Proactive Management of Gestational Hypertension in a Patient With Uterine Fibroids: A Case Report

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The coexistence of uterine fibroids and gestational hypertension (GH) presents a high-risk obstetric scenario associated with adverse maternal-fetal outcomes. We present the case of a 27-year-old primigravida diagnosed with a 22 × 28 mm anterior uterine fibroid at 8 weeks' gestation, which enlarged to 52 × 48 mm by 29 weeks. At 21 weeks' gestation, she developed new-onset GH (blood pressure 150/98 mmHg) without proteinuria. Her management included prophylactic low-dose aspirin (75 mg daily), methyldopa (250 mg twice daily), and structured home blood pressure monitoring. When her blood pressure rose to 155/100 mmHg at 34 weeks, the methyldopa dosage was increased to three times daily, which successfully restored control. Following induction of labor at 40 weeks, the patient had an uncomplicated vaginal delivery of a healthy 3.3 kg neonate with an APGAR score of 9. The postpartum course was unremarkable, and the fibroid regressed significantly. This case illustrated that a proactive, guideline-based strategy uniting early prophylaxis, adaptive pharmacotherapy guided by home monitoring, and anticipatory care can successfully navigate the compounded risks of this clinical dyad, leading to a favorable outcome.

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