Search

Pyomyoma, a rare complication of leiomyoma, presents a unique clinical challenge due to its infrequency with potentially fatal complications. Herein, we report the case of a 44-year-old Para 3+1 woman with red degeneration of uterine fibroids during pregnancy, who experienced worsening abdominal pain and foul smelling vaginal discharge 1 week post Caesarean section. Despite hemodynamic stability, her septic markers were markedly raised. A bedside ultrasound noted a pelvic complex cystic collection, further confirmed on CT scan as spontaneous ruptured of pyomyoma complicated by complex fistulas with surrounding organs. She underwent total abdominal hysterectomy and abdominal washout the next day, with intravenous antibiotic on-board. Histology examination confirmed acute suppurative inflammation of the uterine fibroid with endometritis. This case report contributes to the existing medical literature by shedding light on a rare and potentially life-threatening leiomyoma complication. Its potential to mimic acute puerperal endometritis, makes its diagnosis especially challenging, necessitating a high index of suspicion.

Introduction: Pre-pregnancy care (PPC) is an important part of diabetic care among females in the reproductive age group, as it improves feto-maternal outcomes. Objective: We aimed to assess female diabetic patients’ perception of PPC and family planning prior to PPC care. Method: This was an observational, cross-sectional survey performed from June 2019 to September 2019, using universal sampling of registered female diabetic patients who fit the inclusion criteria prior to integrated PPC care. A self-administered questionnaire was used to assess patients’ perception of PPC. Results: A total of 67 patients were recruited for the study. Only 39.4% (n=26) of the patients had heard of PPC. In our study, Code 1 contraception included those methods with a Pearl index of ≤9. Code 2 & 3 contraception included those methods with a Pearl index of >9. Only onethird of patients, 29.9% (n=20), were using Code 1 contraception, although the majority, 79.1% (n=53), felt that they had completed their family. 45 patients (68.2%) felt that they were at risk of developing complications if they were to become pregnant, and 46 patients (69.7%) felt that their health condition was not suitable for another pregnancy. However, only 31.1% (n=14) and 34.8% (n=16) of these patients were using Code 1 contraception, respectively. There were 30 patients (65.2%) who perceived that their health was not suitable for another pregnancy but were only using Code 2 or 3 contraception. Conclusion: The patients’ perception of PPC was poor. Patients had an inadequate knowledge of the effectiveness of their current contraceptive practice in relation to their intentions for further pregnancy and their self-perceived risk in case of future conception. We suggest that integration of PPC into routine follow-ups for other high-risk medical diseases, such as hypertension, heart disease, and epilepsy, be considered in future practice.