PTCSRT, Harvard University, Cambridge, Massachusetts, USA
Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
BMJ Case Rep. 2020 Nov 3;13(11):e235572. doi: 10.1136/bcr-2020-235572.
Uterine fibroids are common among women of reproductive age. During the pregnancy, the potential complications of fibroids, although rare, are of frequent clinical concern. Available studies describing management and obstetrical outcomes in pregnant women with giant fibroids are limited. We present the case of a 39-year-old pregnant woman with multiple and large uterine fibroids. During the pregnancy, there was adequate fetal development, without major maternal complications. Given the characteristics of the fibroids and breech position of the fetus, an elective caesarean section was decided, and postpartum hysterectomy planned. This challenging obstetrical case required a multidisciplinary approach.We considered crucial discussing five main issues: preconceptional counselling, tailored pregnancy surveillance, decision of time and route of delivery, decision to perform a peripartum hysterectomy and management of decreasing blood loss perioperatively. Given the limitation of the published reports, we believe that sharing our experience, along with a literature review, is beneficial for other clinicians.
子宫肌瘤在育龄妇女中很常见。怀孕期间，尽管罕见，但子宫肌瘤的潜在并发症经常引起临床关注。目前描述患有巨大子宫肌瘤的孕妇的管理和产科结局的研究有限。我们报告了一例 39 岁的孕妇，她有多发性和大型子宫肌瘤。怀孕期间，胎儿发育良好，没有出现严重的母体并发症。鉴于肌瘤的特征和胎儿臀位，决定行择期剖宫产，并计划产后行子宫切除术。这个具有挑战性的产科病例需要多学科方法。我们认为讨论以下五个主要问题至关重要：孕前咨询、个体化妊娠监测、分娩时机和方式的决策、是否行产后即刻子宫切除术的决策以及围手术期减少失血的处理。鉴于已发表报告的局限性，我们认为分享我们的经验和文献复习对其他临床医生有益。
