Myomectomy during the first trimester associated with fetal limb anomaliesand hydrocephalus in a twin pregnancy

Objectives To present the complications of a twin pregnancy after first tri mester myomectomy and to discuss the possible etiologic relationship. Case report A 44-year-old primigravida with a dichorionic-diamniotic twin p regnancy underwent myomectomy in another hospital at 12 weeks' gestational age. At 28 weeks the patient was referred to our unit because of ventriculo megaly and limb anomalies in the second twin. The patient underwent a Caesa rean section at 37 weeks of gestation delivering twin A, a healthy female w eighing 3235 g and twin B, a female weighing 2810 g with hydrocephalus and limb anomalies (clubfeet and hypoplasia of the nails and terminal phalanges ). The placenta from twin A was normal, but in the placenta of twin B haemo rrhage, thrombosis and infarction were noted. Conclusions Despite several reports of myomectomy in pregnancy without any problems for mother and fetus, the authors believe that myomectomy - especi ally in the first trimester - may be associated with the type of problems o bserved in the present case. The pathophysiological relationship between pl acental trauma and haemodynamic alterations as a possible cause of the malf ormations in twin B is discussed. Copyright (C) 2001 John Wiley & Sons, Ltd .