Uterine fibroids during pregnancy what. Uterine fibroids: natural childbirth or caesarean section? Impact of pregnancy and childbirth on uterine fibroids

Uterine fibroids today is a fairly common phenomenon, especially the frequency of its diagnosis during pregnancy has increased. It is quite logical that a woman of childbearing age increasingly has questions about the possibility of becoming pregnant in the presence of uterine fibroids or after its removal, about its effect on the course of pregnancy and methods of its treatment during childbearing.

The effect of fibroids on pregnancy.
It must be said right away that fibroids are a benign tumor that occurs against the background of the growth of muscle fibers of the walls of the uterus. I’ll clarify right away that any tumor formation in the uterine cavity sooner or later leads to its increase. The growth of fibroids can be very fast, but may not be observed at all, and for quite a long time. During gestation, the uterus also increases in size, corresponding to a particular period. That is why the increase in the uterus is initially associated with pregnancy, and only according to the results of ultrasound is an accurate diagnosis made.

Myoma really complicates the process of conception, because its size puts pressure on the fallopian tubes, putting obstacles for the movement of spermatozoa, and also disrupts ovulation. As such, it does not cause infertility, but its removal significantly increases the chances of conceiving a baby, unless, of course, its size exceeds the twelve-week gestation period. With a larger size, the tumor leads to deformation of the uterine cavity, as a result of which, after surgery, it is rather difficult to preserve the childbearing function, since the removal of a large fibroid is often accompanied by severe bleeding, and in some cases, specialists are forced to simply remove the uterus.

In the first months of pregnancy, complications may occur against the background of fibroids, this happens mainly when the tumor is close to the placenta. In this case, the size of the tumor is no less important. With small myomatous nodes, pregnancy proceeds without complications, and the tumor itself does not manifest itself in any way.

Fibroids in the second and third trimester of pregnancy increase the risk of miscarriage as well as premature birth. This happens as a result of the fact that the myomatous nodes leave less and less free space for the fetus, in addition, they stimulate the contractile activity of the uterus. In this situation, the location of the fibroids and its distance from the placenta (is there any contact) also play an important role.

Large tumors can interfere with normal growth and development of the fetus. Often there are cases of the birth of children with low weight, with a changed shape of the skull, curvature of the neck, etc.

Most experts agree that uterine fibroids affect the birth process, significantly delaying it. Also, if it is available, specialists more often decide on a caesarean section. In this situation, it is not the myoma itself, as such, that prevents childbirth, but a significant size of myomatous nodes in combination with pathologies of the position and presentation of the fetus (transverse, pelvic and facial presentation). Sometimes, if the cesarean section incision matches the location of the fibroid, the doctor may remove it.

It should be noted that in pregnant women in the presence of fibroids, placental abruption often occurs, especially with the retroplacental (behind the placenta) location of the tumor. During the birth process, doctors take into account this feature of the tumor.

In the postpartum period, fibroids can also give complications, both immediately (bleeding against the background of low uterine tone), and after a rather long period of time (infectious diseases, the uterus does not reach its original size).

Planning pregnancy in the presence of uterine fibroids.
At the conception planning stage, it is necessary to take into account such facts as the location of the fibroid, its growth trends, and the size of the nodes. If the location of the nodes leads to the deformation of the uterine cavity, then in principle it is impossible to get pregnant, since the spermatozoa, not reaching the fallopian tubes, settle on their surface without meeting the egg. In this case, the nodes are subject to mandatory removal.

If the nodes are small and located in the thickness of the uterine wall or outside, that is, there is no deformation of the cavity, then the probability of pregnancy is quite high. It should only be said that in the case of fertilization, a woman may have problems associated with bearing a fetus.

If a woman has a myomatous node on a thin stalk, then there is a high risk of its torsion during pregnancy, and this, as a rule, leads to surgical intervention and often to miscarriage. In this situation, at the stage of pregnancy planning, such nodes are urgently recommended to be removed.

It is also important to note that if, according to ultrasound, a predisposition of the tumor to rapid growth (doubling within six months) was established, then pregnancy planning is prohibited. This is due to the high risk of an increase in fibroids during gestation, which provokes malnutrition in the node, and this is already fraught with miscarriage. At the stage of conception planning, such a tumor must also be removed in advance.

In the case of large uterine fibroids (4 cm in diameter and above), it is also worth postponing conception, because, firstly, this is unlikely (against the background of endometrial pathology), and if it happens, it is fraught with miscarriage, since the likelihood of miscarriages and malnutrition of the fetus, which will lead to surgery. Nodes are also subject to removal at the planning stage of the child.

Fibroids growth during pregnancy.
No physician can reliably answer how the tumor will behave during pregnancy (if it is present before conception). The genetic factor plays an important role here. In most cases, the growth of fibroids is observed in the first two trimesters of pregnancy, and in the third, on the contrary, their decrease is noted. As a rule, during gestation, fibroids shrink in size by an average of thirty-five percent, but there is still a small percentage of cases of fibroids that double in gestation, but this practically does not complicate or complicate pregnancy. However, the destruction or degeneration of fibroids can contribute to various complications. This process is combined with tissue necrosis of the collapsed fibroids, bleeding, cyst formation, etc. Such a phenomenon can occur, frankly, at any stage of pregnancy and after delivery. In this case, the location of the fibroids matters.

