Complex Cesarean Myomectomy: A Case Report Describing the Removal of 15 Fibroids During Delivery.

Cesarean myomectomy (CM) has traditionally been avoided due to concerns about hemorrhage and the potential need for peripartum hysterectomy, yet recent evidence suggests it can be a safe and effective procedure in selected cases. This report details a rare and complex CM performed on a 40-year-old primigravida with a history of fibroid uterus and infertility. The patient presented with multiple uterine fibroids, including a 15 cm intramural fibroid in the lower uterine segment obstructing the proposed cesarean incision. At 36 weeks, a planned CM was performed, excising 15 fibroids (2-15 cm). Hemostasis was achieved and blood loss was limited to 700 mL. The procedure lasted two hours and 10 minutes. Both mother and neonate recovered well and were discharged on day 4 without complications and have been healthy as of the six-month follow-up. This case highlights the feasibility of CM in managing large and multiple fibroids, emphasizing the importance of experienced surgical expertise and advanced hemostatic techniques.