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Symptoms of fibroids may include:
However, most often there are no symptoms associated with fibroids.
Can fibroids harm my baby? Most studies have not found an increased rate of intrauterine growth restriction
(IUGR) or of stillbirth (fetal demise) in pregnancies complicated by uterine fibroids [2,9] Although there have been uncommon reports of limb abnormalities,
head deformities, congenital torticollis (wryneck), and caudal dysplasia in the fetuses of pregnancies that were
complicated by large uterine fibroids it is unclear whether these abnormalities were related to the presence of the uterine fibroid or an underlying maternal condition [6-8] Studies have most consistently shown pregnant women with fibroids to be at increased risk for
pain, breech presentation, malposition, and cesarean delivery [9]. In at least
one study the size of the fibroids was not significantly associated
with an increased risk for cesarean delivery, and nearly 70% of women
with fibroids 10 cm in diameter or larger were able to achieve a vaginal delivery
[10].
Some but not all studies have shown pregnant women with
fibroids to be at increased risk for preterm birth, premature rupture of the
membranes,postpartum hemorrhage,
and placental abruption [9,10]. Submucosal
, fibroids located beneath the placenta, and fibroids 7 to 8 cm in diameter had
the highest risk for abruption in one study [2].
Studies have not consistently shown an association between uterine fibroids and placenta previa
[9]
Less common complications that have been attributed to fibroids include acute renal failure,
urinary retention, disseminated intravascular coagulation, spontaneous hemoperitoneum,
uterine inversion, and uterine incarceration, [ 14-17]
Can uterine fibroids be treated during pregnancy?
Although removal of fibroids during pregnancy has been performed
safely during the first and second trimesters of pregnancy
removal of fibroids during pregnancy is
usually reserved for women who have subserosal or
pedunculated fibroids with pain that is unresponsive to rest,
intravenous fluids, NSAIDs , and narcotic medications [2,9].
Will the fibroid grow? Overall most uterine fibroids do not appear to change in
size during pregnancy. Growth of fibroids seems most likely to occur during the
first trimester in fibroids larger than 5 cm in diameter. Fibroids less than 5
cm in diameter tend to remain stable or decrease in size [9]. If I have a cesarean delivery can the doctor remove the fibroid at the
time of the surgery? Removal of fibroids (myomectomy) at the time of cesarean delivery has been associated with significant hemorrhage
in some studies [2,9]. However, in experienced hands removal of easily reached
subserosal or pedunculated fibroids may be a safe procedure [11-13].
REFERENCES
1. Rice JP, Kay HH, Mahony BS. The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol
1989;160:1212–6.PMID: 2658611
2. Exacoustos C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol
1993;82:97–101.PMID: 8515934
3. Katz VL, Dotters DJ, Droegemueller W. Complications of uterine leiomyomas in pregnancy. Obstet Gynecol 1989;73:593–6.PMID 2927854
4. Burton CA, Grimes DA, March CM. Surgical management of leiomyomata during pregnancy. Obstet Gynecol
1989;74:707–9.PMID 2812645
5. Hasan F, Arumugam K, Sivanesaratnam V.
Uterine leiomyomata in pregnancy. Int J Gynaecol Obstet 1991;34:45–8.PMID 1671020
6. Matsunaga E., Shiota K.:Ectopic pregnancy
and myoma uteri: teratogenic effects and maternal characteristics.Teratology. 1980;21:61-9.PMID:7385056
7. Graham J.M., Miller M.E., Stephan M.J., et al:
Limb reduction anomalies and early in utero limb compression. J Pediatr;96. 1052-1056.1980;
PMID 7373466
8. Romero R., Chervenak F.A., DeVore G.: Fetal head
deformation and congenital torticollis associated with uterine tumor. Am J
Obstet Gynecol 141. 839-840.1981; PMID 7198386
9.Ouyang DW eat al. ,Obstetric complications of fibroids.Obstet Gynecol Clin North Am. 2006;33:153-69. PMID:
16504813
10. Qidwai Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol.
2006 ;107:376-82.PMID:
16449127
11. Hassiakos D et al,. Myomectomy during cesarean section: a safe procedure? Ann N Y
Acad Sci.2006 ;1092:408-13.PMID:17308166
12. Dimitrov A,et al. [Myomectomy during cesarean section]
Akush Ginekol (Sofiia). 1999;38:7-9. PMID:
10730373
13. Kaymak O,et al. Myomectomy during cesarean section.
Int J Gynaecol Obstet. 2005;89:90-3.
PMID:15847868
14. Phelan J.P.: Myomas and pregnancy. Obstet
Gynecol Clin North Amer 22. 801-805.1995;
PMID:8786883
15. Monga AK, Woodhouse CR, Stanton SL:
Pregnancy and fibroids causing simultaneous urinary retention and ureteric obstruction. Br J Urol 77. 606-607.1996; PMID:
8777631
16. Feusner A.H.,Mueller P.D.: Incarceration of a gravid fibroid
uterus. Ann Emerg Med;30. 821-824.1997; PMID:
9398784
17. Courban D., Blank S., Harris M.A., et al: Acute
renal failure in the first trimester resulting from uterine leiomyomas. Am J Obstet Gynecol 177. 472-473.1997;
PMID:9290476
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