# Complex Cesarean Myomectomy: A Case Report Describing the Removal of 15 Fibroids During Delivery

## TL;DR

A complex cesarean myomectomy successfully removed 15 fibroids during childbirth, showing the procedure can be safe with proper surgical skill.

## Contribution

Demonstrates the feasibility of cesarean myomectomy for managing multiple and large fibroids during delivery.

## Key findings

- A 40-year-old woman had 15 fibroids successfully removed during a cesarean myomectomy at 36 weeks.
- Blood loss was limited to 700 mL, and both mother and baby recovered well with no complications.
- The case emphasizes the importance of surgical expertise and hemostatic techniques in complex myomectomies.

## Abstract

Cesarean myomectomy (CM) has traditionally been avoided due to concerns about hemorrhage and the potential need for peripartum hysterectomy, yet recent evidence suggests it can be a safe and effective procedure in selected cases. This report details a rare and complex CM performed on a 40-year-old primigravida with a history of fibroid uterus and infertility. The patient presented with multiple uterine fibroids, including a 15 cm intramural fibroid in the lower uterine segment obstructing the proposed cesarean incision. At 36 weeks, a planned CM was performed, excising 15 fibroids (2-15 cm). Hemostasis was achieved and blood loss was limited to 700 mL. The procedure lasted two hours and 10 minutes. Both mother and neonate recovered well and were discharged on day 4 without complications and have been healthy as of the six-month follow-up. This case highlights the feasibility of CM in managing large and multiple fibroids, emphasizing the importance of experienced surgical expertise and advanced hemostatic techniques.