscopic myomectomy performed with false negative urine pregnancy test at time of surgery.Main Outcome Measures: Guidance for surveillance and management options during continued pregnancy after a robotic uterine surgery and cavity disruption by a uterine manipulator performed at 4 weeks gestation that went undetected at time of surgery.Results: Patient was able to undergo an uncomplicated delivery by cesarean section at 38 weeks and delivered a healthy infant.Conclusion: Using a multidisciplinary approach, we describe guidelines for antepartum surveillance following uterine surgery during undetected pregnancy which resulted in delivery of a term healthy infant.