- Conception in Case of Fibroids
- The First Trimester of Pregnancy in Case of Fibroids
- Second and Third Trimesters of Pregnancy in Case of Fibroids
- Delivery With Fibroids
- Postpartum Complicated By Fibroids
- How Pregnancy and Childbirth Affect the Fibroids?
- How to Treat Fibroids?
Fibroids During Pregnancy
In recent years, the frequency of uterine fibroids detection during pregnancy increased: firstly, the average pregnant woman has "aged" (and hormonal disorders are more common after 30 years), and secondly, the diagnostic methods are rapidly improving – in particular, ultrasound is implied more and more often. Of course, every woman, planning a pregnancy, when faced to this problem, is concerned how the fibroids can affect her pregnancy and childbirth.
Conception in Case of Fibroids
It should be clarified that, of course, any mass lesion in the uterus causes an increase in its size.
The uterus increases during pregnancy, and its size, corresponding to a certain week of pregnancy, is clearly defined – so, increasing of the uterus size for any other reason is normally correlated with weeks of pregnancy.
Difficulties in conception due to fibroids are explained by a variety of factors, including fallopian tubes compression, obstructing the sperm movement, and ovulation disorders.
The fibroids themselves are not considered to be a cause of infertility, however, if all the determined infertility causes are corrected, the fibroids removal increases the probability of conception greatly. However, this applies to fibroids that are smaller than 12th-week pregnancy.
If the fibroids are large and distort the uterine cavity, it is quite difficult to preserve fertility after tumor removal, especially, considering that such operation may be accompanied by bleeding, sometimes requiring the uterus removal.
The First Trimester of Pregnancy in Case of Fibroids
Serious complications arise in case if fibroids are in contact with the placenta (i.e. in case of placentation in myomatous nodule area). In addition, the size of myomatous nodule also matters (the majority of women with small myomatous nodules during pregnancy does not appear to have any complications, so the disease is asymptomatic). The women with uterine fibroids frequently have miscarriages.
- Increase in uterine contractility (the fact is that during the fibroids destruction it releases prostaglandins that are the physiologically active substances that cause smooth muscle contractions, including uterine muscles);
- Uterine circulatory disorders;
- Neuroendocrine disorders;
- Chronic infectious diseases;
- Processes that are manifested in the growth of the uterine lining (hyperplasia, endometrial polyps).
Second and Third Trimesters of Pregnancy in Case of Fibroids
It is believed that the presence of fibroids increases the risk of miscarriage and premature birth. This is connected to a decrease of uterine space, available for the baby, due to myomatous nodules, as well as to an increase in uterine contractile activity.
As a rule, the larger the size of the fibroids is, the greater is the probability of premature birth. And again, the fibroids location matters, as well as the presence of its contact with the placenta.
Fibroids of large size have a definite influence on fetal growth and development. Thus, there are cases of children, being born with the skull deformation and torticollis that are presumably caused by fibroids pressure. Pregnant women with large fibroids often give birth to babies with low birth weight.
Delivery With Fibroids
It is believed that fibroids affect the delivery process. Indeed, about a half of pregnant women with fibroids have prolonged labor. In addition, the fibroids presence often causes the necessity of cesarean delivery. Although, the fibroids themselves usually do not represent a true obstacle to the childbirth, the fibroids (especially large ones) are often combined with fetal position and presentation anomalies (lateral position, pelvic and facial previa). In these cases the natural delivery is not possible. In some cases, for example, if the caesarean section incision is in fibroids area, the doctor may remove the tumor.
The patients with fibroids often have placental abruption (especially if the fibroids are located behind the placenta – i.e. retroplacentally). The doctors always take this into account during labor management.
Postpartum Complicated By Fibroids
The presence of fibroids may cause both early and late postnatal complications.
The early complications are post-partum bleedings, connected to decreased uterine tone, tight placental attachment and placenta accreta.
The late complications include incomplete uterine involution (it is when the uterus is not reduced to the “source” size), and infectious diseases.
