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Uterus-sparing myomectomy for uterine pyomyoma following cesarean section

2013; Elsevier BV; Volume: 52; Issue: 1 Linguagem: Inglês

10.1016/j.tjog.2013.01.020

1875-6263

Mitsuru Shiota, Yasushi Kotani, Kazumi Ami, Yoshiaki Mizuno, Yuka Ekawa, Masahiko Umemoto,

Endometriosis Research and Treatment

Uterine myoma complicates approximately 1% of pregnancies [1,2]. Pregnancy complicated by uterine myoma presents various problems throughout the perinatal period, including repeated spontaneous abortions, premature delivery, and disorders at delivery. In recent years, the rate of pregnancies complicated by uterine myoma is thought to have increased, because of the increase in late marriages, or because of an increase in diagnoses as a result of advances in imaging technology, including ultrasound. Some studies have reported patients with uterine myoma complicated by infection. However, among these patients, cases of pyomyoma in which the myoma was filled with ichorous pus, were rare. Since 1945, only 13 patients with pyomyoma that occurred during pregnancy and the puerperium were reported [3]. Among these patients, four underwent Cesarean section (C-section) [3e5]. Moreover, for most of these cases, the only option was total abdominal hysterectomy. Here, we report a patient with an infected uterine myoma that developed after a C-section that was indicated for a pregnancy complicated by uterine myoma. After the pyomyoma was discovered during open surgery, myomectomy was performed to conserve the uterus. The patient was a 36-year-old nulligravida, with no significant past or family history. At week 6 of her pregnancy, a transvaginal ultrasound revealed a 13 cm uterine myoma involving the muscle layer and the fetal sac in the uterine cavity. The rest of the pregnancy was uneventful, and the myoma did not increase in size. At week 37 day 6, the patient underwent abdominal C-section at the pelvic level. A baby girl was delivered through a low transverse incision of the uterus. The infant’s weight was 2512 g, the 1-minute Apgar score was 9, and the 5-minute Apgar score was 10. The volume of intraoperative blood loss was 690 mL, which included