Exploring fibroids and pregnancy

Uterine fibroids (leiomyomas) are commonly occurring benign smooth muscle tumors of the uterus. The effect of fibroids and pregnancy is a topic of clinical concern. Although it is estimated that up 60% of women have fibroids, the incidence of fibroids in pregnancy varies between 1.6 and 10.7%. This prevalence increases with age. It is also greater in African-American women.

Symptoms of fibroids and pregnancy

Fibroids within the uterine cavity itself (submucosal) come with an increased risk for pregnancy loss. This is especially true if they are 3cm or greater, or multiple 1-3cm fibroids are present.

Growth of fibroids occurs in approximately one third of patients. It is impossible to predict which fibroids in which patients will grow in size. Growth of fibroids and pregnancy may lead to an increase in complications and pain.

Pain is most common in the late first and second trimesters as rapid growth of the uterus occurs. With this rapid growth, fibroids especially 5cm or greater in diameter.

The incidence of preterm labor, preterm premature rupture of membranes and placental abruption are increased only slightly. However, the risk increases depending on the fibroid’s relation to the placenta. Implantation (placental site) overlying a fibroid being the biggest risk factor. With implantation being completely random, it is also unpredictable which pregnancies will be at risk.

Fibroids can lead to dysfunctional labor with decrease in contractile force. This in itself can increase risk for cesarean delivery.

Treatment of fibroids

With all of these potential risks, what is the treatment of fibroids and pregnancy? Doctors should avoid surgical removal (myomectomy) during pregnancy. Although the risk of cesarean section is higher, MOST women will have an uneventful pregnancy and vaginal delivery. Myomectomy during pregnancy or at cesearean section can cause significant hemorrhage. Pain related to fibroids is managed conservatively with analgesic medications and narcotics.

Pre-conception myomectomy is possible. Myomectomy is the treatment of choice for large intracavitary fibroids and is typically happens via a hysteroscopic resection. We can remove large intramuscular (intramural) fibroids via laparotomy or laparoscopy with newer surgical advances in robotic daVinci techniques. As always, contact us to determine what is best for your unique clinical concerns.