title: Intramural leiomyoma during pregnancy becoming pedunculated postpartally. A case report.
abstract: BACKGROUND
  The natural history of uterine leiomyomas during pregnancy has been reported.
  
  
  METHODS
  A 39-year-old primigravida presented with vaginal spotting in the 10th week of pregnancy. Ultrasonic evaluation revealed a large intramural leiomyoma. Unsuccessful tocolysis at 25 weeks' gestation resulted in a cesarean section for breech presentation. At hysterotomy a 10-cm intramural leiomyoma was found in the right fundus and was left in situ. Six months later, at open laparotomy for myomectomy, the 10-cm leiomyoma was pedunculated, on a 4-cm stalk.
  
  
  CONCLUSIONS
  Large intramural leiomyomas found at cesarean section may become pedunculated postpartally, thus making myomectomy easier and safer at a postpartum intervention than at the time of cesarean section. Also, prior knowledge of the possibility of myoma transformation from intramural to pedunculated postpartally may help in planning a later myomectomy. Myomectomy prior to pregnancy should be considered when it has caused a prior pregnancy complication.
authors: Department of Obstetrics and Gynecology, St. John's Mercy Hospital, Washington, USA.
authors: R D
authors: RD
authors: Haskins
authors: C J
authors: CJ
authors: Haskins
authors: R
authors: R
authors: Gilmore
authors: M A
authors: MA
authors: Borel
authors: P
authors: P
authors: Mancuso
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000473:pathology* / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery