I was diagnosed with uterine fibroids during pregnancy. Will the baby be okay?

Author: Shi Jinqiu, deputy chief physician, The Third Affiliated Hospital of Shenzhen University (Shenzhen Luohu District People's Hospital)

Reviewer: Luo Guangnan Chief Physician, The Third Affiliated Hospital of Shenzhen University (Shenzhen Luohu District People's Hospital)

(Copyrighted images are not authorized for reproduction)

Uterine fibroids are known as the "first gynecological tumor" and are very common benign tumors in women. Statistics show that the incidence of uterine fibroids in women aged 30 to 50 is as high as 20% to 30%, which means that about 1 in every 4 women of childbearing age has uterine fibroids.

Women with uterine fibroids usually worry about the following issues: Can they still get pregnant? Does uterine fibroids have any effect on the fetus? Does uterine fibroids have any effect on the way they deliver their babies?

1. Can women with uterine fibroids get pregnant normally?

In fact, in most cases, uterine fibroids do not affect pregnancy, but it also depends on the size and location of the uterine fibroids.

1. Subserosal uterine fibroids

Subserosal uterine fibroids have little impact on pregnancy. However, as the uterus grows, pedunculated subserosal uterine fibroids may twist, and surgery is required in this case. Surgery for subserosal uterine fibroids does not destroy the integrity of the uterus and has relatively little impact on the uterus. Therefore, it is recommended that uterine fibroids be treated before pregnancy.

2. Submucosal uterine fibroids

Submucosal uterine fibroids grow in the endometrium and have a great impact on conception. Even if pregnancy is successful, the risk of miscarriage during pregnancy will increase. Therefore, it is recommended that patients with submucosal uterine fibroids be treated first and then become pregnant.

3. Intramural uterine fibroids with a diameter of more than 5 cm

Large intramural uterine fibroids affect the development of the fetus during pregnancy, especially in the late pregnancy, which may lead to more risks and relatively more complications in late pregnancy. It is recommended to treat uterine fibroids before pregnancy.

4. Uterine fibroids in special locations

If some uterine fibroids have already produced obvious symptoms, or grow in the isthmus of the uterus, the impact on pregnancy will be relatively large, and uterine fibroids are prone to degeneration after pregnancy. Therefore, surgical treatment should be considered before pregnancy.

5. Patients with uterine fibroids and a history of miscarriage

If a patient with uterine fibroids has a history of miscarriage and/or premature birth, it means that the uterine function is no longer sound. It is generally recommended to undergo a uterine fibroid removal surgery before pregnancy to minimize the factors that affect pregnancy.

Uterine fibroids other than the above five types have little impact on pregnancy, and pregnancy preparation and pregnancy can generally be normal.

2. What to do if uterine fibroids are detected after pregnancy

Some women are diagnosed with uterine fibroids after they become pregnant. At this time, what pregnant mothers are most worried about is whether uterine fibroids will cause miscarriage and whether uterine fibroids will affect the fetus.

(Copyrighted images are not authorized for reproduction)

Most pregnant women with uterine fibroids will not be affected during pregnancy. However, the following three situations require special attention.

1. Uterine fibroids that protrude into the uterine cavity have a greater risk of miscarriage. Generally, uterine fibroid removal surgery is not recommended during pregnancy because it may cause complications such as miscarriage, premature birth, bleeding, and even uterine rupture.

2. If subserosal uterine fibroid pedicle torsion occurs during pregnancy, causing acute abdominal pain, surgical treatment should be considered.

3. Uterine fibroids will change with the pregnancy. Some will change location, some will increase in size, and some will become "reddened and degenerated" due to post-pregnancy tissue congestion and embolism, causing abdominal pain and uterine contractions. At this time, non-surgical treatment can be adopted until the pregnancy is successfully completed [1].

Although some pregnant women are found to have uterine fibroids during pregnancy, the probability of causing serious complications is very low (generally less than 1%), so pregnant women do not need to worry too much.

3. The impact of uterine fibroids on the delivery method of pregnant women

Generally speaking, uterine fibroids cannot determine the mode of delivery, but it also depends on the specific situation of the patient.

Is it possible to give birth naturally?

If there are no other pregnancy complications, most pregnant women with uterine fibroids can give birth naturally. Whether a cesarean section is needed depends on the specific examination results. If the uterine fibroids are not large, there are no complications in the late pregnancy, and the location of the uterine fibroids does not affect the descent of the fetus, vaginal delivery can be considered. If the diameter of the uterine fibroids is greater than 6 cm, the possibility of abnormal fetal position and obstructed delivery increases. At this time, you should communicate with the doctor and choose the delivery method after a full evaluation.

Can uterine fibroids be removed during cesarean section?

It is feasible to remove uterine fibroids during cesarean section, which can avoid postoperative treatment and reoperation of uterine fibroids, and reduce the risk of postpartum hemorrhage caused by uterine atony caused by uterine fibroids. However, it is not suitable for all uterine fibroids.

It should be noted that some uterine fibroids are not suitable for removal during cesarean section because of their large size, rich blood supply and special location.

In addition, if the pregnant woman herself suffers from gestational hypertension, heart disease, coagulation dysfunction or other diseases that are not suitable for prolonged surgery, it is not suitable for her to undergo a myomectomy at the same time as a cesarean section.

Whether to remove uterine fibroids during cesarean section should ultimately be decided after a full evaluation by the doctor.

(Copyrighted images are not authorized for reproduction)

The childbearing age of modern women is generally delayed, and many women suffer from uterine fibroids before and during pregnancy. In most cases, uterine fibroids do not affect pregnancy, and they can usually "coexist peacefully" with the fetus after pregnancy. Even if a pregnant woman has uterine fibroids, she should not have too much psychological burden, relax her mind, analyze specific problems specifically, ensure balanced nutrition before pregnancy, and have regular physical and prenatal examinations to lay a good foundation for giving birth to a healthy baby.

References

Sheng Danjing. Expert diagnosis and treatment of uterine fibroids. Shanghai: Shanghai Science and Technology Literature Publishing House, 2019.