How Can Fibroids Affect Pregnancy

Is It Safe To Get Pregnant With Fibroids

How should you deal with fibroids during pregnancy? – Dr. Hema Divakar

Fibroids during pregnancy are not necessarily a major concern. In fact, a lot of women with fibroids get pregnant and deliver a healthy baby. There are also some women who only find out they have fibroids during their routine pregnancy check-ups.

Still, fibroids and pregnancy complications can and do happen together. As such, a doctor would still closely monitor a patient with fibroids to ensure there are no signs of problems.

Fibroids And Pregnancy Complications

Usually, people with fibroids have normal pregnancies. However, in some cases , fibroids cause complications with pregnancy and/or labor. These problems can include:

  • Abnormal placenta
  • Preterm delivery
  • Slow labor

In about a third of women, fibroids grow during the first trimester of pregnancy. Fibroids can sometimes prevent pregnancy, although this tends to be uncommon. The exact mechanisms are not entirely understood but could include changes in the shape of the uterus and blockages of the cervix or fallopian tubes. Fibroids may shrink or “die out” in pregnancy as their blood flow is redirected to the fetus instead, but this is also not well understood.

Pregnancy Rates And Obstetrical Outcomes Following Myomectomy

Myomectomy is most often used for women who desire future fertility. Pregnancy rates have reached 50-60% after both LM and abdominal myomectomy, with good obstetrical outcomes . Myomectomy, however, does not eliminate symptoms permanently, and is associated with surgical risks and complications . Postoperative adhesions are of particular concern, as it is certainly possible that they may negatively impact future fertility.

Success in myomectomy depends on the location of fibroids. Intramural and subserosal fibroids are often resected using a laparoscopic or abdominal myomectomy. After undergoing an abdominal myomectomy, the risk of uterine rupture in pregnancy is low . Even though the incidence of uterine rupture is lower than that after a previous cesarean , patients with transmural incisions after abdominal or laparoscopic myomectomy generally undergo cesarean delivery .

Myomectomy is of proven benefit. In a study by Casini et al. , patients who underwent myomectomy for resection of submucosal fibroids had higher clinical pregnancy rates when compared to patients with fibroids that did not undergo surgery . The likelihood of live births and spontaneous abortions were similar in both groups. Summarily, data from randomized and controlled studies on the subject suggest that clinical pregnancy, live birth, and spontaneous abortion rates will normalize over time in women with submucosal fibroids following myomectomy when compared to infertile women without fibroids.

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Fibroids And Obstetrical Outcomes

Complications occur in approximately 10-40% of pregnancies in the presence of fibroids . Fibroids may contribute to miscarriage, cesarean section, premature labor, malpresentation of the fetus, and postpartum hemorrhage . Other uncommon complications include pelvic pain due to red or carneous degeneration of the fibroid, low Apgar scores in the neonate, renal failure, fetal limb anomalies, and hypercalcemia. The risk of developing complications during pregnancy increases if the fibroids are over 3 cm in size. However, women with fibroids larger than 10 cm can achieve vaginal delivery approximately 70% of the time .

Second And Third Trimester

Can Uterine Fibroids Affect Your Fertility?

In mid to late pregnancy, fibroid-related concerns change as the baby gets closer to delivery. Fibroids may trigger unusual pain, impact fetal health, cause pre-term birth or birthing complications. Women with fibroids are also 6 times more likely to need a C-section delivery.

Pain experienced early in the pregnancy can elevate, especially if fibroids are large. In addition to putting pressure on internal organs, fibroids can sometimes twist and compress, causing extreme discomfort.

Placental abruption is a medical term for the placenta tearing away from the wall of the uterus before the baby is delivered. While this can also happen in women without fibroids, the condition occurs more often when fibroids are present. Its serious because the placenta provides oxygen to the baby. Also because it can result in severe blood loss to the mother.

Pre-term delivery is more common among women with fibroids than those without. The normal pregnancy period is 37 weeks. Fibroids may cause you to go into labor earlier.

