Haskins R D, Haskins C J, Gilmore R, Borel M A, Mancuso P
Department of Obstetrics and Gynecology, St. John's Mercy Hospital, Washington, USA.
J Reprod Med. 2001 Mar;46(3):253-5.
The natural history of uterine leiomyomas during pregnancy has been reported.
A 39-year-old primigravida presented with vaginal spotting in the 10th week of pregnancy. Ultrasonic evaluation revealed a large intramural leiomyoma. Unsuccessful tocolysis at 25 weeks' gestation resulted in a cesarean section for breech presentation. At hysterotomy a 10-cm intramural leiomyoma was found in the right fundus and was left in situ. Six months later, at open laparotomy for myomectomy, the 10-cm leiomyoma was pedunculated, on a 4-cm stalk.
Large intramural leiomyomas found at cesarean section may become pedunculated postpartally, thus making myomectomy easier and safer at a postpartum intervention than at the time of cesarean section. Also, prior knowledge of the possibility of myoma transformation from intramural to pedunculated postpartally may help in planning a later myomectomy. Myomectomy prior to pregnancy should be considered when it has caused a prior pregnancy complication.
已有关于妊娠期间子宫平滑肌瘤自然病史的报道。
一名39岁初产妇，在妊娠第10周出现阴道点滴出血。超声检查发现一个大的肌壁间平滑肌瘤。妊娠25周时，保胎治疗失败，因臀位行剖宫产。剖宫产时发现右侧宫底有一个10厘米的肌壁间平滑肌瘤，予以原位保留。6个月后，行开腹子宫肌瘤切除术时，这个10厘米的平滑肌瘤有蒂，蒂长4厘米。
剖宫产时发现的大肌壁间平滑肌瘤产后可能会带蒂，因此与剖宫产时相比，产后进行子宫肌瘤切除术更容易、更安全。此外，事先了解肌瘤产后可能从肌壁间转变为带蒂的情况，有助于规划后续的子宫肌瘤切除术。当肌瘤此前已导致妊娠并发症时，应考虑在妊娠前进行子宫肌瘤切除术。
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