Review on Symptomatic pedunculated leiomyomas in pregnancy with special consideration of an example case

OBJECTIVES/HYPOTHESIS: Symptomatic pedunculated leiomyomas in pregnancy; review of the literature with special consideration of an example case. STUDY DESIGN: Retrospective narrative review with an example case. METHODS: Systematic evaluation of 37 reports. EXAMPLE CASE: A 36-year-old Caucasian primigravida was referred symptomatic at 16 + 0 weeks due to a 13,5 cm myoma causing pain, constipation, urine retention and dysesthesias. Our patient underwent myomectomy at 17 + 0 weeks. One pedunculated leiomyoma was successfully removed. CONCLUSION: Myomectomy can be performed and is safe for pedunculated fibroids in pregnancy. Depending on the clinical scenario, surgical removal may be indicated. Based on the size of the fibroids and expected adhesions, a laparotomy is a safe option and is not a contraindication for vaginal birth in the case of pedunculated fibroids. Myomas larger than 10 cm should be removed by laparotomy.