Background and Objective: Degenerated Uterine Leiomyomas (ULs) is one of the most common complications of UL in pregnancy and may cause severe maternal symptoms. In this study we present the rare case of UL permagna with cystic degeneration managed with Caesarean Section (CS) and Myomectomy with uterus preservation.
Methods: A 37-year-old primigravid woman was referred to the clinic with the chief complaint of huge abdominal mass that coincides with the pregnancy. Physical examination showed that the abdomen was overdistended and upon palpation a mass at processus xiphoideus height was felt. Ultrasound examination showed that the foetus had IUGR (Estimated Fetal Weight below the 10th precentile of the fetal growth curve with oligohidramnion) and also a cystic mass with a clear border. The patient was diagnosed with cystic degeneration of UL premagna and IUGR. The first-line management given was CS and myomectomy as an effort to maintain the uterus because this is a case of pregnancy with 15 years primary infertility.
Result: The overall outcome was satisfactory. The neonate came out 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 went home after the baby's weight reached 1800 grams.
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 the case.