Intramural leiomyoma during pregnancy becoming pedunculated postpartally -A case report

BACKGROUND: The natural history of uterine leiomyomas during pregnancy has been reported. CASE: A 39-year-old primigravida presented with vaginal spotting in the 10t h week of pregnancy. Ultrasonic evaluation revealed a large intramural leio myoma. Un successful tocolysis at 25 weeks' gestation resulted in a cesarea n section for breech presentation. Ar hysterotomy a 10-cm intramural leiomy oma was found in the right fundus and tons left in situ. Six months Inter, at open laparotomy for myomectomy, the 10-cm leiomyoma was pedunculated, on a 4-cm stalk. CONCLUSION: Large intramural leiomyomas found at cesarean section may becom e pedunculated postpartally, thus making myomectomy easier and safer at a p ostpartum intervention than at the time of cesarean section. Also, prior kn owledge of the possibility of myoma transformation from intramural to pedun culated postpartally may help in planning a later myomectomy. Myomectomy pr ior to pregnancy should be considered when it has caused a prior pregnancy complication.