Myomectomy during the first trimester associated with fetal limb anomalies and hydrocephalus in a twin pregnancy.
ABSTRACT To present the complications of a twin pregnancy after first trimester myomectomy and to discuss the possible etiologic relationship.
A 44-year-old primigravida with a dichorionic-diamniotic twin pregnancy underwent myomectomy in another hospital at 12 weeks' gestational age. At 28 weeks the patient was referred to our unit because of ventriculomegaly and limb anomalies in the second twin. The patient underwent a Caesarean section at 37 weeks of gestation delivering twin A, a healthy female weighing 3235 g and twin B, a female weighing 2810 g with hydrocephalus and limb anomalies (clubfeet and hypoplasia of the nails and terminal phalanges). The placenta from twin A was normal, but in the placenta of twin B haemorrhage, thrombosis and infarction were noted.
Despite several reports of myomectomy in pregnancy without any problems for mother and fetus, the authors believe that myomectomy - especially in the first trimester - may be associated with the type of problems observed in the present case. The pathophysiological relationship between placental trauma and haemodynamic alterations as a possible cause of the malformations in twin B is discussed.
Article: Uterine myoma in pregnancy.[show abstract] [hide abstract]
ABSTRACT: A review was made of the medical records of 76 patients with uterine myomas during pregnancy with the aim of studying the time and method of diagnosis, symptomatology, treatment, and outcome of pregnancy. In 11 patients (15%) myomectomy was performed during pregnancy. The frequency of abortion was 18% in patients treated both conservatively and with myomectomy. Myomectomy during pregnancy is discouraged in the literature. In cases where conservative treatment cannot be practised it seems that the risk of spontaneous abortion during pregnancy is not significantly increased when myomectomy is performed.Acta Obstetricia Et Gynecologica Scandinavica 02/1990; 69(7-8):617-9. · 1.85 Impact Factor
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ABSTRACT: This report reviews an 8-year experience with surgical management of leiomyomata during pregnancy at Los Angeles County Women's Hospital. Fourteen patients had such surgery, for a rate of 1.1 operations per 10,000 births. Five women had exploratory laparotomy only, six had myomectomy, and three had hysterectomy; one patient aborted after surgery. Thirteen other women had incidental myomectomies at cesarean delivery; one of these had an intraoperative hemorrhage. No other complications occurred. Surgical management of leiomyomata during pregnancy is safe in carefully selected patients.Obstetrics and Gynecology 12/1989; 74(5):707-9. · 4.80 Impact Factor
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ABSTRACT: We present the case histories of three premature infants with congenital posthemorrhagic hydrocephalus. The timing of the lesion was monitored in utero in two of the three cases. Magnetic resonance imaging studies (prenatal in one case, within 24 hours of birth in all three cases) established the duration of the lesions and thereby added to the ultrasonographic findings. All three patients demonstrated a similar pattern of lesions, consisting of (1) unilateral germinal matrix hemorrhage with cystic resorption, (2) residual blood in the cerebrospinal fluid with a "granular" ependymal reaction, (3) asymmetric ventriculomegaly predominating on the side of the hemorrhage with mild atrophy and periventricular cysts, and (4) partial hypoplasia of the ipsilateral thalamus. On the basis of two cases in which information about the pregnancy was available and in which fetal oligohydramnios without ruptured membranes was detected, we assume that this pattern of lesions may have resulted from a hypoxic-ischemic episode followed by intraventricular hemorrhage. Because these three infants with congenital hydrocephalus were born during a period of only 18 months in a perinatal center serving a region with 16,000 live births per year, we speculate that a posthemorrhagic cause for congenital hydrocephalus underestimated.American Journal of Obstetrics and Gynecology 10/1997; 177(3):512-8. · 3.88 Impact Factor