Atypical Pseudo-Meigs Syndrome in Pregnancy; a case report

Introduction: Pseudo-Meigs syndrome is a rare condition characterized by the presence of ascites and pleural effusions in association with gynecologic tumors. Its occurrence in conjunction with uterine fibroids, especially in pregnancy, is uncommon. We report a case of a pregnant woman with a large pedunculated uterine fibroid complicated by massive ascites but no pleural effusion. Case Presentation: A 33-year-old gravida 3, para 2, was admitted to the hospital at 9 weeks of gestation with complaints of generalized abdominal pain and distension for two weeks. Initial evaluation demonstrated a viable intrauterine pregnancy, a large pedunculated uterine fibroid, and significant ascites. There was, however, no pleural effusion, making it atypical. Surgical intervention was applied to resolve her symptoms, as conservative management alone did not yield a good response. A laparotomic myomectomy was conducted, resecting a 16 cm x 20 cm-sized fibroid and drainage of 7.5 liters of ascitic fluid. The patient recovered uneventfully and was able to continue her pregnancy with no recurrence of ascites. Histopathological examination showed a degenerating leiomyoma with no evidence of malignancy. Discussion: This case describes the rare presentation of Pseudo-Meigs syndrome in a pregnant patient with a large uterine fibroid. In such cases, the pathophysiology is unknown but is presumed to be due to mechanical irritation of the peritoneum, lymphatic obstruction, or increased vascular permeability. Myomectomy during pregnancy is risky and, hence, is not often indicated, but is necessary in symptomatic cases where conservative management fails. In this case, surgical intervention led to symptomatic relief and preservation of pregnancy. Conclusion: Pseudo-Meigs syndrome can occur in pregnant women with uterine fibroids, posing diagnostic and therapeutic challenges. When indicated, early recognition and appropriate surgical management can lead to favorable maternal and fetal outcomes. Further clinical awareness of this rare presentation is essential for timely intervention and optimal care.