Unintended pregnancy despite iud, complicated with huge fibroid and scarred uterus, a rare case report

Abstract

Introduction. Unintended pregnancy rates remain high as a percentage in adolescents, socioeconomic groups and women that are already closed to the familiar planning. Thus, the variety of contraception methods are increasing (oral contraception, intrauterine devices etc.) in order to decrease the number of unintended pregnancies. Contraception methods are so accessible in women upper than 40 years old such as IUD’s, in order to avoid an unintended pregnancy and venous thromboembolization (VTE) but what happens when fibroids appear. The aim of this study is to demonstrate that the correct treatment remains a provocation and a difficult decision for the physician, accompanied with the patient's history, wishes and health status of each patient. Case statement. We describe the case of a 42 years old patient, who had an unintended pregnancy, after a placement of IUD 8 years ago and accidentally discovered a fibroid at a routine check-up. The patient is a smoker and also had hypertension and obesity first grade. After rigorous counseling of the patient, description of the risks if pregnancy evolves, the patient undergone under a general anesthesia a subtotal hysterectomy with bilateral adnexectomy in order to remove the Uterus (gestational sack, huge fibroid and IUD), all undergone under histopathologic examination Discussions. Even if the pregnancy was wished for, it will be difficult for the patient and baby to survive, due to the huge size of fibroma, the placement of the pregnancy, comorbidities and the malposition of IUD without strings accompanied with scarred uterus. Conclusion. There are various outcomes but all of them always depend on the primary diagnosis of pre-existing pregnancy pathologies, the desire to have and develop a healthy pregnancy and the obstetrical history of the patient. Also, the literature showed cases with pregnancies and IUD or pregnancies with leiomyoma outcomes but not with all those three in the same case, plus scarred uterus due to previous Cesarean section. socioeconomic groups and women that are already closed to the familiar planning. Thus, the variety of contraception methods are increasing (oral c ontraception, intrauterine devices etc.) in order to decrease the number of unintended pregnancies. Con traception methods are so accessible in women upper than 40 years old such as IUD’s, in order to a void an unintended pregnancy and venous thromboembolization (VTE) but what happens when fibro ids appear. The aim of this study is to demonstrate that the correct treatment remains a provocation and a difficult decision for the physician, accompanied with the patient's history, wishes a nd health status of each patient. Case statement. We describe the case of a 42 years old patient, who had a n unintended pregnancy, after a placement of IUD 8 years ago and accidentally disc overed a fibroid at a routine check-up. The patient is a smoker and also had hypertension and obe sity first grade. After rigorous counseling of the patient, description of the risks if pregnancy ev olves, the patient undergone under a general anesthesia a subtotal hysterectomy with bilateral adnexec tomy in order to remove the Uterus (gestational sack, huge fibroid and IUD), all undergone under histopathologic examination Discussions. Even if the pregnancy was wished for, it will be difficu lt for the patient and baby to survive, due to the huge size of fibroma, the placement of th e pregnancy, comorbidities and the malposition of IUD without strings accompanied with scarred uterus. Conclusion. There are various outcomes but all of them always depen d on the primary diagnosis of pre-existing pregnancy pathologies, the desire to have a nd develop a healthy pregnancy and the obstetrical history of the patient. Also, the literature showed cases with pregnancies and IUD or pregnancies with leiomyoma outcomes but not with all those three in the same case, plus scarred uterus due to previous Cesarean section.