How to Prevent Fibroids From Growing During Pregnancy?

The news of the presence of uterine fibroids is perceived differently. It is one thing, if a woman has already experienced the joy of motherhood, she has one, two, or even three children.

It is quite another thing if the desire to build a career, to create and strengthen your business, to win your level in social status has postponed the birth of a child for later.

Yes, and fibroids “look younger”: 50 years ago, they were found in women closer to 40-45 years, and now they are found after 20. In such a situation, there is a lot of fear: can I get pregnant, and can I bear the child, and give birth to itself or inevitable operation, and whether the baby will be healthy.

Their concerns are not groundless. Unfortunately, often uterine fibroids and pregnancy are not the most favorable effect on each other. At the same time, not everything is so fatal – there are plenty of examples of successful childbirth success without harm to health.

But to understand how to deal with the problem, you need to find out what is uterine fibroids, symptoms. At the same time, it will be possible to understand how myoma during pregnancy behaves, and most importantly, whether it is possible to give birth with a uterine myoma or have to do a cesarean.

The frequency of this pathology increases, occupying 20–44% in the structure of gynecological morbidity, and reaching 27% in women of childbearing age.

That is why it is worth discussing the problem of combining this benign tumor of the reproductive organ and carrying a pregnancy. And in particular, what is dangerous during pregnancy is uterine fibroids and what threatens the very process of carrying a child in this case.

The uterus is a muscular organ. Benign growths of smooth muscle cells with the subsequent development of connective fibrous tissue in the form of nodes – this is the uterine myoma.

Modern science, studying the problem of the appearance of fibroids, has already penetrated the structure of the genome, finding possible “culprits” of the formation of fibroids – the mutation of the MED12 gene. But still no single reason has been established.

The current assumptions are as follows:

  1. Mesenchymal theory. In the prenatal period, the number of mesenchymal cells grows more slowly compared to smooth muscle cells. In the future, immature cells, being under the influence of adverse factors, mutate.
  2. Infectious theory. Growth zones form around the sites of inflammation, proliferation begins.
  3. Disturbance of local blood circulation. Disruption of microcirculation in the uterus leads to the fact that nodules grow from the muscle layer of the vascular wall due to the influence of estrogen.
  4. Progesterone theory. Appeared on the background of the fact that a significant increase in the growth rate of fibroids was recorded during the secretion phase.

Adverse factors leading to myomatous nodes:

  • Manipulation of instruments in the uterine cavity.
  • Chronic diseases in the genital area.
  • Imbalance of sex hormones (endometriosis).
  • Endocrine pathology (diabetes, thyroid disease).
  • Obesity (every 10 kg increases the risk by 21%).
  • Heredity.
  • Somatic diseases (hypertension, diseases of the liver, heart and blood vessels).
  • Sexual dissatisfaction.
  • Stress.
  • Smoking, alcohol.
  • Premenopause.

The growth rate of fibroids depends on the estrogen / progesterone ratio. That is why it is prone to rapid growth during pregnancy.

Growth rate

With a low concentration of both hormones, fibroids grow slowly, but there is a tendency to fibrosis of the nodes. Increasing the concentration of estrogen over progesterone promotes intensive growth. With a high concentration of both hormones, rapid growth is observed.

There are 2 options for the growth of fibroids:

  • Primary appears against the background of existing hormonal disorders, infantilism, already existing infertility.
  • Secondary occurs against the background of inflammation, after interventions.

The principal difference is that the primary variant is more peculiar to the young. These grow slowly, tend degenerative changes. While the second variant is characterized by rapid growth, a multiplicity of nodes, degeneration is not peculiar.

Myoma growth is assessed as true for proliferation and hyperplasia of muscle elements, false – for impaired lymph drainage and simulated – simultaneously with the development of a malignant tumor (for example, with sarcoma).

Localization distinguish fibroids:

  1. Interstitial or intermuscular.
  2. Submucous or submucous. Among them are giving birth, subperitoneal or subserous. Also, the separation is carried out on the principle of the leg and a broad basis.
  3. Cervical.