Why the destruction of fibroids occurs during pregnancy is not fully known. This can be facilitated by hormonal (increase in progesterone), vascular and mechanical changes (impaired blood supply to the neoplasm due to thrombosis). This process is accompanied by pain in the node location area, an increase in uterine tone, an increase in body temperature, an increase in the level of leukocytes in the blood and an erythrocyte sedimentation rate. Fibroids degeneration is diagnosed by ultrasound. Initially, the patient is recommended bed rest and analgesics are prescribed, while maintaining severe symptoms, she is hospitalized for further inpatient treatment.

Surgical treatment is prescribed in exceptional cases in the presence of absolute indications (severe fever, leukocytosis, deterioration in general condition, acute abdominal pain, uterine bleeding). Often, with surgery, it is possible to save the pregnancy.

I note that fibroids that grew in the first months of pregnancy, after childbirth, may not declare themselves at all. After childbirth, as the uterus returns to its original state, the location of the myomatous nodes may change.

Treatment of fibroids during pregnancy.
Initially, fibroid therapy is conservative in nature and is aimed at stopping the growth of a benign formation. Methods in each case depend on the individual characteristics of the tumor and the causes of its development. During childbearing, iron deficiency anemia in a pregnant woman can become a factor provoking the growth of fibroids. It is this fact that serves as one of the arguments for the constant study of a woman's blood during this period.

Therapeutic and preventive measures for uterine fibroids are taking iron supplements, ascorbic and folic acids, B vitamins, a diet with a predominance of protein foods. Vitamins E and A are also recommended, which have a beneficial effect on the neuroendocrine system and reduce the sensitivity of the genital organs to estrogens.

If lipid metabolism is disturbed in a pregnant woman with fibroids, her diet is adjusted: they severely limit the intake of carbohydrate foods, exclude any animal fats (they are replaced by vegetable ones), include more freshly squeezed juices from vegetables and fruits in the diet.

After delivery, a woman is prescribed hormonal agents with progesterone, which reduces the ability of cell division, preventing tumor growth. If it is impossible or unsuccessful attempts to stop the growth of fibroids, a decision is made on surgical treatment (conservative myomectomy - removal of nodes while preserving the uterus).

The laparoscopy technique (an operation performed using an endoscope and instruments, under the control of a video camera installed in the abdominal cavity) significantly reduces the risk of developing adhesions in the small pelvis, which in the future helps to maintain the patency of the fallopian tubes, and this is one of the main factors for pregnancy. The method of treatment with the help of laparotomy (abdominal operation, the surgeon does everything manually) is associated with a high risk of adhesion formation, and their formation can occur both in the small pelvis and in the abdominal cavity. In the future, this leads to infertility, and sometimes to complications from the digestive system (for example, adhesive intestinal obstruction). However, the large size of the nodes in the laparoscopy technique does not allow the uterus to be sutured, as required, due to the peculiarities of the technique, the angle of the abdominal instruments, and some technical points.

As a result, laparoscopy is performed for women planning a pregnancy, if the size of the nodes does not exceed 5-6 cm. In this case, the skill and experience of the surgeon is required to suture the uterus. To remove large nodes, there are new technologies for suturing the uterus, but this significantly increases the risk of uterine rupture along the scar.

If the nodes exceed 9-10 cm in diameter, the risk of uterine rupture along the scar is much higher than the risk of adhesions due to laparotomy. Therefore, it is recommended to abandon laparoscopy and perform an opening of the abdominal cavity to excise the tumor.

After removal of uterine fibroids, regardless of the technique used, it is possible to plan conception only after eight to twelve months, it all depends on the size of the removed tumor.

It should be noted that after the removal of the fibroids, the delivery of a woman can be carried out in a natural way, if the removed nodes were no more than four centimeters in diameter, if there are no complications during pregnancy and after childbirth, if the scar on the uterus is in satisfactory condition. The age of the woman also plays a huge role. In other cases, a caesarean section is indicated.

Multiple uterine fibroids.
It also happens that several myomatous nodes are formed in the uterus at once, and they are different in size. It is very difficult to plan a pregnancy in this situation, since the removal of such formations can lead to the fact that there is no healthy tissue left on the uterus. In such situations, doctors prescribe the removal of only those nodes that interfere with the attachment of the embryo, tend to grow, interfere with the bearing of the fetus and can cause complications, etc. after delivery, you can do the excision of the remaining nodes, or this can be done by doctors during a caesarean section.

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The appearance of symptoms of this pathology causes panic in women. When a fibroid is found in the uterus and pregnancy has already begun, this can have dangerous consequences for the expectant mother and fetus, especially if the tumor is large. Why a neoplasm develops, what it is, whether it can become a problem for conception - it is important to know for women of childbearing age.

What is myoma

When hormonal disorders occur in the body associated with an excess of estrogen and a deficiency of progesterone, a benign tumor process, fibroids, is born in the muscle tissues of the walls of the uterus. Its growth provokes an abnormal division of cellular structures, which begins asymptomatically. With the progression of the process appear:

prolonged menstruation with severe blood loss;
sharp cramping pains in the lower abdomen, in the lower back;
frequent urination if the node is located on the isthmus of the uterus;
constipation;
an increase in the size of the abdomen.

Neoplasms during the period of expectation of a child can develop on any part of the organ and have dangerous consequences. Often there are multiple fibroids. According to the location of the tumor, there are:

subserous (subperitoneal) - under the outer cover of the body of the uterus;
interstitial (intermuscular) - in the thickness of the wall;
submucosal (submucosal) - in the layers under the endometrium.

Is pregnancy possible with uterine fibroids

It is good if a neoplasm in a woman is discovered during pregnancy planning. It is advisable to treat or remove the node during this period. Deformation of the uterus by a tumor can affect conception:

prevents sperm from getting to the egg - the lumen of the fallopian tubes narrows;
prevents ovulation;
makes it difficult for a fertilized egg to attach to the walls;
at large sizes rejects it, causing infertility.

