Postpartum Vaginal Prolapse of an Infarcted Submucosal Leiomyoma After Forceps-Assisted Vaginal Delivery: A Case Report

Submucosal leiomyomas occasionally prolapse through the cervix, and in the puerperium, this may be mistaken for retained products of conception.We report the case of a 33-year-old woman, gravida 10 para 1, whose only previous delivery was in 2011, with eight subsequent first-trimester miscarriages.An anterior wall submucosal fibroid had been identified antenatally.She underwent forceps-assisted vaginal delivery at term.On postnatal day five, she presented with pain, bleeding and low-grade pyrexia, treated empirically as presumed puerperal infection, and had a secondary postpartum haemorrhage.Ultrasound on day six showed the anterior wall fibroid measuring 79 × 73 × 69 mm, together with a separate vascular heterogeneous area in the fundal cavity in which retained products could not be excluded.At approximately seven weeks, transvaginal ultrasound showed an avascular 44 × 33 × 47 mm mass at the lower segment and cervix, with the fibroid no longer seen in its previous position.Contrast-enhanced magnetic resonance imaging demonstrated a non-enhancing 86 × 47 × 56 mm lesion attached to the anterior myometrium by a stalk, prolapsing through the cervix into the vagina, consistent with carneous degeneration.The mass was removed vaginally with endometrial sampling.Histopathology confirmed an infarcted leiomyoma without atypia or malignancy.She recovered well and was discharged.These serial findings are consistent with postpartum displacement and prolapse of a submucosal fibroid, and illustrate that a prolapsing fibroid and suspected retained products may coexist.