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Pregnancy and uterine fibroids
Last reviewed: 23.04.2024
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Myoma (fibromyoma) of the uterus quite often (in 0,5-2,5% of cases) develops during pregnancy. The tumor consists of muscle and fibrous cells in different combinations, has a benign character. Pregnant uterine fibroids are observed more often in the form of nodes of different sizes, located sub-serously and interstitially. Submucosal (submucosal) arrangement of nodes is less common, since either infertility or spontaneous abortions are observed in the early stages of pregnancy.
[The course of pregnancy in uterine fibroids
The course of pregnancy can be complicated, accompanied by interruption of it in the early gestation period, the development of placental insufficiency, the consequence of which is fetal hypotrophy or distress. With a low location of the myomatous node of considerable size, a pelvic presentation or an oblique position of the fetus is often formed. A fibroids node may interfere with the birth of the fetal head. During pregnancy, there may be a malnutrition in the node, which is determined by inadequate blood circulation and the development of aseptic necrosis of the tissue of the node. In special cases, septic necrosis of the myomatous node is possible. Uterine fibroids may not appear clinically during pregnancy. In the presence of nodes, the diagnosis is established by palpation of the uterus (nodes are defined as dense formations). Clarify the presence of uterine fibroids of any location allows ultrasound.
When the placenta is located in the projection of the myomatous node, placental insufficiency is often observed. Absolute contraindications to the preservation of pregnancy with uterine myoma are absent. However, factors that lead to a high risk of complications of pregnancy should be considered: the initial size of the uterus, which corresponds to 10-13 weeks, pregnancy; submucosal and cervical localization of nodes; duration of the disease is more than 5 years; malnutrition in one of the nodes; presence in the anamnesis of a 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 fetus should be carefully monitored, promptly carrying out therapy aimed at treating placental insufficiency. When there are symptoms of blood flow disorders in the myomatous node, drugs improving blood circulation are shown:
- antispasmodics (no-shpa, baralgin, papaverine);
- Infusion therapy, including trental, reopolyglucin.
If the violation of blood flow in the node occurs in the II-III trimester of pregnancy, it is advisable to appoint infusion media in combination with beta-adrenomimetics (partusisten, alupent, briikanil, ginipral).
Absence of the effect of treatment is an indication for surgical intervention - vyshushchivaniyu or clipping of the fibromatous node. This is necessary if, during pregnancy, a myoma knot is found on a thin stalk, which causes painful sensations. In the post-operative period, therapy is continued, aimed at reducing the contractile activity of the uterus, that is, preventing abortion. Pregnant women with uterine fibroids and / or surgical interventions in anamnesis should be hospitalized 2-3 weeks prior to delivery to the hospital. During pregnancy, due to a number of reasons (low position of the nodes that prevent the child's birth, severe fetal hypotrophy, fetal distress), there is often a question about the planned cesarean section. Caesarean section should be performed in cases when, in addition to uterine myoma, other complicating factors are noted: fetal distress, fetal position, gestosis, etc.
During labor, patients with fibroids of the uterus may experience hypotonic bleeding in the third or postnatal period. The fetus may develop distress due to the inferiority of uterine blood flow.
After the extraction of the child during the caesarean section, a thorough examination of the uterus from the inner and outer sides is carried out and the question of the subsequent management of the patient is decided. The tactic is as follows: interstitial nodes of small size can be left, with moderate sizes of nodes and interstitial-subserous location, especially with subserous localization, nodes are harvested, the bed is sewn or coagulated. The presence of large knots on the wide pedicle is an indication for supravaginal amputation of the uterus. In addition, the presence of live children in the parturient woman and her age are important.
In the case of delivery through the natural birth canal, continuous monitoring of the fetal heartbeat and contractile activity of the uterus is necessary. The introduction of oxytocin to enhance the contractile activity of the uterus is not recommended. With the weakness of labor and fetal distress, a caesarean section is indicated.
In the third period 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 noted. In this case, spasmolytic and infusion therapy is performed. The absence of the effect of therapy serves as an indication for surgical intervention by laparoscopic or laparotomic access.