How Pregnancy and Childbirth Affect the Fibroids?
The development of pregnancy involves higher estrogen and (even more important) progesterone production – both of these hormones, as explained above, significantly influence the fibroids state.
In addition to hormonal changes, during the pregnancy purely mechanical changes occur – the increase and stretching of uterine muscles (myometrium), increased blood flow in the uterus wall. The impact of these changes on existing fibroids depends on where and how the tumor is located, the extent to which it “seized” the uterus.
It is believed that fibroids during pregnancy are increasing, but there are other opinions claiming that this is not true, and the increase is not real, but seeming, associated with the growth of the uterus as a whole. Basically, a slight increase in uterine size is observed in the first and second trimesters, and in the third trimester all the fibroids become smaller. In general, a significant growth of fibroids during pregnancy is rare and does not complicate the course of the pregnancy.
Often, during pregnancy another phenomenon is observed – the so-called fibroids degeneration (i.e. destruction). We'll have to disappoint those, who think that this phenomenon is a welcome change: the fibroids destruction is associated with very unpleasant processes – necrosis of fibroids tissue, edema formation, cysts, bleeding, etc. The fibroids degeneration can occur at any stage of pregnancy and during the postnatal period as well – it depends on the fibroids location.
The causes of fibroids degeneration are not fully understood – apparently, it is caused both by hormonal (high progesterone), vascular and mechanical (impaired tumors blood supply due to thrombosis of blood vessels, feeding the fibroids) changes.
The signs of fibroids degeneration are following:
- pain in myomatous nodule area;
- uterine tone increase;
- temperature increase;
- the number of white blood cells increase;
- ESR (erythrocyte sedimentation rate) increase.
The Diagnosis is Confirmed by Ultrasound
This condition usually lasts for one to two weeks. At that time, the doctors usually follow conservative treatment tactics, assigning the patient analgesics and bed rest. If there is pain in the abdomen, and increased uterine tone is maintained, the patient is hospitalized, and her further treatment is carried out in a hospital.
Surgical treatment is carried out very rarely and only if it is absolutely necessary (in case of high fever, leukocytosis, deterioration, acute abdominal pain, severe uterine bleeding). Sometimes a minimal surgical intervention is enough – in this case the pregnancy can be preserved. This operation causes abortion and premature delivery only in the most severe cases.
As for the changes, happening to fibroids in the first months after birth, they are varied and unpredictable. Fibroids, that have brought a lot of troubles during the pregnancy, sometimes do not show themselves in any way and do not cause any symptoms after childbirth. As soon as the uterus after birth undergoes reverse development, the fibroids location often changes.
How to Treat Fibroids?
Conservative (non-surgical) uterine fibroids treatment involves the inhibition of tumor growth. Specific methods depend on the fibroids causes and their individual properties. During pregnancy, iron deficiency anemia often contributes to fibroids growth and development – this is one of the many arguments in favor of the urgent need for systematic blood tests during pregnancy.
As therapeutic and preventive remedies for uterine fibroids treatment, the iron supplements are usually prescribed, as well as protein diet, vitamin B complex, ascorbic and folic acids. Vitamins A and E are also of great importance, as they have a regulating effect on the neuroendocrine system as a whole, and reduce genitals sensitivity to estrogens.
In patients with uterine fibroids, the violation of fat (lipid) metabolism is often observed, resulting in weight gain. In such cases, the correction of diet is necessary: the restriction of carbohydrate intake, the replacement of animal fats with vegetable oils, inclusion of fruit and vegetable juices in the diet.
In the future, when the woman is not pregnant any more, her fibroids are treated with hormonal drugs. The doctors prescribe drugs, containing progesterone (it, as we have said before, reduces the ability of cells to divide, thereby slowing down the tumor growth). If the growth of uterine fibroids cannot be stopped, you may need surgical methods of treatment.
In conclusion, it should be added that prevention is always better than cure, and any disease treatment at an early stage is always more effective than combating neglected ailment, so if you have noticed any alarm symptoms, you should visit your gynecologist as soon as possible.