Localization of myomatous growths has an effect on the onset and course of pregnancy.

Fertility impact

The negative effect of uterine fibroids on the ability to conceive is indisputable. Often it occurs in the first variant of the tumor. With the secondary variant, it is difficult to conceive a child because:

  1. Because of the presence of nodes, the cervix is shifted to the pubic joint, disrupting the passage of sperm.
  2. Submucous nodes deform the uterine cavity, overlap the mouth of the fallopian tubes, creating a mechanical obstacle to the promotion of sperm in the fallopian tubes.
  3. Disturbance of local blood flow in the uterus, local foci of inflammation do not allow a fertilized egg to be instilled in the uterine wall.

To reduce the consequences and prevent infertility of myomas in women of childbearing age, who are planning childbearing, it is necessary to treat them before pregnancy, after conducting a thorough examination. In addition to examination at the gynecological chair, ultrasound, vascular complexometry, hysteroscopy and hysterography, MRI and CT are used in the diagnosis. The hormonal background is studied; the accompanying pathology is studied.

In fairness it should be noted, uterine myoma reduces fertility, but does not exclude the ability to conceive.

With small interstitial or subserous myomas in young women without gross hormonal disorders, pregnancy occurs fairly easily, which cannot be said of submucous, often causing infertility.

Treatment before pregnancy

The question of choosing a method of treatment is decided individually. There are 2 ways of treatment: conservative and operative.

Two effects are expected from conservative drug therapy. The maximum effect is to avoid the operation. Minimum – to achieve a reduction in the size of the nodes before the upcoming operation.

Until recently, the drugs of choice in the treatment of fibroids were progestins. In connection with the revision of the role of progesterone in the pathogenesis of fibroids, completely new drugs are currently being used. These are analogues of gonadotropic hormones or selective modulators, most often Esmia.

This drug is highly effective in preparing for surgery for women of childbearing age due to knot reduction, and sometimes it avoids surgery, stops uterine bleeding, reduces pain.

Surgical treatment has many types of operations, each of which has its indications. Conservative myomectomy is recognized as the leading method, that is, an organ-preserving operation in which the node is eliminated and the uterus remains.

The operation is shown if the size of the dominant node is more than 4 cm, it violates the shape of the uterine cavity and is combined with infertility or miscarriage.

The negative point of operational tactics is that each operation is accompanied by the development of adhesions, as well as the formation of a uterine scar.

Impact of pregnancy on myoma

 

Uterine fibroids during pregnancy are found in 7%. This includes pregnant women for whom it was not a problem to get pregnant, as well as those who have undergone special treatment to get pregnant.

During pregnancy, uterine fibroids undergo certain changes. Increasing the level of the hormones estrogen and progesterone stimulates the growth of fibroids especially in the 1st and 2nd trimester. It also occurs under the influence of the mechanical factor – the growth of the uterus itself.

In the later stages, a violation of the tropism of the nodes and even necrosis is more common. Pregnancy with cervical myoma ends tragically because the doctor has to remove not only the node – it removes the entire fruit center. A woman can no longer conceive and give birth.

A small uterine fibroid during pregnancy may not be adversely affected.

Impact on pregnancy

If a patient with such a diagnosis was able to become pregnant, then she is more concerned about how uterine fibroids will affect pregnancy and how something will pass, and how pregnancy will affect myomatous nodes.

Myoma during pregnancy can cause the following complications:

  • The threat of not carrying the child before the due time (miscarriage).
  • Iron-deficiency anemia.
  • Insufficient function of the placenta and chronic hypoxia.
  • Hypotrophy, disorders of intrauterine development.
  • Premature detachment of the placenta.
  • Incorrect position and presentation of the fetus.
  • Deformation of the skull, torticollis in the baby due to the pressure of the node.

The threat of miscarriage is more often observed in 1-2 trimester, mainly with submucous myoma.

