Are uterine fibroids dangerous during pregnancy? Uterine fibroids and pregnancy, effect on conception and pregnancy, treatment, multiple fibroids

Many women who are suspected of having uterine fibroids fall into a panic in search of answers to the questions - what is it? Why me? Is it possible to conceive a child? Is it possible to give birth with uterine fibroids? Is it dangerous if diagnosed already during pregnancy?

To be honest, doctors have not yet given clear answers to all these questions. But nevertheless, they still have some information.

What is uterine fibroid and why does it occur?

Myoma is a benign tumor of muscle tissue. It occurs when the cells of the uterus begin to actively divide. Doctors have not yet fully figured out why this begins to happen, but one of the most likely reasons is related to hormonal stimulation and increased secretion of estrogen. Thus, the growth of fibroids is stimulated by estrogens, and the reverse process is caused by progesterone. However, this does not mean that if the balance of estrogen and progesterone in the body is not disturbed, then there are no fibroids. The problem is that usually local changes in the level of estrogen in the uterus do not affect, or very little, the content of hormones of this group in the blood.

In fact, fibroids are always represented by several nodes at once. They vary in size and can also develop in different parts of the uterus. Nodes that are located under the outer cover of the uterus are called subperitoneal or subserous. Those in the thickness of the uterine wall are intermuscular or interstitial. Nodes located under the lining of the uterine cavity are submucosal or submucosal. It also happens that the uterine cavity is deformed by one large node.

Uterine fibroids and conception

The first symptoms of fibroids are prolonged cyclic bleeding, which is often accompanied by uterine bleeding. Fibroids are diagnosed through ultrasound.

Uterine fibroids are not a cause of infertility, although it can be very difficult to conceive with such a diagnosis. The fact is that fibroids can compress the fallopian tubes, which significantly complicates the movement of sperm and disrupts ovulation.

The ideal option is to cure or even remove fibroids before pregnancy. True, if the nodes (or node) are no larger than 12 weeks of pregnancy. If the fibroid is larger and deforms the uterine cavity, it will be very difficult to maintain the ability to bear children when it is removed: often such an operation is accompanied by severe bleeding, during which the uterus can be removed.

Uterine fibroids and pregnancy

Of course, there is nothing good about uterine fibroids during pregnancy. Firstly, it is usually accompanied by placental insufficiency, and secondly, by the threat of termination of the pregnancy itself. It is especially dangerous if the placenta is located next to a myomatous node: it disrupts its structure and often its functions, and accordingly, significantly less oxygen and nutrients reach the baby. This arrangement is also dangerous because premature bleeding may occur, which will also be accompanied by severe bleeding.

Some doctors say that during pregnancy, fibroids begin to grow, while others say that this is actually due to the growth of the uterus, but this is actually not dangerous for either the mother or the baby. Another thing is dangerous - if the fibroid degenerates, that is, it is destroyed. This process is usually associated with necrosis of the node tissue and, as a result, the formation of edema, cysts and bleeding in the pregnant woman. The worst thing is that degeneration can occur at any stage of pregnancy.

According to statistics, recently doctors are increasingly discovering fibroids in pregnant women, primarily because nowadays more and more women give birth after 30, that is, when hormonal disorders begin. Of course, the possibilities of modern medicine also have an impact - in particular, early diagnosis, thanks to which it is possible to immediately diagnose fibroids in a woman.

Myoma is not a reason to terminate a pregnancy, but it is a compelling argument to be under the close supervision of the attending physician. For many women, pregnancy with fibroids proceeds absolutely normally and without any complications. True, only in cases where the size of the nodes is not too large.

Childbirth

In half of pregnant women with uterine fibroids, doctors note protracted ones. The doctor may recommend giving birth by caesarean section. Although in fact, the fibroid itself does not in any way prevent the baby from passing through the birth canal. The problem is that fibroids often lead to abnormalities in the position and presentation of the fetus.

Especially for- Maria Dulina

From Guest

At the age of 25, I was diagnosed with multiple uterine fibroids, but the doctor said that it was not at all scary. No one directed or suggested removal. At the age of 31 she became pregnant. At 11 weeks of pregnancy, the uterus was 19 weeks. At 18 weeks my stomach started hurting. It was found that 4 nodes had grown to 5-6 cm in diameter. From 18 weeks she was kept in confinement almost all the time, and at 28 weeks premature birth occurred. Now everything is fine with the baby, but there were a lot of worries. Doctors say that the fibroids pulled out the fetus...

From Guest

At 6 weeks, a diagnosis of non-developing pregnancy was made. Afterwards they discovered a fibroid of about 12 mm. Perhaps she was the reason.

From Guest

I gave birth at the age of 37 and I had fibroids. There were no complications, I gave birth on my own. I went well throughout the pregnancy, and the tests were excellent, even the hemoglobin was surprisingly high for the doctors. I think if everything goes smoothly, there is no worry. Always think only about the good and about your baby.

