Case: A 38-year-old G4P2012 woman at 12 weeks' gestation was referred to me for an abortion. She had been turned away by several providers due to the presence of a large lower uterine segment fibroid that made her cervix inaccessible. Her obstetric history was significant for two prior spontaneous vaginal deliveries and one spontaneous abortion. She had no other medical history and no prior surgeries. Pelvic ultrasound revealed a 12×9×8-cm fibroid in the posterior lower uterine segment. On physical exam, the fibroid displaced the cervix anteriorly between the fibroid and the pubic symphysis. The cervix was not visualizable by speculum exam, but was palpable on bimanual exam, just behind the symphysis pubis. The patient stated that she had been previously asymptomatic from the myoma. She had completed her childbearing. After counseling, the patient stated that she preferred to avoid major surgery and preferred to avoid a hysterectomy. I obtained consent from her for suction aspiration, dilation and evacuation (D&E), possibly laparotomy, possibly hysterotomy and possibly hysterectomy. Any suggestions for managing this patient would be appreciated! Respondent #1: I have had three instances of inaccessible cervix which became more axial and accessible after misoprostol: two were myomata and one was a duplicated reproductive system with the cervix in question displaced far anteriorly by the other cervix. Respondent #2: We had the “luxury” of a patient who desired no further pregnancies, mitigating the risks imposed by a classical scar on the uterus. If a large, posterior fibroid is truly obstructing the cervix, a hysterotomy to remove the fetal tissue can be a completely reasonable option. Abortion