The patient involved was a healthy 28-year-old G1 at 18 weeks of gestation who consented for pregnancy termination via preparatory laminaria dilators and subsequent operative dilatation and evacuation for a confirmed, lethal diagnosis of Trisomy 18. Aside from an ultrasound-diagnosed lower uterine fibroid, her antenatal course was unremarkable and she had had a normal pelvic examination just prior to conceiving. On preparation of the cervix for dilatation, a speculum exam revealed an obstructing 5-6cm fibroid protruding through the cervix into the vagina. The cervix itself was not visualized due to the size of the fibroid and its protrusion into the vagina. On bimanual exam, the internal os was closed around the fibroid, which appeared to arise from the level of the internal os of the cervix. In order to prepare the cervix for dilation, osmotic dilators were tucked around the fibroid within the cervix. After three hours, the internal os was a finger tip dilated with further ripening required. Rather than a sequential set of dilators which would be challenging to place and maintain around the fibroid due to angulation, a cervical Foley catheter was employed to ripen the cervix further. The intent was to allow proper placement of a dilator without increasing the risk of false passage creation. Given the obstructive fibroid, the patient consented for a myomectomy prior to the evacuation, with the added, increased risk of hemorrhage. The possibility of an operative hysteroscopy was explained, as it would allow for removal of the stalk of the fibroid in its entirety, as well as cauterization of the base itself should it be required. Prior ultrasound had indicated that the fibroid was within the lower uterine segment, and the location of the base could not yet be identified. The following day with the Foley having fallen out and under general anesthetic, examination revealed a sufficiently 3-4cm dilated cervix with the prolapsed fibroid now slightly recessed into the cervix due to the dilatation of the internal os. There was clear visualization of the fibroid stalk originating from within the endocervix (). To minimize blood loss intraoperatively, dilute vasopressin (8 units) with 1% lidocaine (20ml) was infiltrated as a paracervical block and at the base of the fibroid. The fibroid was grasped and transected at its base with cautery used to maintain hemostasis. With the obstruction cleared (), the remainder of the uterine evacuation was carried forth in the usual manner utilizing a 12mm suction curette. Sharp curettage confirmed that there was no fibroid base remaining. At the conclusion of the case, hemostasis was noted. The patient's postoperative course was uncomplicated.