Design: Stepwise demonstration of the surgical techniques with narrated footage

Setting: Cervical fibroids in pregnancy are rare, but pose risks to both mother and fetus including vaginal bleeding, preterm labor, PPROM, hemorrhage, and infection. The patient was positioned in dorsal lithotomy for surgery.

Patients or Participants: Single 32 year old patient with history of PPROM at 22 weeks in a prior pregnancy, who presented with vaginal bleeding in pregnancy and desired surgical management. Pelvic examination was notable for a prolapsing fibroid 2cm past the external cervical os, and dilating the cervix to 1.5cm. Preoperative transvaginal ultrasound showed a 4cm cervical fibroid.

Interventions: We discuss our approach, which involves a vaginal approach to dissecting the cervical fibroid and ensuring hemostasis. The fibroid was injected with epinephrine (short acting and not expected to have any long term fetal effects). Vasopressin was not used due to structural similarities with oxytocin and theoretical risk of causing contractions. The fibroid was grasped with a tenaculum and cervix was grasped with a ring forceps for traction. Metzenbaum scissors were used to shell the fibroid. Once dissected and freed, the fibroid stalk was clamped, divided and suture ligated with 2-0 Vicryl. Hemostasis was ensured.

Measurements and Main Results: The patient had a successful vaginal myomectomy and was discharged home the same day, with no further vaginal bleeding in her pregnancy thus far. Transvaginal cervical length measurements by ultrasound were normal at >3cm immediately and at one month postoperatively. Patient is currently 38 weeks gestational age and expected to have a normal spontaneous vaginal delivery at term.

Conclusion: In conclusion, this video demonstrates a technique for vaginal myomectomy of a cervical fibroid during pregnancy that proved safe and effective for patient and fetus.