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Pregnancy and uterine fibroids
Last reviewed: 07.07.2025
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Uterine myoma (fibromyoma) develops quite often (in 0.5-2.5% of cases) during pregnancy. The tumor consists of muscle and fibrous cells in different combinations and is benign. In pregnant women, uterine myoma is most often observed in the form of nodes of varying sizes, located subserously and interstitially. Submucous (submucous) location of nodes is less common, since in this case either infertility or spontaneous abortions are observed in the early stages of pregnancy.
[ The course of pregnancy with uterine fibroids
The course of pregnancy may be complicated, accompanied by its interruption in the early stages of gestation, the development of placental insufficiency, the consequence of which is hypotrophy or distress of the fetus. With a low location of a myomatous node of significant size, breech presentation or oblique position of the fetus is often formed. The myoma node can interfere with the birth of the fetal head. During pregnancy, a nutritional disorder in the node can be observed, which is determined by insufficient blood circulation and the development of aseptic necrosis of the node tissue. In some cases, septic necrosis of the myomatous node is possible. Uterine myoma may not manifest itself clinically during pregnancy. If nodes are present, the diagnosis is established by palpation of the uterus (nodes are determined as dense formations). Ultrasound allows you to clarify the presence of uterine myoma of any localization.
When the placenta is located in the projection of the myomatous node, placental insufficiency is often observed. There are no absolute contraindications to maintaining pregnancy with uterine myoma. However, it is necessary to take into account the factors that determine the high risk of developing pregnancy complications: the initial size of the uterus, which corresponds to 10-13 weeks of pregnancy; submucosal and cervical localization of nodes; duration of the disease more than 5 years; nutritional disorder in one of the nodes; history of conservative myomectomy with dissection of the uterine cavity and a complicated postoperative period.
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Management of pregnant women with uterine fibroids
During pregnancy, the condition of the fetus should be carefully monitored, promptly conducting therapy aimed at treating placental insufficiency. When symptoms of impaired blood flow in the myomatous node appear, drugs that improve blood circulation are indicated:
- antispasmodics (no-spa, baralgin, papaverine);
- infusion therapy including trental, rheopolyglucin.
If the blood flow disturbance in the node occurs in the II-III trimester of pregnancy, it is advisable to prescribe infusion media in combination with beta-adrenergic agonists (partusisten, alupent, brikanil, ginipral).
Lack of effect from treatment is an indication for surgical intervention - enucleation or excision of the fibromatous node. This is necessary if during pregnancy a myomatous node on a thin stalk is detected, which causes pain. In the postoperative period, therapy is continued aimed at reducing contractile activity of the uterus, that is, preventing termination of pregnancy. Pregnant women with uterine fibroids and / or surgical interventions in the anamnesis should be hospitalized 2-3 weeks before delivery. During pregnancy, due to a number of reasons (low location of nodes that interfere with the birth of the child, severe fetal hypotrophy, fetal distress), the question of a planned cesarean section often arises. Caesarean section must be performed in cases where, in addition to uterine fibroids, other complicating factors are noted: fetal distress, abnormal fetal position, gestosis, etc.
During labor, patients with uterine fibroids may experience hypotonic bleeding in the third stage or postpartum period. The fetus may develop distress due to inadequate uterine blood flow.
After the extraction of the child during a cesarean section, a thorough examination of the uterus is performed from the inside and outside, and the issue of subsequent management of the patient is decided. The tactics are as follows: small interstitial nodes can be left, with moderate node sizes and interstitial-subserous location, especially with subserous localization, the nodes are enucleated, the bed is sutured or coagulated. The presence of large nodes on a wide stalk is an indication for supravaginal amputation of the uterus. In addition, the presence of living children in the mother and her age are important.
In case of vaginal delivery, constant monitoring of fetal heartbeat and uterine contractions is necessary. Administration of oxytocin to enhance uterine contractions is not recommended. In case of weak labor and fetal distress, a cesarean section is indicated.
In the third stage of labor, a manual examination of the uterine cavity is performed to exclude the presence of submucosal nodes.
In the early postoperative period, symptoms of malnutrition of the nodes may also be observed. In this case, antispasmodic and infusion therapy are administered. The lack of effect from therapy serves as an indication for surgical intervention by laparoscopic or laparotomic access.