Spontaneous Expulsion of a Large Submucosal Fibroid in the Postpartum Period: A Report of a Rare Case

Abstract

Spontaneous expulsion of uterine fibroids is an uncommon clinical event, most frequently described in the postpartum period or after uterine artery embolisation. Expulsion of a very large submucosal fibroid without surgical intervention is particularly rare. We report the case of a 39-year-old multiparous woman who was diagnosed with a large uterine fibroid during pregnancy. Following an uncomplicated term caesarean delivery, she developed persistent heavy menstrual bleeding that did not respond to initial medical treatment. Ultrasound assessment three months postpartum demonstrated a large submucosal fibroid measuring 116.5 × 92.5 × 100.7 mm, with significant distortion of the endometrial cavity. After counselling regarding medical and surgical options, she opted for conservative management and received leuprorelin acetate. Two months later, she spontaneously expelled a large mass per vagina without significant pain, haemorrhage or infection. Histopathological examination confirmed an infarcted leiomyoma with no evidence of malignancy. Serial ultrasound follow-up demonstrated a marked reduction in residual fibroid tissue, and subsequent diagnostic hysteroscopy confirmed a normal uterine cavity with no residual fibroid or intrauterine adhesions. Endometrial biopsy showed inactive endometrium with no hyperplasia, endometritis or malignancy. This case highlights spontaneous expulsion of a very large submucosal fibroid as a rare but recognised phenomenon in the postpartum period. Postpartum uterine involution and altered vascular dynamics may have played a key role, while gonadotropin-releasing hormone agonist therapy may have acted as a contributing factor rather than the primary cause. Careful follow-up is essential to confirm complete resolution and exclude residual pathology.