Myomectomy During the First and Second Trimesters of Pregnancy. A Therapeutic Dilemma: Report of Two Cases

Myomectomy during pregnancy is a rare situation, reserved for exceptional cases. We report two cases of myomectomy during  pregnancy. Case 1 was a 31-yearold primigravida with a large transmural myoma complicated by intense pelvic pain not responding to medical treatment due to red degeneration in a 6-week pregnancy. Case 2 was a 30-year-old primigravida with multiple myomas  complicated by necrosis and hydronephrosis. We performed multiple myomectomy at 17 weeks’ pregnancy after failure of medical treatment. Concerning the operative technique, we performed myomectomy during pregnancy followed by prophylactic cerclage of the  cervix. The operation is carried out as quickly as possible by the most experienced surgeon of the team, in order to shorten the operating  time and limit blood loss. Myomas that are in contact with the uterine cavity are not removed. In all, 500mg of hydroxyprogesterone was  administered intramusculary 24h before the procedure, intraoperatively, and after operation to limit the risk of abortion. In Case 1,  myomectomy was performed successfully without maternal or fetal complications. However, the patient developed placental abruption  at 33 weeks of pregnancy. The newborn died 3h after birth. In Case 2, myomectomy was complicated by a spontaneous abortion at the  end of the operation. The patient developed necrosis of the remaining myomas and endometritis leading to hysterectomy. Thus myomectomy during pregnancy should be performed as a last resort in only well-selected patients.