Leiomyomas are benign uterine tumours found in 25–35% females of reproductive age. Risk of having fibroids is increased with increasing age. Since more and more couples are delaying childbirth, fibroids are being encountered in pregnancy increasingly. Placental abruption is one of the major lifethreatening obstetric conditions. The fetomaternal outcome of a severe placental abruption depends largely on prompt maternal resuscitation and delivery. We report a case of a 35-year-old Gravida 6, Para 4 woman with 39 weeks gestation who is a known hypertensive poorly controlled. She never followed prenatal consultation. She presented to our hospital Saint Jean marc with one day history of fatigue, vertigo after she collapsed while going to the toilette and picked up by her husband who brought her to the hospital. On examination, ill looking patient in respiratory distress, pale. BP 133/99mmg, pulse rate 116beats/minute, Respiratory rate 36cycles/minute, temperature 35.5°c. The uterus was board like, tender, and there was no fetal heart sound. Diagnoses of chronic hypertension, placental abruption were made. An urgent abdomen ultrasound scan was done which showed a retro placental clot and a large sub-mucosal fibroid in posterior wall of uterus. Two hour later she delivered a fresh still birth male baby. Patient started to bleed per vagina and entered into hypovolemic shock despite manual uterine revision, resuscitation was commenced with intravenous infusion of normal saline, and was transfused with 2 units of fresh whole blood. A diagnosis of uterine atonia was made and patient was taken to theatre urgently. Intraoperatively a large sub-mucosal fibroid in the posterior wall of uterus was removed(figure 1) measuring 5,5x3,5x3cm and the haemorrhage stopped, She received one more unit of fresh whole blood intraoperatively. The postoperative recovery was satisfactory. She was reviewed one week post discharge and transferred to physicians for BP control.
