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MOGS Chronicles | Volume 1 | Issue 1 | September 2024 15IntroductionRecent studies suggest that caesarean myomectomy does not increase the risk of haemorrhage or postoperative morbidity when performed by skilled surgeons with proper haemostatic techniques. Common indications include fibroids obstructing the lower uterine segment, complicating uterine closure, preventing necrobiosis, or presenting with an unusual appearance especially pedunculated and anterior wall fibroids.[1]Case ReportA 38-year-old woman, recently married for the second time and experiencing primary infertility, presented with an abdominal mass to the outpatient department. Upon general examination, there were no significant findings. However, per abdominal examination revealed a firm, mobile mass corresponding to a 16%u201318 weeks pregnancy size, originating from the pelvis. Per vaginal examination also confirmed a firm, mobile uterus of similar size, with free bilateral adnexa. The patient was advised to undergo ultrasonography and magnetic resonance imaging (MRI) of the pelvis.Ultrasonography showed a bulky uterus with multiple small intramural fibroids in the anterior and posterior walls, and a large anterior subserosal fibroid measuring 5.7 %u00d7 5.1 cm. MRI findings were consistent with these results and also revealed an incidental intrauterine solid cystic area representing a gestational sac of 3.2 %u00d7 2.9 cm. An ultrasound performed at 9 weeks of gestation confirmed the viability of a single intrauterine pregnancy. Despite the risks associated with MRI exposure, the patient, aware of the potential dangers, chose to continue with the pregnancy due to her history of primary infertility.A nuchal translucency scan at 11 weeks and an anomaly scan at 19 weeks both returned normal results. The patient was newly diagnosed with hypertension at 14 weeks and was started on labetalol 100 mg twice daily and ecosprin 150 mg once at bedtime. Routine antenatal care investigations and preeclampsia (PIH) profiles were within normal limits. Additional tests, including an electrocardiogram, 2D echocardiogram, and ultrasound of the kidneys, urinary bladder, and renal artery Doppler, were also normal. Retinoscopy showed no signs of hypertensive changes, and the patient was advised to monitor her blood pressure at home.In the second trimester, the patient was admitted due to abdominal pain, but torsion and red degeneration of the fibroid were ruled out. An oral glucose tolerance test at 24 weeks returned normal results. At 32 weeks, the patient developed gross polyhydramnios, with the largest amniotic fluid pocket measuring 14.5 cm, although Doppler studies remained normal. She was admitted for safe confinement and received corticosteroid injections of betamethasone 12 mg intramuscularly, 24 h apart, to promote fetal lung maturity. Weekly Doppler scans and PIH profiles were within normal limits, and her blood sugar and blood pressure remained stable.At 36 weeks, an elective lower segment caesarean section (LSCS) was performed due to the mother%u2019s respiratory distress caused by severe polyhydramnios.A male baby weighing 2.3 kg with an APGAR score of 8/10 was delivered. During the procedure, a caesarean Caesarean myomectomy, traditionally avoided due to fears of complications like haemorrhage and hysterectomy, has been shown to be safe when performed by skilled surgeons with proper haemostatic techniques. In the case of a 36-weeks elderly primigravida with chronic hypertension, polyhydramnios, and multiple fibroids, caesarean myomectomy was successfully performed, demonstrating its safety and effectiveness in a tertiary care setting.Keywords: Fibroid, Pregnancy, Myomectomy, Caesarean myomectomyCaesarean Myomectomy in a Patient with Multiple Maternal and Fetal Comorbidities: A Rare Interesting Case ReportZeba H. Pathan, Niranjan N. Chavan, Deepali S. Kapote, Shreya Kampoowale, Ashwini S. Sakhalkar, Rutuja A. MohiteDepartment of Obstetrics and Gynecology, LTMMC, Sion, Mumbai, Maharashtra, IndiaCase ReportAbstractAddress for correspondence: Zeba H. Pathan, Department of Obstetrics and Gynecology, LTMMC, Sion, Mumbai, Maharashtra, India. Phone: +91-9404261803. E-mail: drzebapathan1494@gmail.com