From Guest

You can also give birth to a healthy child with fibroids. The main thing is to see a good doctor. I was observed at the Clinic of Gynecology and New Reproductive Technologies. Brought to term normally and gave birth

From Guest

Before pregnancy, the fibroid was 30 mm. At week 16 it grew to 12 cm—I was shocked! At the end of pregnancy, the fibroid decreased to 5 cm. Sometimes the fibroid swelled and caused pain like contractions, although the ultrasound showed no threat. There were bleedings once every 2 months. The birth also began with bleeding. Despite all the difficulties, the baby was born full-term and healthy. So girls, don’t panic - just see a good specialist. I was referred for consultation to Moniag

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The appearance of symptoms of this pathology causes panic in women. When fibroids are detected in the uterus and pregnancy has already occurred, this can have dangerous consequences for the expectant mother and fetus, especially if the tumor is large. Why a neoplasm develops, what it is, and whether it can become a problem for conception is important for women of childbearing age to know.

What is fibroid

When hormonal disorders associated with excess estrogen and progesterone deficiency occur in the body, a benign tumor process—myoma—emerges in the muscle tissue of the uterine walls. Its growth provokes abnormal division of cellular structures, which begins asymptomatically. As the process progresses, the following appear:

• prolonged menstruation with heavy blood loss;
• sharp cramping pain in the lower abdomen, in the lower back;
• frequent urination if the node is located on the isthmus of the uterus;
• constipation;
• increase in abdominal size.

During the period of waiting for a child, neoplasms can develop on any part of the organ and have dangerous consequences. Multiple fibroids are often observed. Based on the location of the tumor, there are:

• subserous (subperitoneal) - under the outer cover of the uterine body;
• interstitial (intermuscular) - in the thickness of the wall;
• submucosal (submucosal) - in the layers under the endometrium.

Is pregnancy possible with uterine fibroids?

It is good if a woman’s tumor is discovered during pregnancy planning. It is advisable to treat or remove the node during this period. Deformation of the uterus by a tumor can affect conception:

• prevents sperm from getting to the egg - the lumen of the fallopian tubes narrows;
• prevents ovulation;
• makes it difficult for the fertilized egg to attach to the walls;
• when large in size, it rejects it, causing infertility.

If pregnancy with fibroids does occur, it must be terminated if:

• submucous form of the tumor;
• suspicion of malignancy;
• for sizes greater than 15 cm;
• multiple nodes;
• degeneration or necrosis of tumor tissue;
• severe concomitant pathologies;
• woman's age after 45 years;
• localization of the node in the cervix, complicated by uterine bleeding;
• threats of miscarriage.

How are fibroids diagnosed?

If symptoms of the disease appear, a woman should visit a gynecologist. The tumor is detected by palpation through the anterior abdominal wall. More accurately diagnosed by ultrasound, which reveals the location, number of nodes, size, location relative to the placenta. Ultrasound is performed in two ways:

• transvaginally - by inserting a sensor through the vagina into the uterine cavity - in the absence of a fetus;
• transabdominal - through the anterior wall of the peritoneum.

There are diagnostic methods that are not used when fibroids and pregnancy are diagnosed at the same time. This may pose a risk to the development of the embryo. These include:

• hysterography - x-ray examination using a contrast agent;
• hysteroscopy - examination of the organ cavity with a special device inserted through the vagina.

Consequences of fibroids during pregnancy

A woman with symptoms of a neoplasm must register to continue her pregnancy. A tumor can cause serious problems and affect the development of the child and the health of the mother. Myoma during pregnancy threatens:

• placental insufficiency;
• tumor pressure on the fetus;
• disruption of the supply of nutrition and oxygen to the embryo;
• placental abruption;
• premature birth;
• spontaneous abortion;
• tissue necrosis due to disruption of the blood supply to the tumor;
• compression of veins, the appearance of blood clots;
• iron deficiency anemia;
• rupture of the uterine body.

Myoma during early pregnancy

A woman should be careful in the first trimester, especially if there are hereditary factors. If small nodes are detected, the disease may be asymptomatic. Fibroids during early pregnancy are dangerous when they are large. In this situation:

• bloody discharge appears;
• the risk of frozen pregnancy increases;
• there is a possibility of miscarriage if a submucous form of the tumor is observed;
• circulatory disorders occur;
• contact of fibroids with the placenta causes an increase in uterine tone and miscarriage.

Second and third trimesters of pregnancy

At later stages, a large node leaves little room for the growing fetus. It is dangerous when it is located next to the placenta. This development is fraught with consequences:

• risk of premature birth;
• the emergence of a threat of termination of pregnancy;
• the birth of a low-weight baby;
• the likelihood of placental abruption;
• deformation of the skull in a newborn.

