Iranian Society of Gynecology Oncology


1 Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Gynecologist, Tehran, IR Iran

3 General Physician, Tehran University of Medical Sciences, Tehran, Iran


Introduction: Myoma is the most common benign tumor of the female genital tract. The incidence of myoma increases with age. It mostly presents in the fifth decade of life. Since myoma is often asymptomatic and incidentally diagnosed, the true prevalence is unknown. This tumor may also become symptomatic and affect women’s quality of life. This study was performed to report a rare case of vaginal myomectomy in post-partum severe hemorrhage caused by a submucosal myoma.
Case Report: A 39-year-old G2P1 woman with previous cesarean section and decreased fetal movement at 38th week of gestation was hospitalized. In sonography and biophysical profile, due to fetal compromised, pregnancy was terminated. After delivery of fetus, a submucosal myoma (12 × 12 cm) was protruded through cervical canal. Massive hemorrhage occurred and then vaginal myomectomy was done and the bed of myoma was packed with two long gauzes that removed after one day.
Conclusions: Vaginal myomectomy after natural vaginal delivery or possibly during cesarean section is a safe and reliable method to remove submucosal myomas especially large myomas and decrease the risk of complications and costs of re-surgery. Due to the increased risk of hemorrhage, it is better to conduct this surgery in third-level referral hospitals.


  1. Vilos GA, Allaire C, Laberge PY, Leyland N, Special C. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157-78. [DOI:10.1016/S1701-2163(15)30338-8]
  2. Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010;3(1):20-7.
  3. Tiltman AJ. The effect of progestins on the mitotic activity of uterine fibromyomas. Int J Gynecol Pathol. 1985;4(2):89-96. [DOI:10.1097/00004347-198506000-00001] [PMID]
  4. Shikora SA, Niloff JM, Bistrian BR, Forse RA, Blackburn GL. Relationship between obesity and uterine leiomyomata. Nutrition. 1991;7(4):251-5.
  5. Nair S, Al-Hendy A. Adipocytes enhance the proliferation of human leiomyoma cells via TNF-alpha proinflammatory cytokine. Reprod Sci. 2011;18(12):1186-92. [DOI:10.1177/1933719111408111] [PMID]
  6. Benaglia L, Cardellicchio L, Filippi F, Paffoni A, Vercellini P, Somigliana E, et al. The rapid growth of fibroids during early pregnancy. PLoS One. 2014;9(1):e85933. [DOI:10.1371/journal.pone.0085933] [PMID]
  7. Vitale SG, Padula F, Gulino FA. Management of uterine fibroids in pregnancy: recent trends. Curr Opin Obstet Gynecol. 2015;27(6):432-7. [DOI:10.1097/GCO.0000000000000220] [PMID]
  8. Song D, Zhang W, Chames MC, Guo J. Myomectomy during cesarean delivery. Int J Gynaecol Obstet. 2013;121(3):208-13. [DOI:10.1016/j.ijgo.2013.01.021] [PMID]
  9. Kim YS, Choi SD, Bae DH. Risk factors for complications in patients undergoing myomectomy at the time of cesarean section. J Obstet Gynaecol Res. 2010;36(3):550-4. [DOI:10.1111/j.1447-0756.2010.01195.x] [PMID]
  10. Park BJ, Kim YW. Safety of cesarean myomectomy. J Obstet Gynaecol Res. 2009;35(5):906-11. [DOI:10.1111/j.1447-0756.2009.01121.x] [PMID]
  11. Celal K, Hulya C. The evaluation of myomectomies performed during cesarean section in our clinic. Niger Med J. 2011;52(3):186-8. [DOI:10.4103/0300-1652.86135] [PMID]
  12. Guney M, Oral B, Özsoy M, Mungan T. Sezaryen esnasında myomektomi: retrospektif matermal sonuçların deg˘erlendirilmesi. SDU Tıp Fakultesi Dergisi. 2007;14(1).
  13. Maccio A, Madeddu C, Kotsonis P, Caffiero A, Desogus A, Pietrangeli M, et al. Three cases of laparoscopic myomectomy performed during pregnancy for pedunculated uterine myomas. Arch Gynecol Obstet. 2012;286(5):1209-14. [DOI:10.1007/s00404-012-2441-0] [PMID]
  14. Lee JH, Cho DH. Myomectomy using purse-string suture during cesarean section. Arch Gynecol Obstet. 2011;283 Suppl 1:35-7. [DOI:10.1007/s00404-010-1760-2] [PMID]
  15. Hassiakos D, Christopoulos P, Vitoratos N, Xarchoulakou E, Vaggos G, Papadias K. Myomectomy during cesarean section: a safe procedure? Ann N Y Acad Sci. 2006;1092:408-13. [DOI:10.1196/annals.1365.038] [PMID]
  16. Incebiyik A, Hilali NG, Camuzcuoglu A, Vural M, Camuzcuoglu H. Myomectomy during caesarean: a retrospective evaluation of 16 cases. Arch Gynecol Obstet. 2014;289(3):569-73. [DOI:10.1007/s00404-013-3019-1] [PMID]