Uterine fibroids or leiomyoma are the most common benign pelvic tumor in women of reproductive age group. Presenting the case of 41yr old Gravida 5 Para 4 – previous 1 CS (caesarean section) followed by 3 VBAC (vaginal birth after caesarean section), with history of previous preterm deliveries and this pregnancy complicated by submucosal fibroid of size 7.5*6 cm. She was a late booker at 18 weeks. Fibroid remained almost stable in size throughout pregnancy. She presented to emergency services with pre-term labour at 36+1 weeks and examination revealed that she was in established labour (cervix fully effaced, 5 cm dilated) with breech presentation. She opted for emergency caesarean section and hence shifted to theatre quickly. She was fully dilated on reaching theatre with breech at -1 station. Because of pathological ctg and high station of the presenting part, decision made to proceed with caesarean section. Emergency caesarean section was challenging due to adhesions, multiple fibroids and atonic PPH (postpartum haemorrhage), which was managed with uterotonics. She complained of severe abdominal pain and heavy PV ( per vaginal) bleeding couple of hours after caesarean section and was taken for examination under anaesthesia (EUA) which revealed a prolapsed fibroid of size 7*5 cm in the vagina which was removed by simple traction and bleeding settled. This case underlines the importance of considering fibroids as a cause for abdominal pain during and after pregnancy. This case will be the fourth case of spontaneous fibroid expulsion after caesarean but first case to occur within 12 hours of caesarean section.

Dr.Lovely Thomas has completed her MBBS from Government Medical College, Trivandrum, Kerala, India followed by post- graduation ( MS OBGY) in the subject of obstetrics and gynaecology at Government Medical College , Trivandrum, Kerala ,India. She has gained experience working in various regions of Kerala following her post-graduation. She has successfully cleared Member of Royal College of Obstetrician and Gynaecologists (MRCOG) and is currently employed in the UK.