Pregnancy Challenges Caused by Fibroids

Fibroids are non-cancerous growths of the uterus. They are basically estrogen and progesterone hormone sensitive tumors which are seenin 3 to 12% of pregnant women. In many women, fibroids are insignificant, while in some, fibroids may be detected for the first time in pregnancy and they are asymptomatic. Conversely, in some women, the size, location, and number of fibroids within the uterus can stimulate a myriad of symptoms. Women with fibroids can face subfertility and pregnancy complications.

Here are some common questions and answers about fibroids in pregnancy.

1) Can a woman with fibroids conceive?

Women with fibroids do conceive naturally. It is the location and size of the fibroid that is paramount in adversely affecting the ability to conceive. Fibroids located on the outer aspect of the uterus (subserosal) constitute no risk for subfertility or pregnancy invariably. But fibroids located in the cavity of the uterus (submucous), near the tubal ostia (cornual fibroids), fibroids near the opening of the uterus (cervical fibroids), or the fibroids which distort the cavity are usually the cause of infertility. Based on these sites there may be issues with the propulsion of sperm or ova and defective implantation leading to subfertility or miscarriage. The removal of submucous fibroids or fibroids distorting the uterine cavity increases the pregnancy chances by approximately 30 to 50%.

2)Does having fibroids increase the risks during pregnancy?

Many women with fibroids have an uneventful healthy pregnancy and childbirth. These women do need frequent antenatal visits and close monitoring in a hospital that has expertise in handling high-risk pregnancies with blood bank facilities.

3)What are the effects of fibroids on the mother and baby?

The risk of miscarriage is 15 to 20%; the other complications include

• Bleeding in early pregnancy
• Anemia
• Red degeneration leading to pain, and pressure symptoms due to an increase in size and position
• Fetal growth restriction - 11 to 13%
• Malpresentation - 8 to 10%
• Prematurity
• Placental complications
• Preterm delivery
• Prolonged labor
• Cesarean delivery
• Postpartum hemorrhage - 2 to 4% as the uterus fails to contract adequately

4)What is red degeneration of fibroids?

This is the most common reason for pain in the abdomen in the case of pregnant women with fibroid uterus but it usually does not harm the pregnancy. When fibroids are larger than 5 cm and outgrow the blood supply, it leads to ischemia. Ultrasound is used to detect fibroid degeneration and the warning symptoms are pain in the abdomen, nausea, and vomiting. Rest, hydration, and painkillers can provide relief.

5)Can women with fibroids deliver normally?

Yes, women with fibroids can deliver normally but it depends on the size and location of fibroids. Large fibroids obstructing the cervix, fetal malpresentation, or previous history of myomectomy could be indications for cesarean delivery.

6)Do fibroids shrink post-delivery?

Fibroids tend to increase in volume during pregnancy while interestingly around 10 to 12% regress. Post-delivery, around 50% reduction in the size of fibroids within 3 to 6 months is noted.

7)Can fibroids be removed during cesarean delivery?

Removal of fibroids during cesarean delivery can be considered in only selected patients based on size, location, and number of fibroids.