Giant Uterine Fibroid Coexisting with Twin Gestation: Serial Sonographic Growth Documentation and Successful Management by Cesarean Section, Myomectomy, and Inverted-T Abdominal Incision — A Case Report from Abuja, Nigeria

Abstract

Background: Uterine fibroids may complicate pregnancy and are associated with adverse maternal and foetal outcomes. The coexistence of a giant uterine fibroid and twin gestation presents additional challenges in antenatal surveillance, assessment of fibroid growth and planning of operative delivery. Aim: This case report describes the serial sonographic documentation of a giant uterine fibroid's growth throughout early and mid-pregnancy and the successful management of a twin gestation complicated by the fibroid. Case Presentation: This report concerns a woman in her early 30s who conceived twins spontaneously approximately three years after being diagnosed with uterine fibroids. Her abnormal uterine contour and abdominal distension due to a giant uterine fibroid necessitated an emergency caesarean section with concurrent myomectomy at 37 weeks. Two live female neonates were delivered, both with good Apgar scores. Discussion: This case illustrates the rapid growth of the fibroid from 8.5 cm to 17.8 cm in maximum diameter over approximately 10 weeks and 4 days, highlighting the value of serial ultrasound monitoring and individualised surgical planning for managing giant uterine fibroids in twin pregnancies, particularly in resource-limited settings. Caesarean delivery with myomectomy was performed through an inverted-T abdominal incision and resulted in the successful delivery of two healthy female neonates, with a favourable maternal outcome. This case illustrates that caesarean myomectomy can be performed successfully when meticulous surgical planning and multidisciplinary support are available. Conclusion: This case highlights the rarity, complexity and distinctive features of a twin gestation complicated by a rapidly growing giant uterine fibroid. Multidisciplinary care, close antenatal sonographic monitoring and an appropriate surgical approach, including an inverted-T abdominal incision when required for adequate exposure, contributed to favourable maternal and foetal outcomes.