Pregnancy with small uterine fibroids

Many women who are diagnosed with tumors in the uterus feel well while expecting a child and do not experience any complications. This is due to the small size of the tumor. Problems for the mother and the unborn child appear in cases where:

• there are many nodes that deform the uterus;
• the tumor is close to the neck;
• the placenta is located in the area of ​​the myomatous node.

Pregnancy with large uterine fibroids

When a neoplasm grows to enormous sizes, it can adversely affect the course of pregnancy. Blood circulation in the uterus is disrupted, which can provoke degeneration of fibroids. At the same time, prostaglandins are released from it, causing contraction of the uterine muscles. In such situation:

• premature birth occurs;
• high probability of miscarriage.

For the development of the fetus, a huge tumor poses no less danger. It takes on most of the blood that supplies the uterus with the embryo, providing oxygen and nutrition. In addition, the tumor puts pressure on growing organs. All this leads to serious problems:

• deformations of the skull, neck;
• low birth weight of the newborn;
• underdevelopment of organs;
• fetal death.

Pregnancy management tactics

Women who have symptoms of a tumor in the uterus need to register as soon as possible. The doctor conducts a full examination and determines the size of the tumor. If it has large volumes, is poorly located or there are many nodes, an important task is solved - to terminate or maintain the pregnancy. A positive conclusion is accepted in the following cases:

• long-term infertility ending in conception;
• woman's desires;
• more than 24 weeks when the fetus is viable.

If there is a benign tumor in the uterus, increased attention from the gynecologist and the woman to the state of health is necessary. An important role is played by the prevention of destruction of fibroids and uterine tone. Expectant mothers are advised to:

• regularly undergo ultrasound examination of the placenta and nodes when they are located close;
• exclude physical activity;
• to sleep more;
• ensure sexual rest;
• avoid stressful situations.

Childbirth with uterine fibroids

When diagnosing myomatous nodes, gynecologists recommend hospitalization at 37-38 weeks in order to prepare for delivery. A woman can give birth naturally through the birth canal under certain conditions. This happens in the case:

• if the entire period passed without complications;
• the fetus developed correctly;
• the position of it and the placenta is normal.

A cesarean section may be necessary when subserous uterine fibroids are diagnosed during pregnancy, complicated by tissue necrosis. Indications for surgical obstetrics are:

• breech presentation of the fetus;
• the presence of a scar on the uterine body;
• large tumor size;
• presence of complications;
• fact of multiple nodes;
• low position of the tumor, preventing the opening of the neck.

To avoid late complications, doctors can perform the following when performing a cesarean section:

• removal of fibroids, if it is single, subserous, pedunculated, or there are secondary structural changes in the neoplasm;
• perform a hysterectomy - remove the uterus completely, when the tumor is multiple in nature, localized under the mucous membranes near the vascular bundles, necrosis of muscle tissue, and relapses of tumors are observed.

Treatment of uterine fibroids during pregnancy

To alleviate a woman’s condition and eliminate complications, gynecologists carry out therapeutic measures. Removal of fibroids during pregnancy is an exceptional case when there is a threat to life. For treatment use:

• with rapid growth of nodes - antiplatelet agents that improve microcirculation;
• for pain relief - No-shpu;
• if there is a threat of miscarriage - bed rest, hormonal medications;
• in case of uterine hypertonicity – infusion therapy;
• vitamin complexes.

How pregnancy and childbirth affect fibroids

Hormonal changes that take place in a woman’s body have different effects on the development of neoplasms while expecting a child. According to experts, childbirth does not affect the tumor - it is removed during a cesarean section or subsequently. While expecting a child, myomatous formations can:

• increase in size in the first two trimesters;
• remain unchanged;
• decrease in the third trimester;
• dissolve;
• degenerate - collapse with the appearance of edema, necrosis, bleeding.

Pregnancy after uterine fibroids

If an operation to remove a tumor is performed and no complications are observed after it, gynecologists recommend planning conception in a month. A woman needs to register early and undergo all examinations. After surgery, a scar remains on the uterine wall, which can cause problems:

• threat of spontaneous abortion;
• pathology of the placenta;
• rupture along the seam during fetal growth with bleeding;
• the occurrence of hypertension.

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The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

Uterine fibroids are a gynecological pathology that can occur in a latent form for quite a long time, without causing the woman any particular discomfort. Uterine fibroids during pregnancy are mainly detected during a gynecological examination, after which the doctor refers the patient for diagnosis and, depending on the medical history, prescribes specific treatment. Any woman can become pregnant with uterine fibroids if the neoplasm does not interfere with the fertilization of the egg.

Mostly, fibroids are detected during pregnancy in the early stages, so the gynecologist and the pregnant patient have time to conduct a thorough diagnosis and jointly decide on treatment tactics, which will directly depend on the intensity with which the tumor grows and how the side effects are expressed. An important aspect is the number, density and structure of the detected nodes, as well as their original size and the one to which the nodes have managed to grow since the beginning of pregnancy.

