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28 MOGS Chronicles | Volume 1 | Issue 1 | September 2024IntroductionUterine smooth-muscle tumors (leiomyomas or myomas), with a prevalence rate of up to 70%, are the most common benign uterine tumors in women during their reproductive years.[1]Although they are benign and can be asymptomatic, around 30% of fibroids cause profuse menstrual bleeding, irregular uterine bleeding, pelvic discomfort and pain due to pressure on adjacent organs and structures, obstetric complications such as infertility, recurrent abortions or preterm labour.[2]While hysterectomy is the primary indication for this pathology, considering age of incidence and related symptoms, for the fertile age population, the preferred surgical intervention is myoma removal with uterine preservation.[3]Case ReportDiscussing about the dilemmas and difficulties faced in a case of 37 years old, with history of two abortions (P0A2), married since 15 years with secondary infertility presented with complaints of palpable abdominal mass and heavy menstrual flow.On per abdomen examination uterus was almost 30%u201332 week of size, non-tender, ballotable, side to side mobility was present [Figure 1]. On per speculum examination cervix was deviated to right side. On per vaginal examination uterus was around 30%u201332 weeks, anteverted, bilateral fornices were free and non tender, Hingorani%u2019s sign was negative. On ultrasonography transabdominal and MRI was suggestive of 18.6 %u00d7 13 %u00d7 Save the Uterus! A Case of Large Fibroid with InfertilityKrutika Ramdin, Reena WaniDepartment of Obstetrics and Gynecology, Dr. R. N. Cooper Hospital, Juhu, Mumbai, Maharashtra, IndiaAddress for correspondence: Krutika Ramdin, Department of Obstetrics and Gynecology, Dr. R. N. Cooper Hospital, Juhu, Mumbai, Maharashtra, India. Mobile: +91-7506732966. E-mail: drkrutikaramdin1@gmail.comCase ReportAbstractUterine fibroids (leiomyomas) are the most common benign uterine tumors, affecting up to 70% of women during their reproductive years. While many fibroids are asymptomatic, some cause significant complications, including heavy menstrual bleeding, pelvic pain, and reproductive challenges, such as infertility or recurrent miscarriages. In women of reproductive age, myomectomy is preferred over hysterectomy to preserve fertility.We present a case of a 37-year-old woman, with a history of secondary infertility and two previous abortions, who presented with an abdominal mass and heavy menstrual bleeding. Examination revealed an enlarged uterus (30-32 weeks' size) with right-sided deviation of the cervix. Imaging confirmed a large subserosal fibroid (18.6 x 13 x 18.6 cm) with cystic degeneration and pressure effects on the right ureter, causing hydronephrosis. The case presented challenges regarding the choice of myomectomy vs. hysterectomy, the surgical approach, and considerations for future pregnancies.After preoperative optimization, the patient underwent an open myomectomy. Intraoperative techniques included vasopressin for blood loss control, hydrodissection, hypotensive anesthesia, and triple tourniquet application. The patient required one unit of blood and was discharged on postoperative day 4.Successful myomectomy in this patient with secondary infertility highlights the importance of individualized care in managing symptomatic uterine fibroids, even in complicated cases with significant comorbidities like hydronephrosis.Keywords: %u200aFibroid, Leiomyoma, Cystic degeneration, Hydro dissectionFigure 1: Pre-operative image of abdomen with myomaFigure 2: Intraoperative Single myoma of size 30%u201332 weeks