title: Severe intrauterine growth restriction associated with the development of a submucosal leiomyoma during pregnancy: a case report.
abstract: BACKGROUND
  Small, intramural leiomyomas are not generally considered a risk factor for poor reproductive outcomes.
  
  
  METHODS
  A patient with a 6-mm intramural leiomyoma and a normal uterine cavity by hysteroscopic evaluation who conceived after in vitro fertilization developed severe early-onset intrauterine growth restriction (IUGR), leading to pregnancy termination at 23.4 weeks' gestation. At 6 weeks postpartum, a 1.7-cm, intracavitary leiomyoma was detected on ultrasound evaluation and removed by hysteroscopic resection. The patient conceived in a subsequent in vitro fertilization cycle and gave birth to monozygotic twins with appropriate weights at 34 weeks of gestation. In the absence of other identifiable etiologies of the IUGR, it is plausible that the small, intramural leiomyoma enlarged and migrated into the cavity, causing abnormal placentation and leading to fetal growth restriction in the first pregnancy.
  
  
  CONCLUSIONS
  Uterine cavity reevaluation is recommended in the investigation of IUGR before a woman attempts further pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California 94305, USA.
authors.forename: Natali
authors.initials: N
authors.lastname: Aziz
authors.forename: Tiffanee A
authors.initials: TA
authors.lastname: Lenzi
authors.forename: Amin A
authors.initials: AA
authors.lastname: Milki
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014594:Uterine Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery