STM Article Repository

The present study reports on surgical removal of the morbidly adherent placenta due to multiple uterine fibroids. Retained placenta is a common complication accounting for 3% of all deliveries, and especially in mid-trimester miscarriage. However, when it is further complicated by the presence of multiple fibroids negating removal through the vagina route, it becomes a problematic finding necessitating laparotomy for both myomectomy and removal of the placenta. Risk factors for retained placenta include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions, history of a prior retained placenta, and congenital uterine anomalies. A 36-year-old G3P0+2 who had a miscarriage at 19 weeks 5 days gestation had a retained placenta with failed attempts at both medical and manual removal due to multiple uterine fibroids. She eventually had a hysterotomy and myomectomy with satisfactory results. The intraoperative challenges were the removal of numerous uterine fibroid seedlings of various sizes including large ones in a gravid uterus leading to an estimated blood loss of 4,500 ml and necessitating the transfusion of a total of eight units of blood. This operation has proven to be life-saving because there was no way else to have delivered the placenta, and in doing the surgery, the uterine fibroids were managed, despite the risky circumstances. This case highlights one of the several complications of fibroids coexisting with pregnancy and its management.