Uterine fibroids are not always treated during pregnancy; sometimes the development of the pathology is simply monitored. Therapeutic treatment of uterine fibroids during pregnancy is effective when small nodes are detected. If the tumor grows rapidly, then surgical intervention is indispensable. But modern gynecology is doing everything possible to maintain pregnancy with uterine fibroids.

Pregnancy and small uterine fibroids are quite compatible. Provided that the identified nodes are not too large, pregnancy can proceed without serious abnormalities. But the woman must be under strict medical supervision, since in the early stages there is a high risk of losing the child. The main reasons contributing to miscarriage:

• increased uterine tone;
• impaired uterine blood flow;
• presence of infectious diseases;
• development of concomitant pathologies (polyposis, endometriosis).

Is it possible to confuse pregnancy with fibroids?

Menstruation with uterine fibroids may come irregularly. Often, delayed menstruation misleads a woman; it is quite possible to confuse whether a fibroid or pregnancy is causing a delayed cycle; you can independently determine why your period is delayed using a regular pharmacy pregnancy test. There are cases that even with an ultrasound, a doctor can make an incorrect diagnosis. But with a complete diagnosis, based on tests, you can accurately determine the presence of the disease.

Doctors suggest that uterine fibroids and infertility occur as a result of similar pathological changes in the reproductive system. However, it is quite possible to become pregnant with fibroids.

During the gestation period, the production of hormones increases, this greatly affects the transformation of the identified tumor. Doctors state that active growth of compactions occurs in the first half of gestation; in the later stages, fibroid nodes noticeably decrease. At up to 20 weeks, hypertonicity of the posterior wall of the uterus is often observed. Sometimes small fibroids completely resolve (die).

A very serious complication is the destruction of the tumor formation. Why is degeneration dangerous?

Necrosis of the tissue from which the tumor is formed occurs; as a result, various edema and cysts can form at the site of the pathological focus, causing bleeding.

In the second and third semester of gestation, the risk of premature birth increases due to frequent uterine contractions and increased hormone production. Hormonal imbalance and increased uterine tone often lead to miscarriage. The likelihood of premature birth increases significantly with large sizes of the lumps (12 weeks) and the location of the nodes near the placenta. In this case, the need for unplanned abortion increases. Especially .

If a pregnant woman has bleeding similar to menstruation and pain in the lower abdomen, then these symptoms clearly indicate the threat of a possible miscarriage. In this case, the woman should immediately seek medical help. After examination, the patient is prescribed optimal treatment; abortion is performed only in extreme cases when other methods of therapy have failed.

Important! Late pregnancy after 35 years can cause all sorts of physiological disorders, so the disease must be treated promptly.

With small uterine fibroids, there is usually no serious threat to the life of the mother and child. If large tumors are detected, there is a risk of developing serious fetal pathologies. The pressure of the tumor on the embryo has an extremely negative effect on the formation and growth of the embryo. Cases have been recorded of babies being born with a deformed skull and curvature of the cervical vertebrae.

In addition, uterine fibroids in pregnant women can provoke oxygen starvation of the embryo, which results in the death of brain cells. Also, large tumors with uterine fibroids can block the access of nutrients to the embryo, which makes it more likely that a baby will be born with a low birth weight.

Treatment of pathology during pregnancy

Management of pregnancy with uterine fibroids is different in that specialists constantly monitor the condition of the fetus using ultrasound and CTG. Treatment of fibroids in pregnant women is mainly therapeutic in nature, primarily aimed at stopping the growth of the node. But in each specific case the method of therapy is individual.

The sooner you register with a gynecologist, the lower the risk of complications. When conservative therapy does not help, the only treatment option is surgery. Now such operations have been worked out to the smallest detail, so the risk of complications is negligible, as evidenced by numerous reviews from patients.

Submucous (submucosal) fibroids have the most negative effect on the body of a pregnant woman; it develops due to hormonal changes in the body. With this neoplasm, there may be scanty periods at the beginning of pregnancy. The pathology is characterized by the release of compactions into the abdominal cavity, and pregnancy is aggravated by a number of complications.

There is a possibility of torsion of the leg of the myoma node, with the development of necrosis up to the development of peritonitis. Submucous uterine fibroids and pregnancy can greatly undermine a woman’s health. Based on the medical history, the doctor should prescribe individual drug treatment to the patient and monitor the growth of the nodes.

Multiple uterine fibroids and pregnancy– although the concepts are compatible, this is fraught with various complications. At the beginning of pregnancy, with multiple polyps, menstruation may occur. If a patient is diagnosed with multiple fibroids (many nodes along the back wall, among which there are those that deform the uterine cavity), she should take her health seriously and strictly follow all the doctor’s recommendations. Life-threatening complications are likely. The effect of fibroids during pregnancy: cessation of nutrition of the fibroid nodes, threat of miscarriage, disruption of the mother-fetus connection, severe late toxicosis (preeclampsia). See photo.

