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Case report
Management of pregnancy in case of multiple and giant uterine fibroids
  1. Catarina Reis-de-Carvalho1,2,
  2. João Lopes2,
  3. Alexandra Henriques2 and
  4. Nuno Clode2
  1. 1PTCSRT, Harvard University, Cambridge, Massachusetts, USA
  2. 2Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
  1. Correspondence to Catarina Reis-de-Carvalho; catarinareiscarvalho{at}


Uterine fibroids are common among women of reproductive age. During the pregnancy, the potential complications of fibroids, although rare, are of frequent clinical concern. Available studies describing management and obstetrical outcomes in pregnant women with giant fibroids are limited. We present the case of a 39-year-old pregnant woman with multiple and large uterine fibroids. During the pregnancy, there was adequate fetal development, without major maternal complications. Given the characteristics of the fibroids and breech position of the fetus, an elective caesarean section was decided, and postpartum hysterectomy planned. This challenging obstetrical case required a multidisciplinary approach.

We considered crucial discussing five main issues: preconceptional counselling, tailored pregnancy surveillance, decision of time and route of delivery, decision to perform a peripartum hysterectomy and management of decreasing blood loss perioperatively. Given the limitation of the published reports, we believe that sharing our experience, along with a literature review, is beneficial for other clinicians.

  • obstetrics
  • gynaecology and fertility
  • surgery
  • anaesthesia

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  • Contributors CR-d-C: conception of the work and design of the work and acquisition of data and analysis of data and interpretation of data. JL: drafting the work and acquisition of data. AH: interpretation of data and revising the work critically for important intellectual content. NC: final approval of the version to be published, agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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