Laparoscopic conservative myomectomy at 28 weeks of pregnancy (case report)

Uterine fibroids are the most common benign tumors, the emergence and progression of which during pregnancy can increase the frequency of pregnancy and child birth complications. Currently, there is a recorded increase in the number of patients diagnosed with myoma among pregnant women. This is primarily due to the manifestation of the pathology at the younger age, and secondly, it is caused by an increase in the average age of pregnant women, which necessitates the development of methods for the prevention and therapy of this condition during pregnancy. We present a clinical case of a patient who was admitted as an emergency to the St. Petersburg State Health Care Foundation “Mariinsky City Hospital” with complaints of abdominal pain. The preliminary diagnosis of “Acute appendicitis” was ruled out during the examination. Also was identified a serious circulatory disorder in the myoma node (necrotizing fibroid). Patient V., a first-time pregnant, was transferred to the Perinatal Center of the Federal State budgetary Educational Institution of Higher Education “St Petersburg State Pediatric Medical University” of the Ministry of Healthcare of the Russian Federation with the diagnosis: “Pregnancy 28 weeks and 4 days. Uterine fibroid, subserous type. Impaired blood supply to the fibroid node”. Due to intractable pain syndrome and the ultrasound findings (uterine fibroid with signs of impaired blood supply), a laparoscopic conservative myomectomy was performed. The pregnancy was carried to full term, at 40 weeks and 1 day. The birth was vaginal. The performed laparoscopic treatment confirms the effectiveness of surgical intervention when a clinic of fibroid node necrosis develops during pregnancy. Early diagnosis and timely adequate treatment make it possible to achieve successful pregnancy outcomes, including reaching full term.