Ultrasound-guided aspiration of large cystic uterine fibroids during pregnancy – description of a novel technique

In this case series, we describe a novel technique for the treatment of large cystic fibroids causing pressure on the diaphragm and dyspnoea during pregnancy. In all three cases, patients developed breathing difficulties prior to 28 weeks' gestation. The aim of treatment was to enable continuation of pregnancy and prevent iatrogenic early preterm birth. We performed transabdominal ultrasound-guided aspiration of fibroids under local anaesthesia in the outpatient setting between 24 and 31 weeks' gestation. The volumes of fluid aspirated were 600 ml, 1700 ml and 2000 ml. The procedures were uncomplicated, and all patients continued their pregnancy until elective caesarean delivery between 34 and 37 weeks' gestation. This series shows that antenatal ultrasound-guided aspiration may be a simple, safe and effective option for the treatment of symptomatic cystic fibroids, allowing pregnancy to continue without patients being exposed to surgical or anaesthetic risks, and preventing the major neonatal sequelae of very preterm birth.