At times, myomectomy is mandatory to effect delivery

Myomectomy of a massive fibroid was necessitated prior to delivering the baby.Delivery of a healthy was effected by Classical caesarean section.Leiomyoma in pregnancy is not an unknown entity and is a cause of concern for being a source of excruciating pain, at times, during the ongoing gestation.Although performed rarely, it is sometimes necessary to remove a large myoma to effect delivery of the baby during Cesarean section as is depicted in the case being presented hereunder.According to the various studies, incidence of myomas in pregnancy is estimated to be 2-4%[1-3]. Albeit myomectomy performed during pregnancy remains a rarity, increasing rate of myomectomies during cesarean section has been reported in the past decade[4-6] and, above all, certain studies have regarded this as an effective and safe procedure that is not associated with much bleeding or other complications[7].Written informed consent was taken and the department Ethical Committee approved the case report.A thirty year aged primigravida reported in the out-patient department of our rural based institute at 14 weeks of pregnancy for routine ante-natal check-up. Her per-abdomen findings revealed uterine size to be inconsistently increased to 22 weeks with the patient being sure of her date of last menstrual period and no history of 'quickening' as yet. Her routine investigations were normal but sonography revealed 13.4 weeks intrauterine live fetus along with a large 11.5 cm intramural leiomyoma on the anterior wall of the maternal uterus encroaching upon the cervix.The patient was regularly followed up and twice she had had to be admitted, for a couple of days each, in the second trimester with pain abdomen and was managed conservatively. A detailed sonographic image of the fetus at 20 weeks of gestational age showed no evidence of any major structural abnormalities. During the course of pregnancy, this myoma showed progressive increase in size and the last ultrasonography at term depicted it to