Missed Abortion Associated With Subserosal Leiomyoma

Subserosal leiomyomas rarely have any significant effect on a pregnant uterus, but very large ones may compress the uterine cavity in early pregnancy resulting in abortion. A 32 year old female presented with vagina bleeding for days. There was a 3 month history of amenorrhoea. Her last confinement was 3 years prior to presentation which ended with vaginal delivery with no complication. However, obstetric ultrasound scan done 3 years earlier during the first pregnancy showed a subserous leiomyoma at the fundus of the uterus. On examination, the uterine size was greater than the gestational age. Abdomino-pelvic ultrasound showed huge degenerating leiomyoma extending from the uterine fundus to the left lobe of the liver. The uterus was anteverted and harbours a 12 week non-viable foetus which appeared compressed in the upper aspect of the uterine cavity. The size of the myometrium was normal for the gestational age. An impression of missed abortion associated with a huge degenerating subserous leiomyoma was made.