Cesarean/C-section delivery is 6 times more likely if you have fibroids. They can impair the uterus ability to contract normally during delivery, block the birth canal, slow or inhibit labor. The potential for complications during delivery makes a c-section delivery safer for you and the baby.

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Recurrence And Reintervention Following Uae

Two large randomized trials, the REST and EMMY trials, addressed the safety of UAE. The REST trial was composed of patients who had undergone myomectomy, hysterectomy, and UAE in the United Kingdom. Both surgery and UAE patients had similar improvements in symptoms after 5 years, but reintervention was more likely after UAE with a fibroid recurrence rate of 32%. The EMMY trial, conducted in the Netherlands, compared UAE and hysterectomy, concluding that symptoms improved at similar rates for both procedures. A reintervention rate of 28% after 5 years was noted for patients who had undergone an UAE.

Should I Treat Uterine Fibroids Before I Get Pregnant

Ideally, yes. If you are diagnosed with fibroids outside of pregnancy and your doctor determines that the size or location of your fibroids could interfere with your chances of conceiving or carrying a baby to full term, it would be best to treat them via surgery before you become pregnant, says Dr. Lisa Hansard, board-certified reproductive endocrinologist at Texas Fertility Center. However, you should work closely with your doctor on the timing of that treatment.

âYou should try to plan the surgery in a timeline thatâs close to when you want to conceive,â Dr. Hansard explains. âWe canât change what it is about a woman that makes her prone to making fibroids, and they have a 33% recurrence rate, so as soon as the uterus heals, you should try to become pregnant.â

Otherwise, Dr. Hansard adds, you could have more fibroids or fibroid regrowth after waiting too long post-surgery to try and conceive.

But again, working with your doctor is important here while Dr. Ruiz echoes the same recommendation about not waiting too long, he also adds that fibroid surgery can affect how a baby is delivered if the uterus hasnât fully healed: âIf woman has had fibroid surgery and gets pregnant afterwards, we recommend she wait three to six months to get pregnantbut depending on how big the fibroid was and how deeply we had to cut into the uterus, she may need a C-section to deliver.â

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Do Fibroids Grow In Size During Pregnancy

It is common for fibroids to grow as the pregnant uterus grows. Size of fibroids may be affected by change in estrogen and progesterone levels, uterine blood flow, and, possibly, human chorionic gonadotropin levels. This however does not happen in every case. In some women, fibroids stay stable at a very similar size throughout the pregnancy and others even experience reduction in size of the fibroid.

Will Fibroids Cause Pain During The Pregnancy

Fibroids Pt 2: Pregnancy, Menopause and Natural Remedies

For some women, their uterine fibroids flare up during pregnancy. Pain is a very common symptom for these pregnant women. Those who experience pain from fibroids during their pregnancy should rest, use heating pads, or use a prescription or pain medication that is safe for use by pregnant women.

If the fibroids of a woman grow exceptionally fast during a pregnancy, this can result in red degeneration. Some of the symptoms of red degeneration include severe pain, vomiting, vaginal bleeding, nausea, and even fever. A woman will feel this pain over the entire area where the fibroid is located. This pain may radiate down the entire back of the woman. While this pain typically appears during the second trimester, it can appear at any time during the pregnancy.

If the pain from the red degeneration is incredibly severe, it might cause the uterus to begin to contract, inducing preterm labor. Women who experience this will likely be hospitalized or asked to rest in bed to wait for the signs of preterm labor to disappear.

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How Fibroids Cause Infertility

Fibroids can affect your fertility in several ways. Some examples include:

  • The fallopian tubes may be blocked by fibroids, making it difficult or impossible for a fertilized egg to reach the uterus and implant.
  • Changes in the shape of the cervix due to fibroids can affect the number of sperm that enter the uterus.
  • Changes in the shape of the uterus caused by fibroids can prevent the movement of sperm or the implantation of an embryo.
  • Endometrial thickness may be affected by fibroids.
  • Blood flow in the uterine cavity is affected by fibroids.

