Wang Jianfen, Shu Chengzhao, Dong Yan
Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China.
Gansu Maternal and Child Health Care Hospital, Lanzhou, Gansu Province, China.
Medicine (Baltimore). 2025 Aug 29;104(35):e43874. doi: 10.1097/MD.0000000000043874.
Large uterine fibroids in specific locations (e.g., lower uterus) pose significant controversy regarding removal during cesarean section (C-section) due to surgical difficulty, bleeding risk, and maternal/fetal safety concerns. This case addresses the challenge of a huge fibroid completely blocking the birth canal, preventing standard C-section.
A 35-year-old woman at 35 + 1 weeks presented with poorly controlled hypertension for 9 weeks, diagnosed as chronic hypertension with superimposed preeclampsia and a large uterine fibroid.
Chronic hypertension accompanied by preeclampsia, pregnancy with uterine fibroids.
After failed medical management (antihypertensives and antispasmodics) and onset of labor, an innovative "reverse-sequence cesarean myomectomy" (RCM) was performed with patient consent. This involved removing the giant lower uterine segment fibroid before delivering the fetus via C-section, utilizing a tourniquet.
The RCM procedure was successful. The fibroid was removed, the baby delivered, and the C-section completed with only 400 mL blood loss. Both mother and infant had good outcomes, avoiding fetal removal difficulty and massive hemorrhage. Pathology confirmed leiomyoma. The approach utilized post-myomectomy uterine contraction for hemostasis and prevented the need for secondary surgery.
This case demonstrates that RCM is a safe, feasible, and innovative strategy for extreme cases where huge, strategically located fibroids (e.g., lower uterus) completely obstruct the birth canal. Its core advantages are: (1) solving the "unable to remove fetus" dilemma; (2) reducing bleeding risk via reverse timing (tumor first) and tourniquet; (3) avoiding a second surgery. RCM provides a valuable new option for managing these complex, high-risk pregnancies.
特定位置（如下段子宫）的大子宫肌瘤，由于手术难度、出血风险以及对母婴安全的担忧，在剖宫产时是否切除存在重大争议。本病例解决了巨大肌瘤完全阻塞产道、无法进行标准剖宫产这一难题。
一名35岁、孕35 + 1周的女性，9周来高血压控制不佳，诊断为慢性高血压合并先兆子痫及子宫大肌瘤。
慢性高血压合并先兆子痫、子宫肌瘤合并妊娠。
药物治疗（抗高血压药和解痉药）失败且临产发动后，经患者同意实施了创新的“逆序剖宫产子宫肌瘤切除术”（RCM）。该手术在通过剖宫产娩出胎儿前，先利用止血带切除下段子宫巨大肌瘤。
RCM手术成功。肌瘤被切除，婴儿顺利娩出，剖宫产过程中仅失血400毫升。母婴结局良好，避免了胎儿娩出困难和大量出血。病理检查确诊为平滑肌瘤。该方法利用肌瘤切除后子宫收缩止血，避免了二次手术。
本病例表明，对于巨大且位置关键（如下段子宫）的肌瘤完全阻塞产道的极端情况，RCM是一种安全、可行且创新的策略。其核心优势在于：（1）解决“无法娩出胎儿”的困境；（2）通过逆序（先切除肿瘤）和使用止血带降低出血风险；（3）避免二次手术。RCM为处理这些复杂的高危妊娠提供了一个有价值的新选择。
