Miomectomía en embarazo temprano

Resumen

Los miomas o leiomiomas son tumores benignos monoclonales que histológicamente surgen de la proliferación del músculo liso y tejido conectivo del útero. Son de crecimiento lento y la degeneración maligna es menor a 1% y tan bajo como 0.2%. La prevalencia mundial varia de 5-21%, aumenta con la edad; 1.8% en mujeres de 20-29 años y 14.1% en mayores de 40 años.
Se reporta reducción del embarazo clínico en pacientes con miomatosis uterina mayor de 4 cms (29 vs 52%, p=0.025), comparadas en mujeres sin miomatosis uterina. Si se logra el embarazo como tal, los miomas durante el embarazo pueden causar: incremento en la tasa de abortos espontáneos (por distorsión de la cavidad uterina), contracciones prematuras, ruptura prematura de membranas, placenta previa, desprendimiento prematuro de placenta, presentación fetal anormal, o hemorragia post parto y aumento en el índice de cesáreas. Describimos el caso clínico de paciente femenina de 36 años, primigesta, con historia de infertilidad primaria y diagnóstico de miomatosis uterina de grandes elementos con embarazo de 11 semanas, en quien se decide miomectomía durante embarazo por presentar varios cuadros clínicos de amenaza de aborto y dolor pélvico constantemente, así como dificultad respiratoria por volumen uterino, que evoluciona satisfactoriamente y en quien se resuelve embarazo por medio de una cesárea programada mas histerectomía, obteniéndose recién nacida femenina a término.

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Abstract

Myomas or leiomyomas are benign monoclonal tumors that histologically arise from proliferation of smooth muscle and connective tissue of the uterus. They are slow growing and malignant degeneration is less than 1% and as low as 0.2%. Worldwide prevalence varies from 5-21%, increasing with age; 1.8% in women aged 20-29 years and 14.1% in women over 40 years.
A reduction in clinical pregnancy is reported in patients with uterine myomatosis greater than 4 cms (29 vs. 52%, p=0.025), compared to women without uterine myomatosis. If pregnancy is achieved as such, fibroids during pregnancy may cause: increased rate of miscarriage (due to distortion of the uterine cavity), premature contractions, premature rupture of membranes, placenta previa, placental abruption, abnormal fetal presentation, or postpartum hemorrhage and increased rate of cesarean section. We describe the clinical case of a 36-year-old female patient, primigravida, with a history of primary infertility and diagnosis of uterine myomatosis of large elements with a pregnancy of 11 weeks, in whom myomectomy was decided during pregnancy because she presented several clinical symptoms of threatened abortion and constant pelvic pain, as well as respiratory difficulty due to uterine volume, which evolved satisfactorily and in whom pregnancy was resolved by means of a programmed cesarean section plus hysterectomy, obtaining a female newborn at term.