Introduction. Uterine fibroids are the most common benign tumors in women of reproductive age, and they can cause clinical symptoms such as abnormal uterine bleeding, abdominal pain, infertility or recurrent miscarriage. Fibroids are associated with changes in the vascular structure of the endometrium, including increased angiogenesis, vasodilation and decreased uterine muscle contractility. All of these can contribute to abnormal bleeding. During pregnancy, uterine fibroids (especially cervical fibroids) increase in size under the influence of hormones such as estrogen, progesterone and, possibly, human chorionic gonadotropin (hCG). While the presence of uterine fibroids is not a contraindication to medical abortion, changes in uterine anatomy and decreased contractility may reduce the effectiveness of treatment and increase the risk of complications. Case report. We present the case of a 43-year-old patient with an eight-week pregnancy who underwent medical termination of pregnancy with mifepristone and misoprostol. Following two prolonged episodes of heavy vaginal bleeding associated with severe anemia (hemoglobin 5.2 g/dL), the clinical and ultrasonographic evaluation revealed a highly vascularized 5-6 cm cervical mass consistent with a leiomyoma. Despite hemodynamic stabilization and transfusion, the persistent hemorrhage necessitated total hysterectomy with bilateral salpingectomy for definitive hemostasis. Conclusions. This case highlights severe hemorrhagic complications following medical abortion in patients with undiagnosed or underestimated uterine fibroids. Careful preprocedural assessment and individualized management are essential to minimize risks and optimize outcomes in women undergoing elective termination of pregnancy.
Mustafa et al. (Thu,) studied this question.