A woman with a large uterus containing multiple leiomyomas can pose a diagnostic problem if she gets pregnant. If she misses a period, one can suspect that she could be pregnant. If she has symptoms suggestive of a pregnancy, it would help. One may not be able to appreciate signs of early pregnancy in her case, because the uterus with leiomyomas would not soften appreciably so early in pregnancy, and an enlargement in size would not be appreciated. One can do a pregnancy test on urine and make a diagnosis. But what if she does not miss a period? She might have had irregular and heavy periods due to the leiomyomas prior to the pregnancy. If she gets threatened abortion, she will have vaginal bleeding which may be misinterpreted as menstrual bleeding or abnormal uterine bleeding. Then one does not suspect a pregnancy and does not perform a pregnancy test.
There are some patients who are elderly, and are scheduled to undergo hysterectomy for multiple leiomyomas. If they happen to get pregnant, and if the pregnancy is diagnosed, there is a therapeutic dilemma. Would one perform an MTP first, and a hysterectomy after the postabortal period is over? Or would one perform a hysterectomy and get rid of both the conditions at the same time?
I checked all resources - medical databases, books, journals, search engines like Pubmed and Google - and found nothing on this topic. I asked all faculty in my institute. They promised to answer this question, and only five of thirty three answered. The others may be considered to be neutral or unwilling to commit on this issue. Those favoring MTP first stated that the blood loss would be excessive if a hysterectomy was done primarily, the vascularity of the uterus being increased due to the pregnancy. Those in favor of performing only hysterectomy had a number of arguments to support their choice.
Since I have mentioned only one point in favor of MTP first, and four points in favor of hysterectomy primarily, perceptive readers must have guessed that I am in favor of the latter. Please let me know what your choice will be, should you get one patient like this.
There are some patients who are elderly, and are scheduled to undergo hysterectomy for multiple leiomyomas. If they happen to get pregnant, and if the pregnancy is diagnosed, there is a therapeutic dilemma. Would one perform an MTP first, and a hysterectomy after the postabortal period is over? Or would one perform a hysterectomy and get rid of both the conditions at the same time?
I checked all resources - medical databases, books, journals, search engines like Pubmed and Google - and found nothing on this topic. I asked all faculty in my institute. They promised to answer this question, and only five of thirty three answered. The others may be considered to be neutral or unwilling to commit on this issue. Those favoring MTP first stated that the blood loss would be excessive if a hysterectomy was done primarily, the vascularity of the uterus being increased due to the pregnancy. Those in favor of performing only hysterectomy had a number of arguments to support their choice.
- It would involve a single procedure instead of two, so that the risk of complications (including those of anesthesia) would be reduced.
- If the fetus were implanted near the fundus, reaching it through the distorted uterine cavity could be difficult and the MTP could fail totally or partially (incomplete abortion).
- There would be some risk of postabortal sepsis which could make recovery and subsequent hysterectomy more difficult.
- The blood loss would not be significantly increased with hysterectomy as the only procedure, as there would not be any blood loss after ligation of the uterine vessels.
Since I have mentioned only one point in favor of MTP first, and four points in favor of hysterectomy primarily, perceptive readers must have guessed that I am in favor of the latter. Please let me know what your choice will be, should you get one patient like this.