Complications of the fetus and placenta due to a decrease in uterine blood flow by 2 times. Problems detachment occur more often in the case of attachment of the placenta in the area of the node.

Conservative myomectomy, performed in connection with pain during pregnancy, prevents the growth of the fetus.

Complications

 

What awaits a woman in labor in childbirth, whether it will be possible to give birth with uterine myoma – this question is very topical, especially for age-related primiparas over 35 years old.

Uterine fibroids after birth have the following effects:

  1. Prenatal or early discharge of amniotic fluid.
  2. Violations of labor.
  3. Fetal respiratory distress syndrome.
  4. Pathology of the placenta (tight attachment).
  5. Hypotonic bleeding in the early postpartum period.
  6. Subinvolution of the uterus after childbirth.

To prevent most of these complications, it is recommended to assess the risk for each specific pregnant woman in advance. It depends on:

  • Localization and size of the tumor.
  • The severity of pathological changes.
  • The duration of the disease.
  • Age primiparous.

In rare cases, a uterine rupture along the scar may occur during childbirth, if conservative myomectomy was performed before or during pregnancy.

Tactics of pregnancy

 

It is very important to register for pregnancy early. It will provide an opportunity to conduct a full, timely examination and draw up a plan for managing a pregnant woman with uterine myoma.

In addition to general examination and ultrasound, complexometry is carried out to study uterine blood flow, the hemostatic system, fetal cardiotocography at 10–12, 21–24, 32–34, and 2–3 weeks before the expected date of delivery.

A list of measures for the prevention of a threatened miscarriage, treatment of anemia, and intrauterine oxygen starvation of the fetus is carried out at critical periods of pregnancy.

During pregnancy, in the presence of persistent pain syndrome or malnutrition of the node, surgical treatment is possible. Depending on the gestational age and the situation, a conservative myomectomy is performed, a cesarean section with a conservative myomectomy, a cesarean section followed by removal of the uterus.

If at 37–38 weeks, the risk is assessed as low, then delivery through the birth canal is possible. Prerequisite – advance admission to the obstetric hospital with anesthesiologist 24-hour duty and conditions for emergency deployment of the operating room.

Tactics of childbirth

Pre-natal preparation of the cervix is carried out for its maturation. In the first stage of labor, adequate anesthesia, the appointment of antispasmodics, prevention of fetal hypoxia are advisable. With the developed weakness of labor activity, the use of oxytocin is not recommended – it is better to use prostaglandin E2. After the birth of the head, hypotonic bleeding is prevented.

If a woman’s risk is assessed as high, obstetric tactics change – a planned operative abdominal delivery is recommended. Indications for surgery are:

  1. Nodes are low in the lower segment. In this case, the destruction of the uterus is shown.
  2. The size of the node is more than 10 cm.
  3. The transverse position of the fetus.
  4. A large number of nodes.
  5. The doubtful consistency of the scar after the previous removal of myoma node.
  6. The node trophy is broken, or necrosis begins.
  7. The pelvic end of the fetus is presented to the entrance to the pelvis of the mother.
  8. Perforada aged 35 years and older.

After fetal extraction, the question of supravaginal removal of the uterus is resolved. It is produced in case of multiple myomas, aged 39–40 years, node necrosis, relapse after myomectomy, submucous localization or localization in the region of the vascular bundle.

Sparing conservative myomectomy followed by cesarean section is indicated for subserous myoma, a single node over 4 cm, and initial signs of necrosis.

Postpartum period

Uterine fibroids after birth, provided breastfeeding for 6 months, stop growing. Therefore, it is important to maintain lactation in the interests of the child and their health.

If a woman with uterine myoma has given birth, in the postpartum period, uterotonics (Oxytocin) can be prescribed for the prevention of sub-evolution.

The discharge from the hospital is carried out on 6–7 days after delivery. After discharge, a visit to the antenatal clinic, effective follow-up and a decision on contraception are required.

