A 37-year-old woman, gravid 2, para 3 (a past history of a twin pregnancy with foetal death in utero at term and a vaginal delivery), came to the emergency room with a 6-week pregnancy, complaining of moderate vaginal bleeding and pelvic pain. On examination, a prolapsed, pedunculated leiomyoma, measuring 4 cm×6 cm was detected. The complete blood count showed a haemoglobin concentration of 11.8 g/dl and a haematocrit level of 33%. Pelvic sonography showed a uterus with an embryo 10.5 mm in a craneo-caudal position and a prolapsed pedunculated leiomyoma of 41.5 mm×44.7 mm within the cervix in the vagina (Fig. 1).
Operative hysteroscopy was performed in an ambulatory setting. The procedure was done with a 5.5 mm, continuous flow, hysteroscopy system with a 5-French working channel permitting the passage of a Versa Point bipolar device (Gynecare, Ethicon, Somerville, N.J., USA). We used a twizzle electrode for coagulating and cutting. We introduced the hysteroscope just inside the canal until the internal hole and then we sectioned the stalk. We kept the input pressure below 100 mmHg, using an electronic pump for irrigation and aspiration (Endomat, Karl Storz, Tuttlingen, Germany). Operating time was 20 min. The leiomyoma measured 4 cm×6 cm, with a 2 cm stalk. The histological examination confirmed the leiomyomatous characteristics of the tumour. The patient was discharged on the day after the procedure, asymptomatic and with the prescription of amoxicillin as a prophylactic antibiotic for 8 days.
The pregnancy progressed to term without further complications. She had a normal vaginal delivery with a normal labour at 38 weeks of gestation, and a healthy female infant was born, weighting 3.300 g.