If pregnancy with fibroids does occur, it must be terminated if necessary:

submucosal form of the tumor;
suspicion of a malignant neoplasm;
with sizes over 15 cm;
multiple nodes;
degeneration or necrosis of tumor tissues;
severe comorbidities;
woman's age after 45 years;
localization of the node in the cervical region, complicated by uterine bleeding;
miscarriage threats.

How is myoma diagnosed?

When symptoms of an illness appear, a woman needs to visit a gynecologist. The tumor is detected by probing through the anterior abdominal wall. More precisely diagnosed with ultrasound, which reveals the localization, number of nodes, size, location relative to the placenta. Ultrasound is performed in two ways:

transvaginally - by inserting a sensor through the vagina into the uterine cavity - in the absence of a fetus;
transabdominally - through the anterior wall of the peritoneum.

There are diagnostic methods that are not used when fibroids and pregnancy are established at the same time. This may pose a risk to the development of the embryo. These include:

hysterography - X-ray examination using a contrast agent;
hysteroscopy - examination of the organ cavity with a special device inserted through the vagina.

Consequences of fibroids during pregnancy

A woman with symptoms of a neoplasm should be registered to maintain pregnancy. The tumor can cause serious problems, affect the development of the child, the health of the mother. Myoma during pregnancy threatens:

placental insufficiency;
tumor pressure on the fetus;
violation of the supply of nutrition and oxygen to the embryo;
placental abruption;
premature birth;
spontaneous abortion;
tissue necrosis in violation of the blood supply to the tumor;
squeezing of the veins, the appearance of blood clots;
iron deficiency anemia;
rupture of the body of the uterus.

Myoma during early pregnancy

A woman should be careful in the first trimester, especially in the presence of hereditary factors. If small nodes are identified, the disease may be asymptomatic. Myoma during early pregnancy is dangerous when it is large. In this situation:

bloody discharge appears;
increased risk of missed pregnancy;
there is a possibility of miscarriage if a submucosal form of the tumor is observed;
circulatory disorders occur;
contact of fibroids with the placenta causes an increase in uterine tone and miscarriage.

Second and third trimesters of pregnancy

At later dates, a large knot leaves little space for the growing fetus. It is dangerous when it is located next to the placenta. This development is fraught with consequences:

the risk of preterm birth;
the emergence of a threat of termination of pregnancy;
the birth of a baby with low weight;
the likelihood of placental abruption;
deformity of the skull in a newborn.

Pregnancy with small uterine fibroids

Many women who are diagnosed with neoplasms in the uterus feel good during the period of expectation of the child, they do not experience any complications. This is due to the small size of the tumor. Problems for mom and unborn child appear in cases where:

there are many nodes deforming the uterus;
the tumor is close to the neck;
the placenta is located in the area of the myomatous node.

Pregnancy with large uterine fibroids

When the neoplasm grows to a huge size, it can adversely affect the course of pregnancy. Blood circulation in the uterus is disturbed, which can provoke the degeneration of fibroids. At the same time, prostaglandins are released from it, causing contraction of the uterine muscles. In such situation:

premature birth occurs;
high risk of miscarriage.

For the development of the fetus, a huge tumor is no less dangerous. She takes on most of the blood supplying the uterus with the embryo, giving oxygen and nutrition. In addition, the tumor puts pressure on the growing organs. All this leads to serious problems:

deformities of the skull, neck;
small weight of the newborn;
underdevelopment of organs;
death of the fetus.

Tactics of pregnancy management

Women with symptoms of a neoplasm in the uterus should be registered as soon as possible. The doctor conducts a complete examination, determines the size of the tumor. If it has large volumes, is poorly located or many nodes are noted, an important task is solved - to terminate or maintain the pregnancy. A positive conclusion is accepted if:

prolonged infertility ending in conception;
woman's desires
more than 24 weeks when the fetus is viable.

In the presence of a benign tumor in the uterus, increased attention of the gynecologist and the woman to the state of health is necessary. An important role is played by the prevention of the destruction of fibroids and uterine tone. Expectant mothers are recommended:

regularly undergo an ultrasound examination of the placenta and nodes when they are close;
exclude physical activity;
to sleep more;
provide sexual rest;
avoid stressful situations.

Childbirth with uterine fibroids

When diagnosing myomatous nodes, gynecologists recommend hospitalization for a period of 37-38 weeks in order to prepare for delivery. A woman can give birth naturally through the birth canal under certain conditions. This happens in case:

if the entire period has passed without complications;
the fetus developed correctly;
his position and the placenta are normal.

A caesarean section is necessary when a subserous uterine myoma is diagnosed during pregnancy, complicated by tissue necrosis. Indications for operative obstetrics are:

pelvic presentation of the fetus;
the presence of a scar on the uterine body;
large neoplasms;
the presence of complications;
the fact of multiple nodes;
low position of the tumor, preventing the opening of the cervix.

To avoid late complications, doctors can carry out when performing a caesarean section:

removal of fibroids, if it is single, subserous on the leg, there are secondary structural changes in the neoplasm;
perform a hysterectomy - remove the uterus completely, when the tumor is multiple, localized under the mucous membranes near the vascular bundles, there is necrosis of muscle tissue, recurrence of neoplasms.

Treatment of uterine fibroids during pregnancy

To alleviate the condition of a woman, to exclude the occurrence of complications, gynecologists carry out therapeutic measures. Removal of fibroids during pregnancy is an exceptional case when there is a threat to life. For treatment use:

with the rapid growth of nodes - antiplatelet agents that improve microcirculation;
for anesthesia - No-shpu;
with the threat of miscarriage - bed rest, hormonal drugs;
in the case of uterine hypertension - infusion therapy;
vitamin complexes.

