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Late fetal death after mid-trimestre elective myomectomy

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Author(s): Ana Maria Coelho

Journal: Acta Obstetrica e Ginecologia Portuguesa
ISSN 1646-5830


ABSTRACT
uterine leiomyomas are frequent in pregnant women, and are usually small and asymptomatic. Occasionally they may complicate the course of pregnancy requiring medical management. In the rare cases of failed medical treatment, surgical intervention may be a therapeutic option. Case: an elective myomectomy was performed at 16 weeks of gestation in a 28 year-old black primigravida with sickle cell trait, presenting with abdominal pain refractory to medical treatment. A subserous leyomyoma weighing 3745g was extracted. In the second week after surgery, fetal demise was confirmed. Pathological examination revealed a normally developed fetus and placental endarteritis obliterans with corio-decidual necrosis.Conclusion: the hemodynamic effects of myomectomy on the utero-placental circulation, in addition to the higher risk of veno-occlusive phenomena associated with the patient's hematologic disease, may have determined the late vascular placental lesion. The role of prophylactic low weigh molecular heparin in this situation is yet to be determinated.
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