It is worth noting that iron deficiency in a pregnant woman’s body can provoke accelerated growth of fibroids. Therefore, medications with a high iron content are prescribed as a preventative measure.

Fibroids on the back wall of the uterus can cause constant constipation, so sometimes the doctor prescribes laxatives.

Pregnant women, especially patients after 40 years of age, need to take vitamins of various groups according to doctor’s indications; they have a positive effect on the regulation of hormone levels in the blood. Protein products must be present in your daily diet. Only an experienced specialist can adequately assess the effect of uterine fibroids on pregnancy.

The influence of fibroids on the birth process

Births with uterine fibroids in maternity hospitals are often performed by cesarean section to reduce the risk of possible complications.

Quite often, women in labor with this disease experience placental abruption. Due to the negative influence of the tumor, various abnormalities of the fetal position are formed. In this situation, a caesarean section is performed for uterine fibroids, since it is impossible to give birth naturally.

For medical reasons, women in labor often have fibroids removed during caesarean section. Myomectomy during cesarean section is performed under general anesthesia.

It is better to choose a maternity hospital that specializes in childbirth with fibroids. During a natural birth, large fibroids can make it difficult for the newborn to be born.

There is also a high probability of severe uterine bleeding, after which the woman in labor may not survive.

But not everything is so bad; it is quite possible to give birth with uterine fibroids on your own. If the tumor is small and there are no individual contraindications, a woman can and even should give birth naturally. Childbirth with fibroids is not a phenomenon, so you shouldn’t make a tragedy out of it. Doctors confirm that uterine fibroids can disappear after childbirth without additional treatment.

Possible consequences after childbirth

• growth of the “children’s place” to the uterine cavity:
• uterine bleeding;
• incomplete contraction of the uterus;
• development of infectious diseases;
• prolonged pain in the lower abdomen;
• vaginal discharge of various types.

After the baby is born, the woman is prescribed hormone therapy using injections or capsules of progesterone or estrogen. If this measure does not have the desired effectiveness, a council of doctors decides to perform surgery through myomectomy.

Uterine fibroids after childbirth can change their location, decrease or increase in size, so an individual approach is important in each specific case. Many women have fibroids removed after a caesarean section.

Fibroids and pregnancy are compatible - this is confirmed by medical statistics. But even experienced doctors will not be able to predict how fibroids will behave during pregnancy. Therefore, before planning a conception, you must visit a gynecologist and undergo a full examination. If the pathology is discovered during pregnancy, you must strictly follow all the doctor’s recommendations.

Recently, the frequency of detection of uterine fibroids during pregnancy has increased: firstly, the average woman in labor has “aged” (and hormonal disorders are more common after 30 years), and secondly, diagnostic methods are rapidly improving - in particular, ultrasound is increasingly used .

Of course, every woman planning a pregnancy and facing this problem is concerned about how fibroids can affect the course of pregnancy and childbirth

Conception with fibroids

Difficulties in conceiving caused by fibroids are explained by a variety of factors, including: compression of the fallopian tubes, which impedes the movement of sperm, and ovulation disorders.

Fibroids themselves are not considered a cause of infertility, however, if all established causes of infertility are eliminated, removal of fibroids significantly increases the likelihood of conception. True, this applies to fibroids whose size is less than 12 weeks of pregnancy.

If the fibroid is large and deforms the uterine cavity, it is quite difficult to maintain the ability to bear children after removing the tumor, especially since such an operation may be accompanied by bleeding, sometimes requiring removal of the uterus.

First trimester of pregnancy with fibroids

Serious complications arise if there is contact of fibroids with the placenta (i.e., with placentation in the area of ​​myomatous nodes). In addition, the size of the nodes matters (most women with small myomatous nodes do not experience any complications during pregnancy and the disease is asymptomatic).

Women with uterine fibroids are more likely to have miscarriages.

Causes:

• increased contractility of the uterus (the fact is that when fibroids are destroyed, prostaglandins are released from it - physiologically active substances that cause contraction of smooth muscles, including the muscles of the uterus);
• circulatory disorders in the uterus;
• neuroendocrine disorders;
• chronic infectious diseases;
• processes manifested by the proliferation of the uterine mucosa (hyperplasia, endometrial polyposis).

Second and third trimesters of pregnancy with fibroids

It is believed that the presence of fibroids increases the risk spontaneous abortion and * premature birth**. This is associated with a decrease in free space for the child in the uterus due to myomatous nodes, as well as with an increase in the contractile activity of the uterus.

Typically, the larger the size of the fibroids, the higher the likelihood of premature birth. Again, the location of the fibroid and the presence of its contact with the placenta matter.

Large fibroids have a certain effect on the growth and development of the fetus. Thus, there are cases of children being born with skull deformation and torticollis, apparently caused by the pressure of fibroids. Pregnant women with large fibroids are more likely to give birth to low birth weight babies.

