Abstract
Cesarean myomectomy (CM) has traditionally been avoided due to concerns about hemorrhage and the potential need for peripartum hysterectomy, yet recent evidence suggests it can be a safe and effective procedure in selected cases. This report details a rare and complex CM performed on a 40-year-old primigravida with a history of fibroid uterus and infertility. The patient presented with multiple uterine fibroids, including a 15 cm intramural fibroid in the lower uterine segment obstructing the proposed cesarean incision. At 36 weeks, a planned CM was performed, excising 15 fibroids (2-15 cm). Hemostasis was achieved and blood loss was limited to 700 mL. The procedure lasted two hours and 10 minutes. Both mother and neonate recovered well and were discharged on day 4 without complications and have been healthy as of the six-month follow-up. This case highlights the feasibility of CM in managing large and multiple fibroids, emphasizing the importance of experienced surgical expertise and advanced hemostatic techniques.