How pregnancy and childbirth affect fibroids

Hormonal changes taking place in a woman's body affect the development of a neoplasm in different ways during the period of expectation of a child. According to experts, childbirth does not affect the tumor - it is removed during a cesarean section or subsequently. While waiting for a child, myoma formations can:

increase in size in the first two trimesters;
remain unchanged;
decrease in the third trimester;
dissolve;
degenerate - break down with the appearance of edema, necrosis, bleeding.

Pregnancy after uterine fibroids

If an operation was performed to remove the neoplasm, there are no complications after it, gynecologists recommend planning conception in a month. A woman needs to register at an early date, undergo all examinations. After surgery, a scar remains on the uterine wall, which can cause problems:

the threat of spontaneous abortion;
pathology of the placenta;
rupture along the seam during the growth of the fetus with bleeding;
occurrence of hypertension.

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The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

Only an experienced obstetrician-gynecologist who monitors the condition of a woman expecting a baby can adequately assess the effect of uterine fibroids on pregnancy. Do not try to make predictions on your own. Many articles have been written about how fibroids affect pregnancy, and most of them are outright inventions of non-professionals. As a rule, with a competent obstetrician, everything goes quite well. Myoma during pregnancy does not harm the growing fetus and placenta, the woman feels great. But this does not mean that such cases should be treated without due attention. Uterine fibroids during pregnancy can give rapid growth or completely resolve. It all depends on the tactics of the woman. This article talks about how uterine fibroids affect pregnancy and what risk factors you should pay close attention to. Remember that uterine fibroids during pregnancy can cause some inconvenience that requires immediate medical attention. About what these states are also described in the material.

See how fibroids and pregnancy are combined in the photo: ultrasound images of different women are shown:

Does the fibroid node grow during pregnancy due to hormonal changes?

It is impossible to predict the behavior of the tumor and the growth of fibroids during pregnancy. In all likelihood, it is due to a genetic predisposition. According to the world literature, it is known that 65-75% of myomatous nodes decrease in size by an average of 30%. However, 25-35% of fibroids during pregnancy can grow, while their volume, as a rule, increases by 2 times, that is, by 100%.

Despite the possible growth of fibroids during pregnancy, this condition also has a number of positive effects:

relieves chronic;
promotes long-term saturation of the body with hormones, the ratio of which is favorable for a woman and unfavorable for fibroids;
improves microcirculation in the small and smallest vessels of the uterus, which contributes to the restoration of the uterus after childbirth;
lactation (milk secretion function of the mammary glands) leads to reverse development (reduction in size) of myomatous nodes.

It is known that in 25% of women during pregnancy myoma decreases in size, in 65% it does not undergo any changes, and in 10% it can increase due to a growth spurt during hormonal changes, which can be true or false (as a result of edema and malnutrition in myoma node). If the fibroid grows during pregnancy, then the possibility of secondary changes in the myomatous node (necrosis of the node) also increases.

Uterine fibroids during pregnancy: is this condition dangerous and how

It is possible to talk about the dangers of uterine fibroids during pregnancy only in individual cases. The determining factors in the degree of development of complications are risk factors, which include: the location and size of the fibroid, the form of its growth, the presence of deformities of the uterine cavity, the nature and degree of secondary changes in the node, the location of the placenta in relation to the myoma, the duration of the existence of the fibroid, the age of the woman and her neuroendocrine health. To decide whether fibroids are dangerous during pregnancy in a particular woman, taking into account the above factors of influence, only her attending physician can.

Given the high risk of developing various complications, it cannot be said unequivocally that uterine fibroids during pregnancy are dangerous, but at the same time, doctors need to pay close attention to this group of patients. The main tasks in the process of monitoring a pregnant woman include monitoring the state of the fetal-placental system with timely correction of violations, dynamic control of changes in the localization of the placenta and the size and structure of the myomatous node using ultrasound, and the prevention of possible complications. If uterine fibroids grow during pregnancy, then whether this condition is dangerous and whether treatment should be carried out is also decided by the doctor.

The most frequent complications during pregnancy are secondary changes in the myomatous nodes. Most often this applies to simple fibroids, which have few vessels, are located outside the uterus, sometimes on a thin stalk that can twist. Violation of the blood circulation of myomatous nodes can occur with a prolonged increase in the tone of the uterus, excessive physical activity, increased, swelling of pregnant women. In this case, the outflow of venous blood is disturbed. Violation of blood circulation causes necrosis of part of the myomatous node, there is a lot of hemorrhage in the fibroid tissue. Later, cavities filled with blood contents form. These are secondary changes.

Pregnancy with uterine fibroids of large and small sizes

The size of fibroids during pregnancy is often of great importance. The degree of risk of a complicated course of pregnancy and contraindications for conservation depend on a number of parameters. The size of uterine fibroids during pregnancy refers to them primarily as an indicator of the interruption or preservation of this condition.

