Caesarean section presenting an opportunity for myomectomy: a case report

Obstetricians, all over the world, frowned at the performance of myomectomy during pregnancy due to haemorrhage associated with such a procedure. This haemorrhage is even more severe in a gravid uterus undergoing caesarean section, making obstetric surgeons to avoid this risky adventure of performing the two surgeries (Caesarean section and myomectomy) at the same time. Sometimes, the fibroids are located in different parts of the uterus and they can be subserous/ pedunculated, intramural or submucous. The pedunculated fibroid has long stalk that may be thin making it very easy to “pluck” by suture ligating it. Again, uterine fibroid may be located in the lower uterine segment and bump into the incision line during cutting (uterine incision) to create access to the fetus. Caesarean sections done for different indications can therefore present an opportunity for obstetricians to remove these myomas in a harmless way that defiles the old obstetric dictum of “never a myomectomy during caesarean section”. The case in this report had caesarean section on account of severe preeclampsia with oligohydramnos but chance favoured the performance of unsolicited caesarean myomectomy safely for her.