Childbirth with fibroids

There is an opinion that fibroids affect the course of labor. Indeed, approximately half of pregnant women with fibroids experience prolonged labor. In addition, in the presence of fibroids, there is often a need for delivery by cesarean section. Although fibroids themselves, as a rule, do not represent a true obstacle to the birth of the fetus, myomatous nodes (especially large ones) are often combined with anomalies of the position and presentation of the fetus (transverse position, pelvic and facial presentation), in which natural delivery is not possible. In some cases - for example, if the incision area for a caesarean section is a fibroid, the doctor may remove the tumor.

In patients with fibroids, placental abruption often occurs (especially if the fibroid is located behind the placenta - retroplacentally). Doctors must take this into account when managing childbirth.

Postpartum period complicated by fibroids

Both early and late postpartum complications can be associated with the presence of fibroids.

Early ones include postpartum hemorrhage associated with decreased uterine tone, tight attachment and placenta accreta.

By late - incomplete involution of the uterus (when the uterus does not shrink to its “original” size), infectious diseases.

How do pregnancy and childbirth affect fibroids?

For pregnancy to develop, an increased formation of both estrogen and (to an even greater extent) progesterone is necessary - both, as explained above, significantly affect the condition of fibroids.

In addition, in addition to hormonal changes, purely mechanical changes also occur during pregnancy - enlargement and stretching of the muscular lining of the uterus (myometrium), increased blood flow in the uterine wall. The effect of these changes on an existing fibroid depends on where exactly and how it is located, and to what extent it has “captured” the uterus.

It is generally accepted that fibroids grow during pregnancy, but there is an opinion that this is not true, but apparent growth associated with the growth of the uterus as a whole. Basically, a slight increase in the size of fibroids is observed in the first and second trimesters, and in the third, all fibroids become smaller. In general, significant growth of fibroids during pregnancy is rare and practically does not complicate the course of pregnancy.

More often during pregnancy, another phenomenon is observed - the so-called degeneration(i.e. destruction) of fibroids. We will have to disappoint those who consider this phenomenon a positive change: the destruction of fibroids is associated with very unpleasant processes - necrosis (death) of fibroid tissue, the formation of edema, cysts, bleeding, etc. Degeneration can occur at any stage of pregnancy, as well as during the postpartum period - it depends on the location of the fibroids.

The causes of degeneration are not completely clear - apparently, both hormonal (increased progesterone levels) and vascular and mechanical (impaired blood supply to the tumor due to thrombosis of the blood vessels feeding the myoma) are important.

Signs of fibroid degeneration are as follows:

• pain in the area where the myomatous node is located;
• increased uterine tone;
• temperature increase;
• increase in the number of blood leukocytes;
• increased ESR (erythrocyte sedimentation rate).

The diagnosis is confirmed by ultrasound.

This condition usually lasts one to two weeks. At this time, doctors usually adhere to conservative tactics, prescribing the patient analgesics and bed rest. If abdominal pain appears and increased uterine tone persists, the patient is hospitalized and further treatment is carried out in a hospital.

Surgical treatment is performed very rarely and only for absolute indications (high fever, leukocytosis, deterioration, acute abdominal pain, severe uterine bleeding). Sometimes minimal surgical intervention is enough and the pregnancy can be saved. The operation leads to abortion and premature birth only in the most severe cases.

As for the changes that fibroids undergo in the first months after childbirth, they are varied and unpredictable. Myomas, which caused a lot of trouble during pregnancy, may not manifest themselves and cause any symptoms after childbirth. As the uterus undergoes reverse development after childbirth, the location of the fibroids often changes.

How are fibroids treated?

Conservative (non-surgical) treatment of fibroids consists of inhibiting tumor growth. Specific methods depend on the cause of fibroids and its individual properties. During pregnancy, iron deficiency anemia often contributes to the growth and development of fibroids - this is one of many reasons for the urgent need for systematic blood testing during pregnancy.

Iron supplements, a protein diet, B vitamins, ascorbic and folic acids are usually prescribed as therapeutic and prophylactic agents for uterine fibroids. Vitamins E and A are also of great importance, as they have a regulatory effect on the neuroendocrine system as a whole and reduce the sensitivity of the genital organs to estrogen.

Patients with uterine fibroids often experience a disturbance in fat (lipid) metabolism, which is expressed in increased body weight. In such cases, correction of the dietary regime is necessary: ​​limiting the consumption of carbohydrates, replacing animal fats with vegetable fats, and including fruit and vegetable juices in the diet.

Later, outside of pregnancy, hormonal drugs are used to treat fibroids - agents containing progesterone are prescribed (as we have already said, it reduces the ability of cells to divide, thus inhibiting tumor growth).

If the growth of uterine fibroids cannot be stopped, the issue of surgical treatment methods is decided.