Types of fibroids, depending on the size of the node

Myoma 3 cm – how many weeks of pregnancy? Small myoma (about 2-3 cm) corresponds to the period of 4-6 weeks of pregnancy. In this case, the operation is performed only in the case of twisting the leg of the myoma node, the development of abundant bleeding, which leads to anemia, or infertility.

Myoma 9 weeks – how many centimeters? With an increase in the size of the uterus to 9 weeks of pregnancy, the volume of fibroids does not exceed 20mm.

Often women are interested in; uterine fibroids 4 cm are many or few, fibroids 4 cm – how many weeks of pregnancy. The average is fibroid volume 4-6cm, which corresponds to 10-11 weeks of pregnancy. If active growth of myoma formations and pronounced symptoms of the disease is not observed, the operation can be omitted.

The formations that are located on the outer side of the uterus sometimes disrupt the work of the organs located closest. With fibroids of 5, 6 cm, infertility or miscarriage may occur. The size of the average uterine fibroids varies from 20 to 60mm. The size of the height of the bottom of the uterus corresponds to the following gestational age:

  • 8-9cm – up to 10 weeks;
  • 9-10cm – up to 11 weeks;
  • 10-11cm – up to 12 weeks.

The size of large fibroids exceeds 60mm. With a height of standing of the bottom of the uterus 11-12 cm, the organ itself increases to 13-14 weeks of pregnancy. With an increase in the uterus to 19-20 weeks of pregnancy, the height of the bottom of the body is 16-20cm, 39-40 weeks – from 39 to 49cm.

Fibroids that exceed 6 – 8 cm in diameter are considered large. In this case, the uterus is increased to the period of 12-16 obstetric weeks of pregnancy. Most gynecologists remove such fibroids by surgery or carry out drug therapy. Uterine fibroids 9 mm is large.

The doctors of the clinics with which we cooperate, regardless of the size of the fibroids, perform uterine artery embolization for the treatment of the disease. It is a minimally invasive procedure, after which myoma is reduced in size, some myomatous nodes disappear. A year after surgery, in all patients, according to ultrasound, the uterus becomes normal in size.

Dimensions of uterine fibroids with fibroids in centimeters

To make a correct diagnosis, gynecologists of our clinics not only conduct a traditional examination but also send the patient to an ultrasound examination.

The diagnosed tumor is described in centimeters and weeks. The size and height of the bottom of the uterus, in this case, correspond to obstetric gestational age. For convenience, doctors use a table that combines data on the size of fibroids, uterus, term in weeks.

Small consider uterus size up to 20mm. The height of standing of the bottom of the uterus 1-2cm corresponds to 1-4 weeks of pregnancy, 3-7cm – up to 7 weeks, 7-8 – up to 9 weeks. When uterine myoma is 7-8 weeks, the neoplasm diameter is 2 cm.

The size of the average uterine fibroids varies from 20 to 60mm. The size of the height of the bottom of the uterus corresponds to the following gestational age:

  • 8-9cm – up to 10 weeks;
  • 9-10cm – up to 11 weeks;
  • 10-11cm – up to 12 weeks.

The size of large fibroids exceeds 60mm. With a height of standing of the bottom of the uterus 11-12 cm, the organ itself increases to 13-14 weeks of pregnancy. With an increase in the uterus to 19-20 weeks of pregnancy, the height of the bottom of the body is 16-20cm, 39-40 weeks – from 39 to 49cm.

Symptoms of fibroids depending on the size of the node

Myoma is not more than four weeks of pregnancy in the early stages of the disease is asymptomatic. Myoma of 8-10 weeks with an increase in nodes up to 5 cm is manifested by the first symptoms – painful menstruation. With an increase in the uterus to 12 weeks of pregnancy, bloating appears.

If the myoma node is located on the leg, with its torsion, there is a sharp pain in the abdomen, nausea, vomiting. With necrosis of myoma formation, body temperature rises, symptoms of peritoneal inflammation develop.

