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Delivery with obstructing fibroidFrom: Shannon Burke (shannon.burke@dhha.org)Thu Jul 24 18:01:00 2003
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?
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