Cystic Degeneration of Leiomyoma Permagna in Pregnancy: A Case Report

Background & Objective: Degenerated Uterine Leiomyomas (ULs) is one of the most common complications of UL in pregnancy that may cause severe maternal symptoms. In this study, we present a rare case of UL permagna with cystic degeneration managed with Caesarean Section (CS) and myomectomy with uterus preservation. Case Presentation: A 37-year-old primigravid woman was referred to the clinic with the chief complaint of huge abdominal mass that coincides with pregnancy. Physical examination showed that the abdomen was overdistended and upon palpation a mass was felt at processus xiphoideus height. Ultrasound examination showed that the foetus had IUGR (Estimated Fetal Weight below the 10th percentile of the fetal growth curve with oligohidramnion) and a cystic mass with a clear border was found. The patient was diagnosed with cystic degeneration of UL premagna and IUGR. The first-line management was CS and myomectomy as an effort to maintain the uterus because is the patient was a case of pregnancy with 15 years primary infertility. The overall outcome was satisfactory. The neonate was born alive, Ballard score equivalent to 32 weeks, and weighing around 1480g. The degenerated UL was successfully extracted. The patient was discharged 4 days post-operatively. The baby was treated in the NICU for prematurity and discharged after the baby's weight reached 1800 gr. Conclusion: Degenerated UL permagna in pregnancy is a very rare and serious condition. It needs to be studied further as there are no global consensus on how to manage such cases.