Management of Hemorrhagic myoma prolapsing through the cervix at 29 weeks of gestation: a case report

Abstract

Uterine fibroids are the most common benign tumors in women of reproductive age. Outside pregnancy, a submucosal fibroid may protrude through the cervix, referred to as a “delivered fibroid,” leading to metrorrhagia and pelvic pain. During pregnancy, this condition becomes more complex, with risks of fetal distress and severe maternal hemorrhage. We report the case of a 32-year-old patient, gravida 7 para 5104, admitted to the Annex Regional Hospital of Tibati (Cameroon) for third-trimester hemorrhage at 29 weeks of gestation. Clinical examination revealed hemorrhagic shock, fetal bradycardia, and a large 15 cm mass protruding through the vulva, consistent with a hemorrhagic sessile isthmic fibroid delivered through the cervix. After initial resuscitation and blood transfusion, an emergency laparotomy was performed. The surgical procedure consisted of a subtotal hysterectomy following myomectomy, carried out one hour and thirty minutes after fetal extraction. A male neonate weighing 1500 g was delivered, with APGAR scores of 4-3-0, and died in the delivery room. The maternal postoperative course was uneventful, and the patient was discharged after 5 days of hospitalization. A hemorrhagic fibroid delivered through the cervix during pregnancy constitutes an obstetric emergency with life-threatening maternal and fetal prognosis. Systematic prenatal monitoring using ultrasound remains the best screening tool.