Pregnancy with Fibroids

Fibroids are benign tumors of uterus, made of muscle and fibrous tissue. Pregnancy with fibroids is a quite common condition, affecting around 30% of women of 15 to 45 years of age. Sometimes it is diagnosed for the first time at ultrasound during pregnancy. In majority of the cases, it does not cause trouble, but 10 to 30% women can have complications with it.

The purpose of this blog is to guide and educate about fibroids, complications and danger signs requiring treatment.

How pregnancy affects fibroid?
During pregnancy majority of fibroids remain the same size but few can increase in size due to rising estrogen levels and increased blood supply to uterus, nearly 80% of these fibroids regress after 6 months of delivery. In few cases fibroids shrink during pregnancy and 6 months after delivery.

What percentage of pregnant women with fibroids have complications?
Most pregnant women do not have any problem or complication due to fibroids, only 10% to 30% of women have complications that requires treatment.

What is the most common complaint about fibroid?
Pain is common most complaint of pregnant women having fibroid.

Does size is related to complications?
Yes, more than 5 cm fibroids are troublesome.

Which trimester is affected the most?
Second and third trimester time-period is the most vulnerable time for problems.

Does site of fibroid affect pregnancy?
Yes, sub serosal (outer wall) fibroids do not have any effects. However, intramural (in walls of uterus) or intracavitary (inside uterine cavity) fibroids give problems during pregnancy and delivery.

What are danger signs of fibroids in a pregnant woman?
If you are having pressure, pain or any bleeding consult your doctor immediately as these could be early warning signs of abortion or preterm labor, which may require hospital admission and treatment.

How do fibroids affect pregnancy?

• Fibroids double risk of abortion and miscarriage.
• They can restrict growth of baby if fibroid is in intracavitary distorting the cavity of uterus.
• There are chances of abnormal placental position like low lying placenta (placenta previa)
• There are chances of placental abruption (breaking away from uterine wall) resulting in excessive bleeding, pain, and premature delivery.
• Preterm contractions can start resulting in preterm delivery.
• Malpresentations and malposition’s of fetus occur if shape of cavity is distorted.
• Women with fibroids are six times more prone to Cesarean delivery.

What are risks during labor?
There are chances of ineffective weak uterine contractions, prolonged labor, and incomplete dilatation of cervix.

What are immediate problems after delivery?
There is risk of post-partum hemorrhage (PPH); excessive bleeding. After 24 to 48 hours of delivery, its due to weak uterine contractions, prolong labor and failure of uterus to contract after delivery.

What are delayed complications after delivery?
Red degeneration of fibroids occurs due to decreased blood supply and falling hormone levels during puerperium, it is commonest problem after delivery, patients present with severe pain, fever, and bleeding.

How are fibroids treated during pregnancy?
Painkillers, bed rest and hydration help in treating pain and pressure symptoms during pregnancy on contrary surgical interventions and removal of fibroids is avoided as far as possible.

What is best mode of delivery in cases of fibroid?
Normal delivery is preferable over a caesarean, BUT always Consult your doctor who after history, examination and evaluating risk factors can decide about safest option of a normal delivery or a planned caesarian section.

What are risks after myomectomy?
There are chances of excessive bleeding, uterine cavity distortion, adhesions formation and tubal blockage, but the greatest risk after myomectomy surgery is life threatening complication of uterine scar rupture during trial of normal labor, though its chances of are low in cases of hysteroscopic resection of fibroids but still it is there.

What should be the mode of delivery with myomectomy surgery in past?
Caesarian section is safe mode of delivery after myomectomy.

Remember fibroids are quite common among women of reproductive age group and is diagnosed by ultrasound. Problems associated with it depend on its size and site in uterus. Majority of pregnant women with fibroids have no problem but, in few cases, there are problems with baby growth and delivery, therefore timely diagnosis and management is crucial.

Dr. Ayesha Azam Khan