Vasopressin to Reduce Blood Loss during Cesarean Myomectomy

Abstract

Objective: To report the use of intramyometrial vasopressin to reduce intraoperative blood loss during cesarean myomectomy
for a large uterine fibroid.

Methods: We present the case of a term pregnant woman with a large intramural uterine fibroid who underwent myomectomy
during cesarean delivery.

Results: A 38-year-old woman, gravida 5 para 4, presented at term with uterine contractions that had persisted for two days. She had been diagnosed with uterine fibroids three months earlier and remained asymptomatic throughout the pregnancy. An emergency cesarean section was performed under spinal anesthesia because of obstetric indications. Intraoperatively, a large intramural uterine fibroid measuring 17 × 11 cm and weighing 1.2 kg was identified and successfully removed. The procedure included bilateral fimbrectomy, uterine repair, and myomectomy. To reduce intraoperative bleeding, 20 IU of vasopressin was injected intramyometrially. The estimated blood loss was 900 mL, and the patient received a transfusion of 250 mL of packed red blood cells. Considering the size of the fibroid, the blood loss was relatively low, and the procedure was completed without major hemorrhagic complications or the need for hysterectomy.

Conclusion: Although uterine fibroids during pregnancy are often asymptomatic, large fibroids may require surgical management during cesarean delivery. This case highlights the potential role of intramyometrial vasopressin as an effective adjunct for reducing intraoperative blood loss during cesarean myomectomy. Careful patient selection, meticulous surgical planning, and close hemodynamic monitoring are essential to ensure patient safety and optimize surgical outcomes.

Keywords: bleeding, cesarean myomectomy, pregnancy, uterine myoma, vasopressin