Can Uterine Fibroids Affect Ivf

Fibroids and IVF may not work together if youre trying to conceive. Discover the best approach to deal with this problem.

Uterine fibroids are a common disorder in women of reproductive age: About 20% to 50% of women have fibroids. Although many fibroids are completely harmless, you may still wonder how they may affect your IVF success and whether their removal would improve the outcome.

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How Common Are Fibroids

Fibroids are very common and are found in up to 30% of all women, especially during the reproductive years . Many women may not be aware that they have fibroids since only about 1 in 3 women would experience symptoms like heavy or painful periods, abdominal or lower back pain, frequent urination, and pain during sex. Fibroids can be easily diagnosed with an ultrasound scan.

How Do Fibroids Affect Fertility

Can Fibroids Affect My Pregnancy?

Although fibroids can affect fertility, a lot of women have no trouble getting pregnant with fibroids. In fact, for most, conceiving naturally is possible and usually does not require treatment.

However, there are some cases when getting pregnant with uterine fibroids is difficult.

The ways in which fibroids can cause infertility include:

Mechanical/anatomical factors

  • Fibroids can grow towards the cervix diminishing or blocking the entry of sperms into the uterus

  • They can grow towards the fallopian tubes, impairing or blocking the passage of the egg.

  • Submucosal fibroids that grow inside the uterine cavity can work as a foreign body and reduce the space for implantation of the embryo and development of the fetus.

Functional/physiological factors

  • Fibroids can change the endometrial receptivity to embryo implantation by changing the hormonal milieu, blood flow and hence endometrial development. This was shown in studies using assisted reproductive fertility where the removal of fibroids increased the success rate after IVF treatment.

There are many causes of infertility and they are not always obvious. Infertility patients may have to undergo other investigations to rule out other factors before attributing their difficulty to fall pregnant to fibroids.

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Recurrence And Reintervention Following Myomectomy

Fibroid recurrence has been reported in 15-51% of cases up to five years after myomectomy . This large variability was probably due to ethnic diversity of the study groups, as well as different criteria and methods used to diagnose recurrence. In the past, the probability of a subsequent surgery was thought to be based on the patient’s age during the first myomectomy, but may actually be more affected by parity as the cumulative probability of recurrence is decreased if a woman has children after myomectomy.

Causes And Risk Factors

Although fibroids are quite common, their cause is still unknown. However, the following factors can increase your chances of developing them:

  • Abnormal estrogen levels
  • Low levels of Vitamin D
  • Family history
  • African American heritage
  • Obesity

A recent study has also shown a link between a common type of hair loss and the development of fibroids.

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How Fibroids Affect Fertility And Pregnancy

If youre struggling to conceive then one reason could be that you might have fibroids. These are tumors or lumps which can occur singly or in clusters within the wall of the uterus.

Fortunately, they are almost always benign but unfortunately, they can cause havoc with fertility and pregnancy.

Fibroids are extremely common in fact, its estimated that as many as 77% of women of child-bearing age could have fibroids and not know. They can be as small as 1 inch across to as large as 8 inches and can vary in size.

To put this in perspective, a uterus is normally around 4 inches in diameter, so its hardly surprising that a large fibroid could make your belly swell and cause discomfort.

How are fibroids detected?

More often than not, fibroids are found accidentally during a routine pelvic examination when they are sufficiently big for your doctor to notice irregularities in the shape of your uterus.

Smaller fibroids, on the other hand, can easily go undetected especially if you havent noticed any symptoms.

If its suspected that you have fibroids, this is usually confirmed with an ultrasound, MRI scan, or a hysteroscopy procedure.

But what about the types of fibroids?

There is more than one type of fibroid depending upon where its positioned in or on the uterus.

So what causes fibroids?

In reality, no one really knows, but its thought to be related to the levels of hormones produced by the womans ovaries.

What about the symptoms?

How can fibroids affect fertility?

Delivery And Postpartum With Fibroids

Uterine Fibroids and Pregnancy

Many studies have shown that complications during delivery can arise as a result of fibroids.

