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Re: Delivery with obstructing fibroidFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Sat Jul 26 18:36:56 2003
At Thu, 24 Jul 2003, Shannon Burke wrote: > >We have a primigravid woman at 36 weeks with a 9x11x13 cm fibroid in the >lower uterine segment that fills the pelvis. The infant is above the >fibroid, is growing well and the placenta is fundal. We are planning a >cesarean delivery in IR at 37.4 weeks with embolization if needed for PP >hemorrhage. One of our faculty suggested that instead we attempt a >vaginal delivery. He had a similar case in which a fibroid as large as >this "pulled up" during labor and the patient delivered without any >complications. The difficulty of course, is that if she has a >hemorrhage after a vaginal delivery (if she could deliver) we may or may >not be able to make it to IR and she might have a hysterectomy instead. >Has anyone else had a similar situation? Do you have suggestions for how >the differentiate the case that will deliver vaginally? Any other >thoughts? I would manage this patient by doing a pelvic exam at term and then when she is in labor (hopefully spontaneously), if I feel a well applied and engaged fetal head I could care less about the fibroids, it never ceases to amaze me me how babies find there way around fibroids. I have only had one persistent transverse lie secondary to fibroids and the patient was almost fully dilated so I did a classical section. Doing a uterine embolization is a terrible idea, the only indication for this is irretraceable bleeding, the last thing this mother needs is a big necrotic mass on her uterus in the postpartum period.
--
Take care, John
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