EP11.12: Ultrasound‐guided aspiration of painful cystic degeneration of myoma in pregnancy: a management approach
Year: 2024
Type: conference-abstract
Abstract: Pain due to degenerative changes or, rarely, torsion is the most common complication of fibroids in pregnancy. Conservative approach consisting of hydration, bed rest and analgesia is the generally acceptable first line of management and surgical consideration when pain becomes intractable. We present this case of successful aspiration of a degenerated fibroid cyst as a management option in carefully selected patients with intractable pain due to cystic degeneration of uterine fibroid in pregnancy. 28-years Afro-Caribbean primigravida who presented at 24+6 weeks with history of recurrent abdominal pain of worsening severity not relieved with oral opioid analgesics. Previous ultrasound evaluation had shown a gravid uterus with multiple uterine fibroids and a coexisting large thick-walled ovarian cyst. Examination revealed a young woman in painful distress who could barely walk. Abdomen was tender marked at the left lower quadrant. A bedside ultrasound showed a viable pregnancy, multiple uterine fibroids, and a 10cm simple cyst. She remained in severe pain despite use of non-opioid and opioid analgesics. She was offered ultrasound guided cyst aspiration to manage her pain. She underwent ultrasound guided cyst drainage using an 18G chorionic villus sampling needle under local anesthesia. 220ml of hemorrhagic fluid was drained with a clear outline of the uterine fibroid demonstrated. She developed intense crampy abdominal pain within 5 minutes of the procedure, necessitating admission. This was managed with tocolytics, analgesia, and a course of antenatal corticosteroids. She was discharged the next day, her pregnancy progressed uneventfully, and she delivered her baby at 41+1 weeks gestation. Cystic degeneration of uterine myoma in pregnancy presenting with severe pain, though rare, may present as an acute abdomen. Ultrasound-guided cyst aspiration may be a management option in carefully selected patients when medical management therapies have failed.
DOI: 10.1002/uog.28535
Authors: G.T. Igwemadu, N. Madipola, C. Otigbah
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402361413