Case Report

Medical Abortion of a First-Trimester Pregnancy with Large Multiple Uterine Leiomyomata

Table 1

List of a case series and seven reported cases of patients with large uterine leiomyomata who underwent abortion.

Authors/year of publicationGestational age (weeks)/remarksDescription of leiomyoma/size of uterusDescription of interventionInduction to abortion time

Saad-Naguib et al. [7]
2017
9 cm of subserosal leiomyoma at posterior wall of uterus
20-week pregnancy
1 mEq/mL of fetal intracardiac potassium chloride injection followed by 2 doses of 20 mg/m2 methotrexate2 weeks
Mark et al. [8]
2016
10-20
Case series of 12 patients
Uterine sizes range from 16- to 32-week pregnancyFor patients up to 14-week pregnancy, 200 mg of oral mifepristone followed by 2 doses of 800 μg misoprostol vaginally 24 and 48 h
For patients beyond 14-week pregnancy, 200 mg of oral mifepristone followed by 400 μg of misoprostol vaginally every 4–6 h until delivery
6-17 h
3 patients underwent uterine evacuation due to incomplete abortion
Seto et al. [9]
2013
14
Prior classical cesarean section
 cm subserous leiomyoma arising from posterior aspect of uterus
16-18-week pregnancy
Dilapan®-S1 intracervically 12 h before 3 doses of misoprostol vaginally every 4 h (50, 100, and 150 μg, respectively)9.5 h after first dose of misoprostol
Li et al. [10]
2005
6Nine measurable leiomyomata, the largest of which measured  cm and was located in the posterior lower uterine segment
24-week pregnancy
3 tablets of 200 mg mifepristone and 3 tablets of 200 μg misoprostol 48 h later and then 5 tablets of 200 μg misoprostol vaginallyNA2
Dalton and Lebovic [11]
2003
11
3 prior unsuccessful evacuation attempts
Multiglobular, heterogenous masses with the largest’s diameter measuring 8 cm in the posterior corpus, extending cephalad, and caudad
NA2
Surgical abortion using a flexible cannulaNA2
Fenwick and Divers [12]
1995
6 cm intramural leiomyoma
24-week pregnancy
600 mg mifepristone orally, followed by 1 mg gemeprost vaginally after 36 hNA2
Creinin [13]
1996
6-7
History of myomectomies
Multiple leiomyomata
25-week pregnancy
104 mg of methotrexate intramuscularly, followed by four tablets of 200 μg misoprostol vaginally 6 days later3 h after first dose of misoprostol
Buckshee and Dhond [14]
1992
10Large multiple leiomyomata
32-34-week pregnancy
Intra-amniotic and intraplacental instillation of methotrexate, 25 mg at each site8 days

1Dilapan®-S (synthetic osmotic cervical dilator; Gel-Med International, Kamenne Zehrovice, Czech Republic). 2No information available.