Fibroids In Pregnancy

Uterine fibroids are a very common finding in women of reproductive age. Therefore, it is not uncommon to have pregnant women who also have fibroids.

The 3 commonest questions asked are

Will the pregnancy have any impact on the fibroid?

Will the fibroid affect (harm) the pregnancy?

Can you remove the fibroid at the time of Caesarean Section?

Let me try and answer these questions

Impact of pregnancy on the fibroid

Sonography is the commonest modality used for diagnosis and surveillance of fibroids in pregnancy. Majority of the fibroids may remain asymptomatic but some will increase in size and also impact the pregnancy.

The increase in size mainly happens in the first trimester. The small fibroids are more likely to grow than the larger ones. In the postpartum period, some fibroids may shrink in size.

Sometimes, the fibroids undergo a process called red degeneration which can cause pain.

Impact of Fibroids on Pregnancy

Fibroids can cause some problems in pregnancy. The mechanism is not very clear.

There is a chance of bleeding in early pregnancy and the risk of spontaneous miscarriage is increased. The risk depends on the number of fibroids (more the number more is the risk) location of fibroid (chances are higher if the fibroid is in the body of uterus as compared to the ones that are subserosal)

Pregnant women with fibroids are more likely to have

Preterm labour-that is deliver before 37 weeks,

Placental abruption (bleeding in between the placenta and the body of the uterus)

Placenta previa (placenta is in the lower segment of the uterus)

Foetal growth restriction

Increased risk of malpresentation (more chances of the baby not being in head down position)

Increased risk of caesarean section

Post-partum Haemorrhage (increased bleeding after delivery)

Retained placenta i.e. the placenta does not deliver spontaneously and will require
intervention.

Management of fibroids in pregnancy

Pain Management

Severe abdominal pain is the commonest symptom. It is usually more common with large fibroids and in the second and third trimester. Pain during pregnancy can be difficult to manage. Bed rest Hot fomentation and analgesics are commonly used. Pain Killers should be used cautiously as they too can have harmful effects on the pregnant woman and the foetus. In severe pain, even narcotics can be used judiciously.

Myomectomy

The general opinion is that one must avoid removing the fibroid at the time of a caesarean section. Though there are situations where a surgeon may still do it and this decision is best left to the surgeon and the situation at that time.

If myomectomy has been done before the pregnancy then these women may require an elective caesarean section especially if the uterine cavity was opened during the myomectomy.

Ideally this should be attempted if required after the pregnancy.