In conclusion, it must be added that prevention is always better than treatment, and treating any disease at an early stage is always more effective than combating an advanced disease, therefore, if any alarming symptoms appear, you should contact a gynecologist as soon as possible.

Uterine fibroids today are a fairly common phenomenon, and the frequency of its diagnosis has especially increased during pregnancy. It is quite logical that women of childbearing age increasingly have questions about the possibility of becoming pregnant if they have uterine fibroids or after their removal, about its effect on the course of pregnancy and methods of its treatment while carrying a child.

The effect of fibroids on pregnancy.
It must be said right away that fibroids are a benign tumor that occurs against the background of the proliferation of muscle fibers of the walls of the uterus. Let me clarify right away that any tumor formation in the uterine cavity sooner or later leads to its enlargement. The growth of fibroids can be very rapid, but it may not be observed at all, and for quite a long time. During gestation, the uterus also increases in size corresponding to a particular period. This is why uterine enlargement is initially associated with pregnancy, and only the results of an ultrasound can make an accurate diagnosis.

Myoma really complicates the process of conception, since its size puts pressure on the fallopian tubes, creating obstacles for the movement of sperm, and also disrupts ovulation. As such, it is not a cause of infertility, but its removal significantly increases the chances of conceiving a baby, unless, of course, its size does not exceed twelve weeks of pregnancy. With larger sizes, the tumor leads to deformation of the uterine cavity, as a result of which it is quite difficult to maintain reproductive function after surgery, since the removal of large fibroids is often accompanied by severe bleeding, and in some cases, specialists are forced to simply remove the uterus.

In the first months of pregnancy, complications may arise from fibroids; this occurs mainly when the tumor is close to the placenta. In this case, the size of the tumor is no less important. With small myomatous nodes, pregnancy proceeds without complications, and the tumor itself does not manifest itself in any way.

Fibroids in the second and third trimester of pregnancy increase the risk of miscarriage, as well as premature birth. This happens as a result of the fact that myomatous nodes leave less and less free space for the fetus, in addition, they stimulate the contractile activity of the uterus. In this situation, the location of the fibroid and its distance from the placenta (whether there is contact) also plays an important role.

Large tumors can affect normal growth and development of the fetus. There are often cases of children being born with low weight, with an altered shape of the skull, curvature of the neck, etc.

Most experts agree that uterine fibroids affect the birth process, significantly delaying it. Also, if it is present, specialists more often decide to perform a cesarean section. In this situation, it is not the fibroid itself, as such, that prevents childbirth, but significant size myomatous nodes in combination with pathologies of the position and presentation of the fetus (transverse, pelvic and facial presentation). Sometimes, if the C-section incision matches the location of the fibroid, the doctor may remove it.

It should be noted that in pregnant women with fibroids, placental abruption often occurs, especially when the tumor is located retroplacentally (behind the placenta). During the birth process, doctors take this feature of the tumor into account.

In the postpartum period, fibroids can also cause complications, both immediately (bleeding against the background of low uterine tone) and after a fairly long period of time (infectious diseases, the uterus does not reach its original size).

Planning pregnancy in the presence of uterine fibroids.
At the conception planning stage, it is necessary to take into account facts such as the location of the fibroid, its growth tendency, and the size of the nodes. If the location of the nodes leads to deformation of the uterine cavity, then it is in principle impossible to get pregnant, since the sperm, not reaching the fallopian tubes, settle on their surface without ever meeting the egg. In this case, the nodes must be removed.

If the nodes are small and located in the thickness of the uterine wall or outside, that is, there is no deformation of the cavity, then the probability of pregnancy is quite high. It should only be said that in the event of fertilization, a woman may have problems associated with bearing a fetus.

If a woman has a myomatous node on a thin stalk, then there is a high risk of torsion during pregnancy, and this, as a rule, leads to surgical intervention and often to miscarriage. In this situation, at the stage of pregnancy planning, it is urgently recommended to remove such nodes.

It is also important to note that if, according to ultrasound data, it was established that the tumor is predisposed to rapid growth (doubling in size within six months), then planning pregnancy is prohibited. This is due to the high risk of fibroid enlargement during pregnancy, which provokes malnutrition in the node, and this is fraught with miscarriage. At the stage of planning conception, such a tumor must also be removed in advance.

In the case of large uterine fibroids (4 cm in diameter and above), it is also worth postponing conception, since, firstly, this is unlikely (against the background of endometrial pathology), and if it happens, it is fraught with miscarriage, since the probability of miscarriages and malnutrition of the fetus, which will lead to surgery. Nodes are also subject to removal at the planning stage of the child.

