Abstract: We report a case of 41yr old Gravida 5 Para 4-previous 1 CS (caesarean section) followed by 3 VBAC (vaginal birth after caesarean section), with history of previous preterm deliveries and this pregnancy complicated by submucosal fibroid of size 7.5*6 cm. She was a late booker at 18 weeks hence EDD (expected date of delivery) calculated from scan at 18+6. Fibroid remained almost stable in size throughout pregnancy. She presented to emergency services with pre-term labour at 36+1 weeks and examination revealed that she was in established labour (cervix fully effaced, 5 cm dilated) with breech presentation. She opted for emergency caesarean section and hence shifted to theatre quickly. She was fully dilated on reaching theatre with breech at -1 station. Because of pathological CTG (cardiotocogram) and high station of the presenting part, decision made to proceed with caesarean section. Emergency caesarean section was challenging due to adhesions, multiple fibroids and atonic PPH (postpartum haemorrhage), which was managed with uterotonics. She had severe abdominal pain and heavy PV (per vaginal) bleeding couple of hours after caesarean section and was taken for examination under anaesthesia (EUA) and surgical management of PPH. EUA revealed a prolapsed fibroid of size 7*5 cm in the vagina which was removed by simple traction and bleeding settled. This case underlines the importance of considering fibroids as a cause for abdominal pain during and after pregnancy.
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