Symptomatic uterine fibroids in pregnancy — wait or operate? Own experience

Abstract

Objectives: Uterine fibroids are one of the most common benign tumors of the female genital tract. The major complication of myomas in pregnancy is a recurrent pain, however the misscariage is the main threat. The negative impact of myomas on the course of pregnancy may also result in i.e. uterine bleeding, higher incidence of a maternal-fetal incommunicability, an incorrect position of the fetus and its deformities. Material and methods: The patient aged 31 was admitted to Mother and Child Health Center in Zabrze due to the threatened miscarriage. The primigravid at 19 weeks' gestation was previously diagnosed with myoma. On admission the ultrasonography revealed one alive fetus in the uterus and a nodular change on the right side of the uterine fundus, 13 x 11 cm in size and non-homogenous echo. Results: The patient was qualified to the conservative myomectomy. 11 days after the enucleation of 25 cm in diameter myoma, patient in good condition, with the maintained, alive foetus was discharged from the hospital. Patient at 34 weeks' gestation was re-admitted due to the beginning of uterine contraction. After one week of observation within the ward, with tocolytic drugs and steroids administered, at 35th week of pregnancy the patient gave birth to a live daughter via the Ceasarian section. Conclusions: Prenatal myomectomy can be safely performed in the first and second trimester of pregnancy, however it is recommended to deliver the baby via Caesarean section, due to fear of intrauterine rupture of the uterus.

Metformin use is associated with a lower risk of uterine leiomyoma in female type 2 diabetes patients

“…Second, because UL may increase the risk of infertility, 35 and cause some complications during pregnancy (e.g. recurrent pain, miscarriage, uterine bleeding, maternal-fetal incommunicability, incorrect fetal position, and fetal deformities), 36 and metformin can be used safely during pregnancy, 37 the prescription of metformin to female patients with type 2 diabetes mellitus during childbearing age may provide extra benefits to these women. Third, because UL has been reported to affect female sexual dysfunction in postmenopausal women but not in premenopausal women, 38 continuous use of metformin in diabetes women ever since the diagnosis of diabetes mellitus may potentially improve their sexual function when they progress into menopause.…”

The Experience of the Management of Pregnancy with Large Uterine Fibroids

“…Рост миоматозных узлов связан со сложным многоуровневым взаимодействием стероидных гормонов и их рецепторов в миометрии и клетках опухоли, которое осуществляется посредством комплекса факторов роста, влияющих на процессы пролиферации, апоптоза и ангиогенеза [1,5].…”

Change of uterine leiomyoma size during pregnancy and the influencing factors: A cohort study

“…It is commonly believed that uterine leiomyoma appears to negatively impact perinatal outcomes 5 . Women with pregnancies complicated by leiomyoma may need to undergo prenatal myomectomy and may experience iatrogenic preterm birth 6 . Meanwhile, no adverse impact on future health of the offspring can be concluded 7 .…”

“…and may experience iatrogenic preterm birth. 6 Meanwhile, no adverse impact on future health of the offspring can be concluded. 7 However, the size change of uterine leiomyoma during pregnancy is deemed controversial.…”