Fibroids in pregnancy
FIBROIDS are non-cancerous, hormone-dependent tumours of the uterus. They usually cause many symptoms including heavy and painful menstrual bleeding and compressive symptoms such as urinary frequency (when they compress the bladder) and constipation (when they compress the rectum).
With regards to pregnancy and becoming pregnant, symptoms of fibroids include infertility issues, pain, and possibly an increased risk of Caesarean section. Sometimes there may be no symptoms and the fibroids are inadvertently diagnosed when an ultrasound is done for the first time in pregnancy.
Fertility issues
Fibroids within the uterus (submucousal) decrease fertility by up to 70 per cent and removal of these fibroids results in a significant increase in fertility. Sometimes these fibroids can physically obstruct the Fallopian tubes, preventing the egg and sperm from meeting and thus preventing conception. In the event of a developing embryo within the uterus, a submucosal fibroid can thin out the lining of the uterus and decrease the blood supply to the developing embryo, leading to miscarriage. Ultrasound, MRI, saline infusion sonography (ultrasound after sterile water is placed into the uterus), and hysteroscopy (camera to look within the uterus) are some of the common methods used to evaluate the location of fibroids.
Growth
Fibroids are dependent on hormones (oestrogen and progesterone). In pregnancy, there is a tremendous increase in these hormones. In some women, due to genetic variances and growth factors, some fibroids may grow in pregnancy, resulting in an increase in compressive symptoms. However, an ultrasound study of pregnant women with fibroids found that 69 per cent of the women had no increase in the size of fibroids throughout the pregnancy. In the 31 per cent of women who had an increase in size, it usually happened before the third month. Almost always, fibroids shrink after delivery.
Pain
In pregnancy, fibroids can undergo a process known as “Red Degeneration” where the fibroids tend to spontaneously break down, resulting in pain. This usually happens in the second trimester. This pain is usually treated with painkillers, heat therapy, ice packs, bed rest and increased fluid intake. At times the pain can be very severe, resulting in hospital admission and administration of intravenous/intramuscular painkillers and fluids.
Increased risk of Caesarean section
Increased risk of Caesarean section
Fibroids will not physically hurt the baby. Depending on the location and the size of the fibroid, this can affect the presentation and positioning of the baby, resulting in Caesarean section. If the fibroids are in the lower aspect of the uterus, this can physically prevent the baby from entering the birth canal. Abnormal positioning secondary to fibroids include breech presentation (bottom first) and transverse (crossways), both of which would require abdominal delivery.
