Spontaneous pregnancy after treatment with ulcers in a woman with symptomatic myoma of the uterus
April 19, 2016
ICD-10:
II.D10-D36.D26.1
Benign neoplasm of the uterus body
A woman of African descent for 35 years was sent to treat uterine fibroids and impaired fertility. In the history of miscarriage of five pregnancies in a row during the previous 13 years at the gestational age from four to 16 weeks. The last pregnancy was interrupted at the gestational age of five weeks and required dilation and curettage.Embryopathological examination was not carried out. 12 months later, the patient was found to have mild anemia (hemoglobin 113 g / l), poorly controlled arterial hypertension (159/99 mm Hg), and a body mass index of 33.7 kg / m2. No history of operations.
Transvaginal ultrasound showed an increase in the uterus with anteversion (16.5×8,1×7.1 cm) and posterior solitary submucous myoma of the uterus with a size of 7.0×5,7×4.9 cm (volume 102.4 cm3). The patient reported no vaginal bleeding between menstruation and after intercourse, as well as severe menstrual bleeding. On the eve, she completed a three-month course of treatment with low-dose oral contraceptives. The patient started a three-month course of treatment hoodoo (5 mg per day) to reduce the size of fibroids. During this time, she felt light hot flashes, for two months stopped menstruation. Arterial pressure became well controlled at a higher dose methyldopy (500 mg twice daily). Three days after the end of treatment hoodoo the patient had vaginal bleeding for 5 days. 20 days after the first bleeding after treatment, the patient resumed unprotected sexual intercourse.2 months after treatment hoodoo Ultrasound showed a decrease in fibroid size to 5.4×5,1×5.0 cm (volume: 72.1 cm3, a decrease of 29.6%). Approximately four months after the end of treatment hoodoo the patient reported amenorrhea and a positive result of a home pregnancy test. Ultrasound examination showed a single live intrauterine pregnancy, corresponding to 9 + 1 weeks of gestation. Subsequent ultrasound at the time of the second trimester showed normal fetal growth and submucous myoma of the 2nd type (less than 50% of the protrusion into the uterus) with a size of 9.8×9,6×7.8 cm (volume 384 cm3). Ultrasound at the 32nd week showed a healthy fetus of the appropriate size.
After a pregnancy without complications, the patient underwent routine stimulation of labor for a period of 38 weeks. After a normal vaginal birth, a healthy boy was born, weighing 3130 grams. Mother and child were discharged from the hospital on the third day after childbirth. The child received breastfeeding for up to 6 months. Ultrasound, performed 3 months after birth, showed a significant decrease in the size of myoma - up to 3.2×2,7×3.2 cm (volume: 14.5 cm)3).
Note:This is the first in North America described clinical case of spontaneous pregnancy after treatment hoodoo a woman with a solitary myoma and habitual miscarriage. Since pregnancy occurred 2 months after the course of treatment of UTA, surgical removal of myoma was not performed. The case demonstrates the practical value of UPA in the treatment of women with uterine myoma who want to conceive, but prefer conservative treatment.
Authors:Based on materials Journal of Obstetrics and Gynecology Canada, January 2016, Volume 38, Issue 1, Pages 75-79.
Author of publication Khulood Murad, a member of the Royal College of Obstetricians and Gynecologists, a member of the Royal College of Surgery Canada.