In the case of large fibroids, the adjacent organs are squeezed, urination is disturbed, and constipation occurs. Patients are concerned about pain in the lower back and near the rectum. Fibroids larger than 12 weeks cause the formation of adhesive processes in the pelvis.

diagnosis of fibroids

Examination for suspected uterine fibroids gynecologists begins with a thorough history taking. Attention is drawn to the onset of menarche, the presence and number of abortions, childbirth and their complications, the presence of the disease in the patient’s close relatives.

Doctors find out whether a woman with a diagnostic or therapeutic purpose did not perform any surgical interventions, did not undergo infectious diseases of the female reproductive system. These factors provoke the development of fibroids. Gynecologists clarify the severity and duration of blood loss during menstruation.

During an objective examination, skin and mucous membranes are evaluated. On palpation of the abdomen in the suprapubic area, you can determine the uterus, enlarged to 12 weeks of pregnancy and more when bimanual vaginal examination finds myoma significantly smaller. The absence of palpatory signs of myomatous nodes does not exclude their presence.

Using ultrasound scanning accurately determine the size and location of fibroids. For better visualization of the neoplasm and evaluation of its features, functional diagnostics doctors use transabdominal and transvaginal sensors. This method allows you to monitor the growth rate of myoma nodes and monitor the effectiveness of treatment. Ultrasound scans are also performed as a screening screen for uterine fibroids at risk.

The following ultrasound signs of fibroids exist:

  • increase in the size of the uterus;
  • the roughness of its contours;
  • offset median M-echo;
  • the presence in the thickness of the myometrium or the uterine cavity structures of ovoid, rounded shape with increased echogenicity.

The use of a transvaginal sensor allows our doctors to obtain information about the presence of ultrasound signs of uterine fibroids, which is in the proliferation stage. At the same time, doctors detect cystic inclusions and dense components of the tumor.

Their ratio varies by the severity of proliferative processes. Our specialists study the blood flow inside the fibroids using three-dimensional ultrasound and Doppler.

The integrated use of ultrasound diagnostic methods by our doctors ensures the identification and sufficiently accurate assessment of the condition of myomatous formations. This allows you to predict the course of the disease, to carry out a differentiated approach to the choice of treatment method.

Computed or magnetic resonance imaging is used to clarify the structure of the myoma host and conduct a differential diagnosis with adenomyosis. If a submucous localization of fibroids is suspected, endoscopic and X-ray examinations are performed.

Diagnostic laparotomy is performed with a subserous arrangement of fibroids, the presence of lesions on the pedicle, and to assess the state of the pelvic organs.

Treatment of uterine fibroids depending on size

If myoma increases in size, corresponds to the period of 8-9 weeks of pregnancy, most gynecologists recommend a woman to undergo surgery – laparoscopic myomectomy. The myoma nodes are removed through incisions made on the front wall of the abdominal cavity. After such surgery, there is no cosmetic defect, but the quality of the scar on the uterus is not always good.

Removal of fibroids 10 weeks through the incision of the anterior wall of the abdominal cavity. This is a difficult operation to remove a neoplasm of the uterus. It requires a long operation. After surgery, scars remain on the skin of the abdomen and uterus. Pregnancy and childbirth can occur with complications.

Removal of fibroids 12 weeks gynecologists perform hysterectomy – complete removal of the uterus. After surgery, the woman loses the reproductive organ.

The term of rehabilitation is about two months. In the postoperative period, mental health disorders, arterial hypertension can develop. After embolization of the uterine arteries, fertility is restored quickly, women have increased libido, pregnancy and childbirth proceed physiologically.

The main indicators for removal gynecologists consider:

  • late detection of myoma formations;
  • prolonged blood loss;
  • suspicion of a malignant neoplasm;
  • increasing anemia.

Doctors of the clinics with which we cooperate think that the indications for the operation of removal of fibroids are unnecessarily expanded. Modern diagnostic methods allow us to determine with great accuracy the nature of the volume of education in the uterus.

Even with large fibroids, our doctors first make an embolization of the uterine arteries, and after reducing the size of the fibroids, the remaining nodes are removed by the laparoscopic method in technically more favorable conditions.