Case description
  • The pregnant patient was a 37-year-old G2P0 with a growth restricted fetus on the 1st centile for estimated fetal weight.
  • Concurrently, there was a 9cm posterior lower uterine segment intramural fibroid.
  • A preoperative mapping ultrasound was performed to characterize the fibroid and indicates that a Pfannensteil skin incision and transverse lower uterine segment uterine incision are feasible.
  • A Cesarean delivery with myomectomy was planned at 37 weeks gestation.
  • A transverse incision was made in the lower uterine segment and the infant was delivered in vertex presentation.
  • The uterus was exteriorized from the abdominal cavity and the incision was sutured closed with a running technique.
  • A Penrose drain was passed through the broad ligament windows and secured anteriorly to temporarily occlude blood flow through the uterine arteries to minimize hemorrhage.
  • Dilute vasopressin was injected as an acute vasoconstrictive agent.
  • The fibroid was carefully removed and the myometrial defect was re-approximated in layers.
  • The uterine serosa was re-approximated using a baseball or herringbone suture technique