Breech births are 13% more likely and can be caused by large fibroids located in the lower part of the uterus, or if there are multiple fibroids present.

Cesarean section 48.8% of women with fibroids deliver via C-section due in part to the increased risk of dystocia slow or protracted labor, which is twice as likely in pregnant women with fibroids. Fibroids can also block the birth canal which can also necessitate a c-section.

Postpartum hemorrhage women with fibroids have an increased risk of postpartum hemorrhage also called PPH. PPH occurs in 2.5% of women with fibroids and presents as heavy bleeding after delivery. It can happen within the first 24 hours and up to 12 weeks after giving birth. Interventional radiologists can perform a procedure very similar to Uterine Fibroid Embolization in an emergency setting for postpartum hemorrhage. The wife of legendary professional golfer Phil Mickelson was saved by this procedure following the birth of their third child.

Placenta retention it is considered a medical emergency when the placenta is not delivered within ½ hour after the baby during vaginal birth. One source reported that fibroids located in the lower portion of the uterus resulted in a higher instance of placenta retention. When comparing all data available, regardless of the location of the fibroids, 1.4% of women with fibroids experienced placenta retention.

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How To Deal With Fibroids During Pregnancy

Most fibroids do not affect pregnancy or grow during pregnancy. Most people with fibroids have normal pregnancies without complications.

Depending on the size, location, and rate of growth during pregnancy, some fibroids may affect the position of the baby during labor. This increases the chances of needing a cesarean section to deliver the baby.

What Size Fibroids Should Be Removed

Larger fibroids are associated with lower chances of getting pregnant and carrying a full-term pregnancy, but the jurys still out on what size fibroids should be removed.

Whether fibroids should be removed before pregnancy depends on many factors, including location, size, and number of fibroids, as well as your past and current health history.

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Should You Remove Fibroids During A Caesarean Section

The standard answer is no but if the fibroid is pedunculated, which means it is attached to the uterus by a thin stalk of tissue, or causing obstruction, exceptions might be made. It is usually not advised because the risk for bleeding is greatly increased due to the increase in blood supply and engorged blood vessels in the pregnant uterus.

What Are Uterine Fibroids

Montefiore Fibroid Center

Uterine fibroids are benign muscular growths that can develop inside or outside the uterus, usually in women in their childbearing years. They are also called leiomyomas or myomas.

Fibroids are almost always benign in nature and are extremely common almost 40 to 60% women get fibroids by the age of 35, and 60-80% by the time they turn 50. They can be found as a single growth or in clusters. The size of a single fibroid can vary greatly from 1 mm to 8 inches in diameter in size for perspective, a uterus is usually 4 inches in diameter, so a fibroid that big can distend your belly and cause discomfort.

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Pregnancy Rates And Obstetrical Outcomes Following Uae

UAE is not recommended for women with fibroids who desire future fertility, in part due to reported cases of transient and permanent amenorrhea. The reduction in menstrual flow raises the concern for endometrial damage that may contribute to abnormal placentation and/or reduced ovarian function or failure. However, the incidence of amenorrhea has been found to occur in less than 5% of patients and is clearly exacerbated by advanced age or perimenopausal status.

Can Fibroids Recur Or Regrow

Yes, definitely. The recurrence rate of fibroids is about 30-40%. Predisposing factors include age, race, the number of times the woman has given birth, and the number of fibroids removed. Generally, fibroids are hormonal dependent and there should not be any further growth after a woman reaches menopause.

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Fibroid Treatment After Pregnancy

For nonpregnant patients, fibroid treatment procedures are generally safe and effective. We recommend that patients wait at least six months after delivery to consider a fibroid removal procedure.

We make this recommendation for two reasons. First, the uterus will shrink during the postpartum period. Once the body recovers, you can assess how much the fibroids affect your daily life.

Second, fibroid removal surgery requires some downtime for recovery. New moms are already healing from delivery and trying to establish a routine at home. Having a non-emergency procedure on top of that can lead to unnecessary stress.

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