Impact of Uterine Fibroids on Pregnancy and Postpartum Surgery Considerations

Uterine fibroids and pregnancy?

Hello, Doctor: I am currently 36 years old and about 9 weeks pregnant with my first child.
Last week, an ultrasound examination revealed a uterine fibroid measuring approximately 11 centimeters.
Prior to the ultrasound, I had no symptoms, but I did notice my abdomen felt larger due to the pregnancy, which I found quite strange.
Typically, does a fibroid of this size affect the pregnancy? Additionally, after giving birth, what size of fibroid would warrant a recommendation for surgical removal? Furthermore, how long after delivery can surgery (either traditional or laparoscopic) be performed? I would appreciate your professional advice.
Thank you.

Tina, 30~39 year old female. Ask Date: 2016/06/16

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, uterine fibroids can sometimes lead to miscarriage or affect fetal development or fetal positioning, but this does not mean that it will happen in every case.
Some individuals with fibroids do not experience any negative effects.
After giving birth, if there are no symptoms, observation is sufficient, and surgical removal is not necessary.
If surgery is required, it is important to thoroughly discuss the options of traditional surgery or laparoscopy, as well as the timing, with the attending physician before making a decision.
Wishing you good health.

Reply Date: 2016/06/16

More Info

Uterine fibroids, also known as leiomyomas, are non-cancerous growths of the uterus that can affect women during their reproductive years. The presence of fibroids during pregnancy can raise several concerns, particularly regarding their size, location, and potential impact on both the pregnancy and delivery.

In your case, with a fibroid measuring approximately 11 cm, it is essential to consider how this may influence your pregnancy. Generally, fibroids can cause complications such as:
1. Pain and Discomfort: Larger fibroids can lead to abdominal pain, especially as the uterus expands during pregnancy. This discomfort may be exacerbated by the growing uterus pressing against the fibroid.

2. Obstructed Labor: Depending on the fibroid's location, particularly if it is situated near the cervix, it may obstruct the birth canal, potentially necessitating a cesarean section (C-section).

3. Placental Issues: Fibroids can sometimes interfere with the implantation of the placenta, leading to conditions such as placenta previa, where the placenta covers the cervix, posing risks for both mother and baby.

4. Increased Risk of Preterm Labor: In some cases, fibroids can contribute to preterm labor, although this risk varies based on individual circumstances.

5. Fetal Growth: Large fibroids may affect the space available for the fetus to grow, potentially leading to growth restrictions.

Given that you are currently around 9 weeks pregnant, it is crucial to monitor the fibroid's growth and any symptoms you may experience. Regular ultrasounds can help assess the fibroid's size and its impact on the pregnancy. Your healthcare provider may recommend a tailored monitoring plan to ensure both your health and that of your baby.

Regarding postpartum considerations, the decision to remove fibroids typically depends on several factors, including:
- Symptoms: If the fibroid causes significant pain, heavy bleeding, or other complications after childbirth, surgical intervention may be warranted.

- Size and Growth: If the fibroid continues to grow or remains large (generally over 5 cm) postpartum, your doctor may recommend surgery.

- Type of Surgery: The choice between traditional open surgery and laparoscopic surgery will depend on the fibroid's characteristics, your overall health, and your doctor's expertise. Laparoscopic surgery is often preferred due to its minimally invasive nature and quicker recovery time.

As for the timing of surgery after childbirth, it is generally recommended to wait at least 6 to 8 weeks postpartum before undergoing any surgical procedures. This allows your body to heal from the delivery and reduces the risk of complications. However, the exact timing can vary based on individual circumstances and should be discussed with your healthcare provider.

In summary, while uterine fibroids can pose challenges during pregnancy and postpartum, many women with fibroids have successful pregnancies and deliveries. Close monitoring and open communication with your healthcare team are vital to managing any potential risks associated with fibroids. It is essential to follow up with your obstetrician and possibly a specialist in maternal-fetal medicine to ensure the best outcomes for you and your baby.

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