Transverse position of a fetus caused by a giant leiomyoma in the lower segment of the uterus: A case report
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A 20-year-old primigravida presented at 39 weeks' gestation with the fetus lying in the transverse position. Ultrasound examination indicated an anterior placenta praevia grade II-III. During a vertical lower uterine segment caesarean section, a giant intramural leiomyoma of approximately 25 x 25 cm was found. The uterine incision was extended into the upper segment and a healthy male fetus of 2,568 g delivered. The placenta was situated anteriorly but did not extend into the lower uterine segment. A myomectomy had to be performed to enable closure of the uterine incision. The association of a transverse lie with anterior implantation of the placenta may result in a false ultrasound diagnosis because the lower anterior portion of the uterine wall and the attached portion of the placenta simulate a placenta praevia. In our case, an unsuspected leiomyoma in the lower segment contributed to this. Furthermore, this case illustrates the advantage of using a lower uterine segment vertical incision when performing a caesarean section for transverse lie. The incision can then readily be extended into the upper uterine segment when necessary.
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