Fibroids during pregnancy

Dear Dr Mitchell,

I am pregnant and in my second trimester, and I have a few fibroids that were seen in the ultrasound scan. The doctor expressed some alarm that they will become problematic as my belly grows. It was at the clinic so I didn’t get to ask all the questions I wanted, so can you clarify what kinds of issues I’m facing? Will the fibroids get bigger? Will they make my baby deformed? Will I have to have an early delivery? And finally, can they remove the fibroids when I give birth?

Uterine fibroids are extremely common in black women and tend to grow to exceptionally large sizes. Fibroids are growths arising from the muscles of the uterus and are usually not cancerous. In less than 0.5 per cent of women, fibroids can be cancerous. This tends to be seen in older women.

In pregnancy, fibroids tend to increase in size because the production of oestrogen from the placenta increases. Oestrogen causes fibroids to grow. When a woman reaches menopause the production of oestrogen decreases significantly since the ovaries start to fail and the usual tendency is for the fibroids to shrink in size. If they continue to grow after menopause then surgery should be done to remove them since this may suggest that the fibroids are cancerous.

The increase in size of fibroids in pregnancy is usually associated with significant abdominal pains. The fibroids undergo what is called red degeneration or cystic degeneration because the blood flow to the centre of the fibroids is somewhat reduced because of the increased growth of the fibroids. The pain is usually managed with painkillers in the form of tablets initially, but in some cases if the pain is severe admission to hospital becomes necessary to administer more powerful painkillers via injections in order to control the pain. As the pregnancy progresses, the pain tends to settle down.

Uterine fibroids do not cause the foetus to become deformed and women with large uterine fibroids have gone on to have perfectly normal babies. There is an increased risk of premature delivery with the presence of large uterine fibroids and this is especially so if the fibroids are present in the cavity of the uterus where the baby is developing. These are called submucous fibroids. If the fibroids are present in the lower part of the uterus they can block the passage and prevent the foetus from going down into the pelvis. This will then warrant the need for delivery by a Caesarean section. The presence of uterine fibroids can also be associated with an increased chance of having a breech presentation at full term. This means that the foot or buttocks of the baby is present in the lower part of the uterus. This will then warrant delivery by Caesarean section.

Uterine fibroids are usually left alone during the pregnancy and at the time of delivery they are usually not removed if a Caesarean section is done because of the risk of severe bleeding. The removal of uterine fibroids might be necessary at the time of the Caesarean section if they are present in the section of the uterus where the baby has to be delivered through. It might also be necessary to remove fibroids at the time of the Caesarean section in order to close back the uterus properly. The overall practice, however, is to leave the fibroids until after delivery and then do a review three to six months later. Uterine fibroids tend to shrink somewhat to the pre-pregnancy size after delivery. Fibroids can be safely removed three to six months after delivery with a reduced risk of severe bleeding. The possibility of having to do a complete removal of the uterus at this time is significantly reduced.

It is important for you to take iron supplementation and eat foods rich in iron to reduce the risk of anaemia (low blood count in the pregnancy). Women who have uterine fibroids are at an increased risk for blood loss at the time of delivery because the uterus tends to not contract properly. Having a good blood count will reduce the risk of having to get a blood transfusion and developing complications from blood loss at the time of delivery. It is also important for you to have a couple of friends and family donate blood for you in advance to ensure that you will be able to access blood if the need arises.

It is important to keep up with your regular visits and be guided by your obstetrician who is responsible for your management and delivery.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.