Uterine Fibroids and Pregnancy: Key Concerns and Surgical Options - Obstetrics and Gynecology

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Uterine Fibroids vs. Pregnancy


1.
If a laparoscopic myomectomy is performed without confirming pregnancy (for example, if conception is less than a month or even earlier), is there a risk of miscarriage, or does it not affect the ability to conceive?
2.
Is it possible to perform a myomectomy during pregnancy?
3.
If it does not affect the ability to conceive, is it still necessary to perform a procedure to remove the embryo?
4.
Last year, there was a case where pregnancy was discovered only after surgery, and due to concerns for maternal and fetal health, a therapeutic abortion was performed.
Can you explain why a myomectomy might impact health, and which aspects of health are affected?
I would greatly appreciate your insights on these questions!

MOMO, 30~39 year old female. Ask Date: 2020/08/03

Dr. Cao Guotao reply Obstetrics and Gynecology


Hello, will surgery cause a miscarriage? It needs to be monitored.
Generally, it is recommended to perform surgery when not pregnant.
If surgery is necessary while pregnant, please discuss with your attending physician whether to preserve the embryo.
Wishing you good health.

Reply Date: 2020/08/03

More Info


When it comes to understanding uterine fibroids and their implications for pregnancy, there are several key concerns and surgical options to consider. Uterine fibroids, also known as leiomyomas, are benign tumors that can develop in the uterus. They are quite common and can affect a woman's reproductive health, particularly during pregnancy. Here are detailed answers to your questions:
1. Laparoscopic Myomectomy and Early Pregnancy: If a woman undergoes laparoscopic myomectomy (surgical removal of fibroids) without confirming pregnancy, there is a risk of miscarriage, particularly if the procedure is performed very early in the pregnancy (before a missed period or at less than four weeks gestation). The risk of miscarriage is generally higher in the first trimester due to the natural fragility of early pregnancy. However, if the fibroids are not affecting the uterine cavity or the implantation site, the procedure may not necessarily lead to miscarriage. It is crucial to confirm pregnancy before any surgical intervention to minimize risks.

2. Myomectomy During Pregnancy: Performing a myomectomy during pregnancy is generally not recommended unless absolutely necessary. The risks associated with surgery during pregnancy include preterm labor, miscarriage, and complications from anesthesia. If fibroids are causing significant problems, such as severe pain or obstruction, a careful evaluation by a specialist is necessary to weigh the risks and benefits. In most cases, management of fibroids during pregnancy is conservative, focusing on monitoring rather than surgical intervention.

3. Impact on Pregnancy and Need for Surgery: If fibroids are present but not causing complications, they may not necessitate surgical removal during pregnancy. However, if the fibroids are large or located in a way that they obstruct the pregnancy or cause significant symptoms, surgical options may need to be considered. In such cases, the health of both the mother and the fetus must be prioritized. The decision to proceed with surgery would depend on the specific circumstances, including the size and location of the fibroids, the gestational age, and the overall health of the mother.

4. Concerns About Health Risks Post-Surgery: The news about a woman undergoing surgery and later discovering she was pregnant, leading to a forced abortion, highlights the importance of preoperative pregnancy testing. Surgical procedures, especially those involving the uterus, can pose risks to both maternal and fetal health. These risks include infection, bleeding, and potential damage to the uterus, which could affect future pregnancies. The health implications can vary based on the type of surgery performed, the timing in relation to the pregnancy, and the individual’s health status.

In summary, if you suspect pregnancy, it is crucial to confirm it through a pregnancy test before considering any surgical procedures like myomectomy. If fibroids are present during pregnancy, close monitoring and conservative management are typically recommended unless complications arise. Always consult with a healthcare provider who specializes in obstetrics and gynecology to discuss the best course of action tailored to your specific situation. They can provide personalized advice based on your medical history, the characteristics of the fibroids, and your reproductive goals.

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