Initially, we will focus on the risk factors for fibroids during pregnancy, which are further summarized in the degree of low or high risk:

Features of the previous history of gynecological diseases. Aggravated obstetric and gynecological history (infertility, induced pregnancy that occurred during stimulation, the birth of a sick or non-viable child).
The presence of scars on the uterus after conservative myomectomy, caesarean section, conservative plastic surgery.
Concomitant diseases and their characteristics (hormonal, chronic inflammatory, vascular, varicose veins, including veins of the small pelvis).
Localization and location of myomatous nodes outside the uterus, intermuscular, with growth into the uterine cavity, the location of the fibroid node in the bottom, the body of the uterus or in the cervical-isthmus region, the lower segment of the uterus.
The size of the myomatous node. Up to 4 cm in diameter, fibroids are small, 5-6 cm are medium, 7-8 cm or more are large.
The severity of myoma changes in the uterus, which is determined by the number of myoma nodes. The presence of 1-4 myomatous nodes refers to a moderate degree of severity, 5 fibroids or more - to a pronounced degree of myomatous changes in the uterus.
Growth form of uterine fibroids. The most unfavorable is the growth of the tumor towards the uterine cavity or the presence of a myomatous node in close proximity to the cavity, which deforms the uterine cavity, which refers to the risk of fetal disorders.
The location of the placenta in relation to the intermuscular myomatous node of large size. Localization of the placenta in the projection of the intermuscular myomatous node is a risk factor for the development of placental insufficiency.
The presence of secondary changes in the nodes of the tumor (edema, necrosis), in which the tone of the uterus increases, there is a violation of microcirculation, difficulty in venous outflow. All this contributes to the threat of premature termination of pregnancy.
The presence of a pronounced myomatous change in the uterus, the presence of large fibroids during pregnancy can cause the syndrome of “stealing” the fetus, when a significant part of the blood is consumed for the blood supply to uterine fibroids.
The structure of the tumor (simple and actively growing uterine fibroids).
The age of the patient. In accordance with age-related general changes in nulliparous 30-35 years and older, cell aging processes occur in the uterine muscle. If before the age of 30-35 a woman had no pregnancies and childbirth, the uterus did not undergo changes caused by pregnancy (it did not stretch, did not contract), then in the "elderly" primiparas, the organization of the structure of smooth muscles is determined primarily by functional activity and contractile (motor) activity uterus. Obstetricians distinguish late age (30-35 years or more) in primiparas as a risk factor for functional inferiority of the uterus, in which a frequent complication in childbirth is the weakness of labor, hypotension of the uterus and other complications caused by a decrease in the contractile activity of the uterus.
Heredity for tumor diseases. Hereditary uterine fibroids of small sizes during pregnancy in daughters occur 10-15 years earlier than in their mothers. Most often, these fibroids are of an actively growing type. Pregnancy with simple uterine fibroids proceeds without any special complications, since this variant of the development of fibroids is asymptomatic, calm and has the least number of violations in the regulatory systems, including at the level of molecular biological cell-cell relationships.

It is recommended to preserve the fetus in patients with small fibroids during pregnancy and a low degree of risk. With a high risk of a complicated course of pregnancy and childbirth, the issue of maintaining pregnancy with a large myoma should be approached individually.

If pregnancy with uterine fibroids is large, then the following factors are taken into account:

The persistent desire of a woman to have a child, when no doctor's arguments about a certain degree of risk of pregnancy for the patient matter.
Late admission under medical supervision in terms of more than 22-24 weeks of pregnancy, when the fetus is viable.
Prolonged infertility and unexpected onset of a real pregnancy.
The inability to terminate the pregnancy through the natural birth canal, except for a small caesarean section (cervical-isthmus location of the myomatous node, complete placenta previa, growth of low-lying fibroids towards the uterine cavity, etc.).
Extremely late reproductive age (39-42 years) of a primiparous patient with uterine myoma. At a later age, a real pregnancy may be the only one in the patient's life, which imposes a special responsibility on the doctor.

Contraindications to maintaining pregnancy in patients with high-risk uterine fibroids:

Suspicion of sarcoma, a malignant variant of a muscle tumor, with any localization, even in relation to pregnancy with small uterine myoma, but with negative prognostic signs.
Submucosal localization of the myomatous node, disrupting the condition and growth of the fetus. Pregnancy with submucosal uterine fibroids can occur, but rarely persists.
Necrosis of the myomatous node (spread of the inflammatory process throughout the inner surface of the uterus).
Cervical-isthmusic localization of a large myomatous node (organic insufficiency of the cervix, ajarness of the internal opening of its canal, which should normally be closed). This condition of the cervix is a real threat of miscarriage, intrauterine growth retardation, the threat of bleeding.
The presence of very large sizes of myomatous nodes (more than 15 cm in diameter), their low location and multiple.
The large size of the myomatous-changed uterus: in the first trimester, the size of the uterus corresponds to its size at 20-22 weeks of pregnancy.
Very late age of primiparous (over 43-45 years old) in combination with high risk factors.
Poor health of the patient.

Symptoms that fibroids interfere with pregnancy: pain, discharge

Symptoms of pregnancy with fibroids can be aggravated by signs of trouble in the placenta and the muscular layer of the uterus. It is safe to say that fibroids interfere with pregnancy in cases where the following symptoms are present:

Pain or a feeling of pressure in the lower abdomen, in the pelvic region.
Pain in the lower abdomen, radiating to the back of the legs.
Pain during intercourse.
Feeling of pressure on the bladder. Frequent urination, urinary incontinence, or inability to empty the bladder.
Impaired bowel function (constipation and / or bloating).
An increase in the size of the abdomen, which can be mistakenly attributed to weight gain during pregnancy.

Myoma pain during pregnancy is always an indication for emergency hospitalization and the establishment of round-the-clock medical supervision of the patient's condition. Symptoms that pathogenetic changes are taking place can worsen very quickly. If a fibroid gives blood during pregnancy, then uterine rupture, placental abruption and node necrosis can be suspected. Emergency surgery may be required.

