Postpartum expulsion of a massive degenerated intramural–submucosal fibroid following emergency caesarean section: a rare case report

Abstract

Large uterine fibroids complicating pregnancy may cause significant obstetric morbidity, including malpresentation, foetal growth restriction, and postpartum complications. Spontaneous fibroid expulsion following caesarean delivery is extremely uncommon, particularly when involving large intramural lesions. A 37-year-old primigravida with a rapidly enlarging intramural–submucosal fibroid presented with severe early-onset foetal growth restriction and abnormal Doppler studies. She underwent an emergency lower segment caesarean section at 31+ weeks, delivering a preterm male neonate. Postpartum recovery was initially uneventful; however, the patient developed persistent fever and subsequently presented on postoperative day 32 with severe abdominal pain and a large foul-smelling mass protruding through the vagina. Imaging revealed absence of the previously documented fibroid and presence of a large necrotic mass extending from the uterine cavity to the vaginal canal, consistent with spontaneous fibroid expulsion. Due to extensive necrosis and infection, a total abdominal hysterectomy was performed. Massive intramural fibroids in pregnancy require close surveillance even after caesarean delivery. Postpartum expulsion, though rare, may occur and prompt recognition is essential to prevent sepsis and maternal morbidity.