Growth of fibroids during pregnancy.
No doctor can reliably answer how a tumor will behave during pregnancy (if it is present before conception). The genetic factor plays a big role here. In most cases, the growth of fibroids is observed in the first two trimesters of pregnancy, and in the third, on the contrary, their decrease is noted. As a rule, during gestation, fibroids are reduced in size by an average of thirty-five percent, but there is still a small percentage of cases where fibroids double during gestation, but this practically does not complicate or complicate pregnancy. However, destruction or degeneration of fibroids can contribute to various complications. This process is combined with tissue necrosis of destroyed fibroids, bleeding, formation of cysts, etc. This phenomenon can occur, frankly, at any stage of pregnancy and after delivery. In this case, the location of the fibroids matters.

Why fibroids are destroyed during pregnancy is not completely known. This can be facilitated by hormonal (increased progesterone levels), vascular and mechanical changes (impaired blood supply to the tumor due to thrombosis). This process is accompanied by pain in the area where the node is located, an increase in uterine tone, an increase in body temperature, an increase in the level of leukocytes in the blood and the erythrocyte sedimentation rate. Degeneration of fibroids is diagnosed using ultrasound. Initially, the patient is recommended to rest in bed and prescribed analgesics; if severe symptoms persist, she is hospitalized for further inpatient treatment.

Surgical treatment is prescribed in exceptional cases in the presence of absolute indications (severe fever, leukocytosis, deterioration of general condition, acute abdominal pain, uterine bleeding). It is often possible to save a pregnancy with surgical intervention.

I note that fibroids that grew in the first months of pregnancy may not make themselves known at all after childbirth. After childbirth, as the uterus returns to its original state, the location of myomatous nodes may change.

Treatment of fibroids during pregnancy.
Initially, fibroid therapy is conservative in nature and is aimed at stopping the growth of a benign tumor. Methods in each specific case depend on the individual characteristics of the tumor and the reasons for its development. During pregnancy, iron deficiency anemia in a pregnant woman can become a factor that provokes the growth of fibroids. It is this fact that serves as one of the reasons for the constant study of a woman’s blood during this period.

Therapeutic and preventive measures for uterine fibroids are taking iron supplements, ascorbic and folic acids, B vitamins, and a diet with a predominance of protein foods. Vitamins E and A are also recommended, which have a beneficial effect on the neuroendocrine system and reduce the sensitivity of the genital organs to estrogen.

If lipid metabolism is disturbed in a pregnant woman with fibroids, her diet is adjusted: the consumption of carbohydrate foods is severely limited, any animal fats are excluded (they are replaced with vegetable fats), and more freshly squeezed juices from vegetables and fruits are included in the diet.

After delivery, the woman is prescribed hormonal drugs with progesterone, which reduces the ability of cell division, preventing tumor growth. If it is impossible or unsuccessful attempts to stop the growth of fibroids, a decision is made on surgical treatment (conservative myomectomy - removal of nodes while preserving the uterus).

The laparoscopy technique (an operation performed using an endoscope and instruments, under the control of a video camera installed in the abdominal cavity) significantly reduces the risk of developing adhesions in the pelvis, which in the future helps to maintain the patency of the fallopian tubes, and this is one of the main factors in pregnancy. The treatment method using laparotomy (abdominal surgery, everything is done by the surgeon manually) is associated with a high risk of the formation of adhesions, and their formation can occur both in the pelvis and in the abdominal cavity. In the future, this leads to infertility, and sometimes to complications from the digestive system (for example, adhesive intestinal obstruction). However, the large size of the nodes during laparoscopy does not allow suturing the uterus as required, which is due to the peculiarities of the technique, the angle of the abdominal instruments, and some technical issues.

As a result, laparoscopy is performed for women planning a pregnancy if the size of the nodes does not exceed 5-6 cm. In this case, suturing the uterus requires the skill and experience of a surgeon. To remove large nodes, there are new technologies for suturing the uterus, but this significantly increases the risk of uterine rupture along the scar.

If the nodes exceed 9-10 cm in diameter, the risk of uterine rupture along the scar is significantly higher than the risk of formation of adhesions due to laparotomy. Therefore, it is recommended to abandon laparoscopy and open the abdominal cavity to excise the tumor.

After removal of uterine fibroids, regardless of the technique used, conception can be planned only after eight to twelve months, it all depends on the size of the removed tumor.

It should be noted that after removal of fibroids, a woman’s labor can be carried out naturally if the removed nodes were no more than four centimeters in diameter, if there are no complications during pregnancy and after childbirth, if the uterine scar is in satisfactory condition. The woman’s age also plays a huge role. In other cases, a caesarean section is indicated.

Multiple uterine fibroids.
It also happens that several myomatous nodes are formed in the uterus at once, and of different sizes. Planning a pregnancy in this situation is very difficult, since removal of such formations can lead to the fact that there is no healthy tissue left on the uterus. In such situations, doctors prescribe the removal of only those nodes that interfere with the attachment of the embryo, tend to grow, interfere with the gestation of the fetus and can cause complications, etc. After delivery, you can begin excision of the remaining nodes, or doctors can do this during a cesarean section.