What threatens fibroids during pregnancy: features of patient management

The first thing that fibroids threaten during pregnancy is premature termination with the possibility of rupture of the uterine wall in the later stages. Therefore, it is necessary to know the features of pregnancy management with fibroids and take them into account when planning a woman’s examination schedule.

The frequency of threatened miscarriage in patients with uterine myoma in the first half of pregnancy is 42-58%. It is especially pronounced in patients with high risk, as well as in the proliferating variant of tumor development. The threat of preterm birth is 12-25%. With the threat of premature termination of pregnancy, patients with uterine fibroids use the same drugs as patients without fibroids.

It is necessary to find out the cause of this complication if possible. On the part of uterine fibroids, this can be an increased tone of the myometrium as a result of a malnutrition of one of the nodes, a rapid increase in the size of 100 fibroids, low placentation, partial detachment of the chorion in patients at high risk, insufficient production of progesterone, the main hormone that preserves pregnancy. In all these cases, for preventive and therapeutic purposes, it is necessary to prescribe antispasmodic, antiplatelet and metabolic drugs.

In hormonal deficiency (progesterone deficiency), artificial hormones are used during clinical signs of threatened miscarriage. For pain, antispasmodics are recommended, but care must be taken when prescribing them, as they can cause shortening and softening of the cervix.

Keeping the pregnancy "by all means" is hardly justified. The concept of "happy motherhood" is, first of all, to have a healthy full-fledged child. In pregnant women with large uterine fibroids, with a tendency to grow towards the uterine cavity and a low location of the tumor nodes, there are risk factors for disrupting the normal development of pregnancy, so it is important to prevent complications from the actions of physicians.

It is important to observe a bed or half-bed sparing regime, to refuse sexual and physical activity. Staying in a warm bed improves uteroplacental and renal blood flow to a certain extent even without medication.

Isthmic-cervical insufficiency. With ICI, due to the low location of the myomatous nodes, suturing the cervix is not recommended because of the risk of necrosis of the fibroids.

Treatment is carried out according to the generally accepted method:

bed rest;
drugs that relax the uterus.

Treatment of uterine fibroids during pregnancy

There are conditions that require treatment of fibroids during pregnancy, most often it is the rapid growth of fibroids. With a rapid increase in myomatous nodes, it is necessary to prescribe drugs that reduce blood clotting, which improve blood flow in the small vessels of the placenta and uterus.

In the presence of large myomatous nodes or a conglomerate of nodes, multiple myomatous changes in the uterus, the phenomenon of “robbing” the fetus may occur. The formation of additional vessels that feed fast-growing myomatous nodes is insufficient. A decrease in the volume of arterial blood coming from the mouths of the uteroplacental arteries to the fetus is formed. To improve the microcirculation of the muscular layer of the uterus in these complex cases, hospitalization and infusion therapy are necessary.

The drugs used in the treatment of uterine fibroids during pregnancy should have a directed action:

decrease in uterine tone;
elimination of circulating fluid deficiency and a decrease in the amount of blood proteins (introduction of fresh frozen plasma, glucose solutions with vitamins);
optimization of metabolic processes (hepatoprotectors).

Removal of uterine fibroids during pregnancy and possible consequences

An absolute indication for the removal of uterine fibroids during pregnancy is a violation of blood circulation in the myomatous nodes. Unfortunately, this is a possible consequence of uterine fibroids during pregnancy and it occurs in almost 15% of all diagnosed episodes of complications.

The clinical picture is very characteristic. Pain syndrome appears (at rest or during palpation). Painful sensations are of different localization, intensity and nature (aching, constant, periodic). There may be signs of peritoneal irritation, increased heart rate, elevated body temperature, leukocytosis, a marked increase in the size of the tumor (swelling of the node). The general condition of the woman is changing. There are symptoms of a threatened abortion.

The nature and irradiation of pain depend on the localization of the tumor. When the nodes are located on the anterior wall of the uterus, the pains are local in nature or radiate to the lower abdomen, when they are located on the posterior wall of the uterus and palpation is inaccessible, pains of a different, unclear nature occur in the sacrum and lower back.

Differential diagnosis should be compared with acute appendicitis. With appendicitis, an increase in heart rate (100-120 beats per minute) does not correspond to body temperature, which may be slightly elevated (37.1 ° C) or even normal. It is also differentiated from acute pyelonephritis, which is characterized by severe intoxication, clinical and bacteriological signs of urinary infection.

Treatment of malnutrition of uterine fibroids is carried out with antispasmodic drugs in combination with antibacterial, detoxifying and desensitizing agents. Treatment is monitored taking into account clinical symptoms, thermometry data (every 3 hours), and a general blood test in dynamics.

If there is no effect from the therapy for 3-5 days, an increase in the pain symptom and intoxication, the removal of fibroids during pregnancy is indicated, which consists in enucleating the node.

Basically, only externally located nodes are subject to removal. An attempt to remove intermuscular nodes during pregnancy is accompanied by a high risk of interruption.

Indications for removal of the uterus during pregnancy are:

node necrosis,
peritonitis,
suspicion of malignant degeneration of uterine fibroids,
infringement of the uterus in the small pelvis,
node capsule rupture,
the presence of contraindications to the preservation of pregnancy.

Necrosis of the myomatous node is accompanied by a clinical picture of an "acute" abdomen and intoxication: acute local pain, nausea, vomiting, tension of the anterior abdominal wall, fever, malaise, sometimes there may be urinary and stool retention.

