Fibroid in pregnancy: characteristics, complications, and management

Abstract

Fibroid in pregnancy is common in clinical obstetric practice. The topic is becoming more relevant in contemporary obstetrics due to the demographic shift towards delayed childbearing, the rising rate of obesity, and many pregnancies occurring after the treatment of fibroids. However, there are conflicting reports in the literature on many so-called fibroid complications in pregnancy, and there are inadequate data on the optimum management strategy. An evidence base is lacking on the pregnancy outcome of many conventional and newer treatment modalities of fibroids. This review addresses the characteristics and behaviour of fibroids during pregnancy, their incidence and demography, diagnosis, the complications that can arise during pregnancy and their antenatal management, the labour pattern, mode of delivery and the postpartum course, with critical appraisal of the literature together with certain special situations such as pregnancy after various types of myomectomy and uterine arterial embolisation.

Myomectomy After a Vaginal Delivery to Treat Postpartum Hemorrhage Resulting From an Intracavitary Leiomyoma

“…1,2 Leiomyomas affect fertility and miscarriage rate, cause pain during pregnancy, and can have adverse effects on obstetric outcomes, including higher rates of fetal growth restriction, placenta previa, placental abruption, preterm labor, cesarean delivery, malpresentation, labor dystocia, retained placenta, peripartum hysterectomy, and postpartum hemorrhage. 1,2 Postpartum hemorrhage resulting from uterine leiomyomas is thought to occur as a result of decreased uterine contractility and uncoordinated contractions within the leiomyoma itself. 1,2 There is also an increased risk of retained placental tissue when the leiomyoma is submucosal.…”

“…1,2 Postpartum hemorrhage resulting from uterine leiomyomas is thought to occur as a result of decreased uterine contractility and uncoordinated contractions within the leiomyoma itself. 1,2 There is also an increased risk of retained placental tissue when the leiomyoma is submucosal. 1,2 Large, pedunculated, submucosal leiomyomas can prolapse through the cervix, obstructing passage of lochia leading to hematometra and uterine atony.…”

Safety of pregnancy in uterine fibroids

“…near cervix) might result in obstructed labor, submucosal fibroids are associated with higher miscarriage rates, and large-sized fibroids (>5 cm) are associated with uterine cavity distortion, abnormal fetal position, and presentation. [21][22][23] .…”

“…It is estimated that uterine fibroids are associated with 13% risk for breech presentation, 19% risk for pre-term labor and premature rupture of membranes, 49% risk for cesarean delivery, and 8% risk for abortion, antenatal hemorrhage, postpartum hemorrhage, abruptio placentae, and labor dystocia. 23 Abortion is often associated with submucosal fibroids. It is estimated to occur in 14% of pregnant females with fibroids in comparison to 7.6% in healthy pregnant women.…”

Laparoscopic Approach to Fibroid Torsion Presenting as an Acute Abdomen in Pregnancy

“…1 During pregnancy, they can become symptomatic by undergoing red degeneration, bleeding, or torsing around a stalk if they are pedunculated. 2 Previous case reports have described open laparotomy for management of such cases in the first trimester.…”