Optimal Outcomes Following Combined Cesarean-Myomectomy for High-Risk Intramural Leiomyoma: A Case Report
DOI:
https://doi.org/10.25077/aoj.10.2.375-384.2026Keywords:
Leiomyoma, Myomectomy, Cesarean Section, Hemostatic TechniquesAbstract
Background: Uterine leiomyomas during pregnancy pose significant management challenges, especially when large or located near the cervix. FIGO Type 5 myomas, characterized by their intramural yet cervix-adjacent position, may compromise cervical integrity and complicate labor. Traditionally, cesarean myomectomy has been avoided due to the risk of severe hemorrhage, yet emerging evidence supports its feasibility in selected patients. This report presents a technically refined approach to managing a high-risk intramural myoma during cesarean delivery.
Case Presentation: A 35-year-old multigravida (G3P2) with two prior cesarean sections was diagnosed at 13 weeks of gestation with a posterior intramural uterine myoma measuring 8.4 × 5.9 × 8.85 cm (FIGO Type 5). Transvaginal ultrasound revealed a short cervix (2.1 cm) and marked intralesional vascularity. Progesterone therapy and close monitoring led to cervical length improvement to 2.53 cm. At 39 weeks, elective cesarean delivery with concurrent myomectomy was performed. Circumferential basal ligation of the myoma pedicle provided rapid hemostasis before enucleation and layered uterine repair. A 223-gram benign leiomyoma was removed, with minimal blood loss.
Discussion: This case illustrates that precise surgical planning, effective hemostatic control, and multidisciplinary readiness are critical for achieving optimal outcomes in cesarean myomectomy. The basal ligation technique proved to be an effective method to minimize intraoperative bleeding and preserve uterine integrity. These findings align with current reports advocating for carefully selected cesarean myomectomy when technical expertise and resources are adequate. While further evidence is required to establish standardized guidelines.
Conclusion: Cesarean myomectomy can be safely performed in selected patients with large intramural leiomyomas when appropriate hemostatic strategies, such as basal ligation, are employed. This case supports reconsidering the traditional reluctance toward cesarean myomectomy, emphasizing individualized patient selection and surgical expertise.
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Copyright (c) 2026 Ardiar Rahmannanda Laksanadi, Nareswari Imanadha Cininta Marcianora, Bayu Priangga, Hamzah Rafly Rahman
This work is licensed under a Creative Commons Attribution 4.0 International License.