In case of malnutrition of the myomatous node, it is necessary to eliminate the hypertonicity of the uterus (the appointment of drugs of tocolytic and antispasmodic action). Antibacterial and detoxification therapy should be carried out. After a few days, the clinical signs of this pathology gradually disappear. The need for surgery is rare. With necrosis of the myomatous node (as a rule, this is the torsion of the legs of the subperitoneal node of the tumor), myomectomy is indicated. The temptation to remove other myoma nodes should be avoided, since with the expansion of the volume of the operation, a termination of pregnancy will most likely occur.

It is interesting to note that myomatous nodes during pregnancy can change localization. As the volume of the uterine cavity increases, the myometrium layers shift relative to each other, the lower segment stretches, and the uterus naturally rotates to the right. Tumor nodes seem to move relative to the axis of the uterus to the side, up or, on the contrary, to the center. It depends on the displacement of that layer of the myometrium (outer, middle, inner) in which the myoma is located. Intermuscular nodes may become more subperitoneal or take a centripetal direction, causing deformation of the uterine cavity.

Cervical and cervical-isthmus myomatous nodes can lead to severe complications. As the uterus grows and increases in size during pregnancy, large fibroids in the small pelvis may be infringed. Prolonged pressure of the tumor on the walls of the small pelvis can cause thrombosis of the veins of the small pelvis and cause thrombotic complications.

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When a disease of the reproductive system is detected, women often panic. Many questions immediately arise about whether it is possible to get pregnant, how to treat the disease and how dangerous the disease is? Let's try to answer these questions regarding uterine fibroids.

What is this disease and how dangerous is it

Fibroids appear in women during the period of active uterine cell division, this tumor is benign. Note that fibroids cannot just happen in a healthy woman, as a rule, a tumor occurs as a result of hormonal disorders, it can be caused by endocrine-metabolic or inflammatory diseases. Past intrauterine interventions in history can also be the cause of uterine fibroids.

In addition, recently fibroids are often found in young women, which allows doctors to talk about the hereditary factor that provoked the disease.

Myoma is dangerous, first of all, because it is often combined with inflammatory diseases of the ovaries and appendages, diseases of the mammary glands, dysfunction of the adrenal glands and the thyroid gland.

The tumor can complicate pregnancy if it is unfavorably localized, large in size, or the nutrition of the fibroid node is disturbed. The diseases that caused its appearance can also have an adverse effect on pregnancy.

Myoma is suspected when the following symptoms appear:

prolonged and heavy menstrual flow;
pain and pressure in the pelvic region and lower abdomen;
the appearance of disorders of the intestines;
pain during intercourse;
feeling of pressure on the bladder.

Diagnosis of the disease is made by ultrasound examination of the uterus.

How does uterine fibroids affect conception

When a fibroid is found, many are interested in whether they can conceive a baby? Uterine fibroids are not the cause of infertility, however, it can be quite difficult for women with this disease to conceive a child due to the fact that the tumor compresses the fallopian tubes and prevents the movement of sperm through them. Also, the disease often disrupts the process of ovulation.

Small knots located in the muscular layer of the uterus practically do not affect the process of embryo implantation. As a rule, during such a pregnancy, complications do not occur.

Ideally, before planning for conception, it is worth curing fibroids or even removing them. If the tumor is large (more than 12 weeks of pregnancy), you should not risk removal, quite often such operations are accompanied by heavy bleeding and the uterus is completely removed. After the operation to remove the fibroids, it is allowed to plan a pregnancy after 6 months.

Myoma and pregnancy

Often, the detection of uterine fibroids occurs after the onset of pregnancy. In this case, it is especially important for a woman to know how the tumor can affect the pregnancy.

Risk factors in the presence of fibroids in a pregnant woman:

tumor size more than 7 cm;
the tumor is located close to the cervix;
a woman has several myoma nodes that deform the uterus;
attachment of the placenta near the uterine node.

Often, fibroids can provoke an abortion due to an increase in the tone of the uterus, provoked by myomatous nodes. Pregnancy can cause disruption of the normal blood supply to the myomatous node, which can subsequently even lead to its disintegration, in this case, not only the tone of the uterus increases significantly, but also serious pain occurs. If the attachment of the placenta occurs in the region of the node, then its proper formation will be disrupted, which can cause an early miscarriage, cause fetoplacental insufficiency and placental abruption in late pregnancy. The most important thing for pregnant women with fibroids, in case of fetoplacental insufficiency, is to prevent fetal hypoxia - this can cause deviations in the development of the child.

Unfortunately, not a single doctor and not a single examination can accurately determine how the tumor will behave during pregnancy: whether it will cause complications in the process of bearing a baby or will not cause any problems. Some fibroids continue to grow during pregnancy, others, on the contrary, decrease significantly in size, but it is worth remembering that after childbirth, the tumor usually returns to its original size.

Given the possible complications that may occur in a pregnant woman due to fibroids, the course of pregnancy should be monitored very carefully. It is necessary to regularly visit a doctor, do ultrasound and prevent uterine tone.

Pregnant women with fibroids need to eat well, get enough sleep, give up physical activity, and avoid stress.

Constant monitoring of the state of myomatous nodes allows timely detection of their inflammation and, if this pathology is detected, a decision can be made in time on the need for medical or surgical treatment.

When are tumor removal surgeries performed?

If medical treatment is ineffective and the fibroid is destroyed, then the intervention of a surgeon is required. Removal of fibroids during pregnancy is performed using laparoscopy, this operation is tolerated quite easily, but for pregnant women it is indicated only in case of emergency, as it can cause abortion. This procedure does not bring a risk to the health of a woman.

Laparoscopy is the most suitable method for removing a tumor during pregnancy. The operation is recommended for a period of 16 to 32 weeks. Later the risk is too great.

