{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:04:12Z","timestamp":1756425852560,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,7,2]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Although leiomyomata are common, it is rare for them to be associated with severe complications in pregnancy. We describe the case of a primigravida with a known multifibroid uterus. She presented at 16 weeks\u2019 gestation with abdominal pain, distension, raised serum inflammatory markers and features of a gastrointestinal ileus. The patient was initially managed conservatively; however, her clinical condition deteriorated and she developed a severe systemic inflammatory response syndrome (SIRS). Imaging demonstrated red degeneration of two large leiomyomata, small bowel obstruction and ascites. Following a multidisciplinary team meeting, the patient was offered an antenatal abdominal myomectomy, or a termination of pregnancy plus deferred elective myomectomy. She underwent a successful abdominal myomectomy at 17+4 weeks\u2019 gestation and subsequently had an uncomplicated elective Caesarean section at 39 weeks\u2019 gestation. This report highlights the importance of multidisciplinary team management and informed consent in a surgically complex patient in the second trimester of pregnancy.<\/jats:p>","DOI":"10.1136\/bcr-2025-266076","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T09:25:25Z","timestamp":1753435525000},"page":"e266076","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Second trimester semi-elective abdominal myomectomy to manage severe systemic inflammatory response syndrome secondary to fibroid degeneration"],"prefix":"10.1136","volume":"18","author":[{"given":"Robyn","family":"Edney","sequence":"first","affiliation":[{"name":"Department of Gynaecology, St George\u2019s Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, St George\u2019s Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Childs","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics, St George\u2019s Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sourav","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, St George\u2019s Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Fagan","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, St George\u2019s Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,25]]},"reference":[{"key":"2025082804022371000_18.7.e266076.1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ejogrb.2020.08.018","article-title":"Myomectomy during pregnancy: A systematic review","volume":"254","author":"Spyropoulou","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2025082804022371000_18.7.e266076.2","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(19)32322-0","article-title":"Seeing red degeneration in uterine fibroids in pregnancy: proceed with caution","volume":"394","author":"Cerdeira","year":"2019","journal-title":"Lancet"},{"key":"2025082804022371000_18.7.e266076.3","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deg318"},{"key":"2025082804022371000_18.7.e266076.4","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2011-130319"},{"key":"2025082804022371000_18.7.e266076.5","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/GRF.0000000000000169","article-title":"Are Women With Uterine Fibroids at Increased Risk for Adverse Pregnancy Outcome?","volume":"59","author":"Ezzedine","year":"2016","journal-title":"Clin Obstet Gynecol"},{"key":"2025082804022371000_18.7.e266076.6","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/j.1447-0756.2008.00873.x","article-title":"Myomectomy during pregnancy: a feasible option","volume":"35","author":"Bhatla","year":"2009","journal-title":"J Obstet Gynaecol Res"},{"key":"2025082804022371000_18.7.e266076.7","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.bja.2020.05.061","article-title":"Intrathecal hydrophilic opioids for abdominal surgery: a meta-analysis, meta-regression, and trial sequential analysis","volume":"125","author":"Koning","year":"2020","journal-title":"Br J Anaesth"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266076","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:02:35Z","timestamp":1756378955000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":7,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,25]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bcr-2025-266076"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266076","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}