Childbirth with myoma

Myoma can cause complications in childbirth. In the case when it is located in the area of the cervix, a barrier is created for the baby - in such a situation it is necessary to perform a caesarean section. More

The tumor can cause a violation of the coordination of the muscles of the uterus during childbirth and lead to a weakening of labor. There is also a risk of incomplete separation of the placenta.

As a rule, childbirth in women with fibroids is protracted, and after delivery, the uterus recovers longer than the uterus without myomatous nodes.

So, summing up, we can conclude that the onset of pregnancy and its favorable resolution in uterine myoma is possible only with careful monitoring of the state of myomatous nodes. In some cases, it is recommended to terminate the pregnancy for medical reasons when the risk to the woman's health is too great.

If you know that you have uterine fibroids, then it is imperative to consult with your doctor before planning a pregnancy. Remember that only a thorough examination and treatment of fibroids is the way to the birth of a healthy baby.

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Answers

The diagnosis of "uterine fibroids" during the planning of a child can scare and lead to despair. Indeed, in fact, it is a tumor, although benign, but located in the place where the child grows and develops for nine very important months. And how can they be compatible? pregnancy and fibroids? Doubts about this are quite appropriate and expected, and only a doctor can dispel or confirm them during a personal examination.

What is uterine fibroids?

As mentioned above, fibroids are a benign change in the muscular layer of the uterus, or rather, the growth of quite ordinary muscle cells as a result of improper division. Recent studies show that fibroids are usually not prone to malignant transformation. The probability of this is only 0.3%. As much as the rest of the cells of the uterus.

Possible complications during pregnancy

This point is very important in the disclosure of this topic. After all, it is advisable for a woman who is about to become pregnant if there are fibroids in the uterus to find out about all the problems that she may encounter.

Possible reasons for abortion with fibroids can be:

Unnaturally increased uterine tone during pregnancy, caused by myomatous nodes.
Violation of the blood supply to fibroids as the gestational age increases and the walls of the uterus stretch, leading to inflammation of the node and even to its disintegration. In addition, this condition is accompanied by increased uterine tone and serious pain.
Attachment of the placenta in the area of the location of the myomatous node and the violation of its correct formation, which can cause miscarriage or fading of pregnancy and fetoplacental insufficiency or premature detachment of the placenta at later stages in the early stages.

No doctor can accurately predict how the nodes will behave during pregnancy. Some of them increase, others, on the contrary, decrease and even cease to be visualized on ultrasound. However, most often after childbirth, all fibroids return to their previous size. Therefore, pregnancy in combination with fibroids requires increased attention of the attending physician and the pregnant woman herself, since measures to prevent uterine tone and destruction of fibroids in such situations are quite important. It follows from this that the sooner a woman gets up not accounting, the better for her.

Usually, women with fibroids during pregnancy are recommended:

healthy long sleep;
lack of any physical activity and stress;
additional ultrasound of myomatous nodes and placenta, if it is located on the node or next to it.

In the case of inflammation of the fibroids, it is very important to quickly detect this pathology, since further treatment depends on it - medical or surgical. The main thing is to restore the blood supply to the fibroids, for this they often resort to the same means that are prescribed for violations of placental metabolism. In addition, drugs are used to eliminate the tone, pain or bleeding, if necessary.

Surgery to remove uterine fibroids during pregnancy

The help of a surgeon is usually required in very rare cases, when conservative treatment is ineffective and the fibroids continue to collapse. Surgery to remove fibroids although it is quite easily tolerated by the laparoscopy method, it is performed according to absolute indications, since it carries a certain risk of abortion. At the same time, it is believed that the risk to a woman's health is minimal.

Laparoscopy is the most suitable method for removing fibroids during pregnancy. Recommended favorable terms for removal - starting from the 16th week. After 32 weeks, the uterus becomes too large for such an operation.

Myoma and childbirth

Childbirth with myoma also requires special attention. For example, it happens that a large fibroid is located in the region of the cervix. In this case, a barrier is created for the child and a caesarean section is more often required for delivery.

Also, due to myomatous nodes, there is a slightly higher probability of disruption of the coordinated work of the muscles of the uterus during contractions or weakening of labor. Possibly incomplete separation of the placenta.

In addition, a uterus with multiple nodes may take longer to return to its normal state than a uterus without fibroids.

Difficulties in conception with myoma

Quite common is the question is it possible to get pregnant with fibroids? Submucosal fibroids, growing, in fact, on the inner lining of the uterus in its cavity, can become a serious obstacle to conception. For example, they can prevent sperm from reaching an egg or a fertilized egg from implanting in the endometrium. In addition, it is known that large fibroids are able to squeeze the fallopian tubes.

In turn, small nodules (less than 2 cm) located in the muscular layer of the uterus rarely have a negative effect on embryo implantation. They are the safest among all types of fibroids. Most often, the course of pregnancy does not have any features. And if there are no other reproductive health problems, then conception is highly likely. However, in any case, it is highly desirable to consult a surgeon before planning, since pregnancy may not be recommended for some types of fibroids. These are the so-called pedunculated nodes, prone to twisting and malnutrition, nodes located in the submucosal layer of the uterus and large fibroids any localization, because the larger the size of the fibroids, the higher the risk of preterm birth.

In order to avoid various complications associated with problematic fibroids during pregnancy, doctors recommend their removal after prior therapy aimed at reducing the size of fibroids. Modern technologies make it possible to achieve this without traumatic manipulations and removal of the entire uterus. After removal of uterine fibroids pregnancy planning is allowed on average after about 6 months.