Although fibroids can cause heavy bleeding, pain, and pressure symptoms, many women still manage to conceive and have successful pregnancies despite these challenges.
Understanding the potential impacts of fibroids and how to effectively manage them during pregnancy is important for ensuring a healthy outcome for both mother and baby. At the Rylon Clinic, we are dedicated to providing expert private care and support to women facing fibroids whilst pregnant or considering pregnancy.
Keep reading to learn about pregnancy with fibroids, explore management options, early scanning during pregnancy and understand the comprehensive services offered by our clinic, led by experienced gynaecologist Mr Osama Naji.
Assessment of fibroids during pregnancy
Assessing fibroids during pregnancy scanning is a critical step in ensuring the health and safety of both mother and baby. Fibroid mapping is an essential tool used to evaluate the size, number, and location of fibroids, which are key factors in determining the potential impact on pregnancy.
Size
The size of fibroids can vary greatly, from as small as a pea to as large as a melon. Smaller fibroids, generally less than 5 centimetres in diameter, are less likely to cause significant complications during pregnancy. Large fibroids, on the other hand, can lead to issues such as pain, increased bleeding, and complications during delivery. Accurate measurement of fibroid size through ultrasound or MRI helps in planning appropriate management and monitoring strategies throughout the pregnancy.
Number
The number of fibroids present also plays a role in pregnancy outcomes. A single fibroid or a few small fibroids are usually less problematic compared to multiple fibroids, which can collectively alter the shape of the uterus and affect its function. Multiple fibroids may increase the risk of complications such as preterm labour and placental abruption. Fibroid mapping helps in identifying and counting the fibroids, providing a clear picture of their potential impact.
Location
The location of fibroids within the uterus is perhaps the most significant factor in determining their effect on pregnancy. Fibroids can be classified based on their location as submucosal (growing into the uterine cavity), intramural (within the uterine wall), or subserosal (on the outer surface of the uterus). Submucosal fibroids are more likely to interfere with implantation and foetal growth, whereas intramural and subserosal fibroids might have less impact depending on their size and number. Fibroid mapping accurately identifies the position of each fibroid, helping in assessing the risks and planning for any necessary interventions.
Positive outcomes
Small fibroids that do not disrupt the uterine cavity or placenta typically do not pose significant risks and can lead to a fairly normal pregnancy with regular monitoring and care. Regular monitoring and appropriate management strategies can further enhance the chances of a positive outcome [1-4].
At the Rylon Clinic, we utilise advanced fibroid mapping techniques to provide detailed assessments of fibroids during pregnancy. Our comprehensive approach ensures that all potential risks are identified early, allowing for tailored care plans that support both maternal and foetal health.
When fibroids can be a concern in pregnancy
While many women with fibroids experience uncomplicated pregnancies, certain fibroids can pose significant risks that require careful monitoring and management. Specifically, fibroids that are 5-7 centimetres or larger, regardless of their location, necessitate a thorough understanding of potential adverse obstetric outcomes.
Larger fibroids and potential risks
Fibroids of considerable size can create complications that affect both the mother and the developing baby. These complications include:
Premature labour: large fibroids can increase the risk of preterm labour and delivery [5-6]. This can lead to a host of complications associated with premature birth, such as respiratory issues and developmental delays in the newborn.
Placental abruption: the presence of large fibroids can increase the risk of placental insufficiency or abruption, where the placenta detaches from the uterine wall before delivery [7]. This condition can lead to severe bleeding and endanger both the mother and the baby.
Foetal Growth Restriction (FGR): large fibroids can limit the space available for the baby to grow, potentially leading to intrauterine growth restriction (IUGR) [8]. This can result in a baby being smaller than expected for their gestational age, which might necessitate specialised care after birth.
Malpresentation: the position of the baby can be affected by large fibroids, leading to malpresentation issues such as breech position (where the baby is positioned feet-first instead of head-first). This can complicate labour and delivery, often requiring a caesarean section.
Increased pain and discomfort: larger fibroids are more likely to cause significant pain and discomfort during pregnancy due to their size and the pressure they exert on surrounding tissues and organs. This can impact the mother's quality of life and may require medical intervention to manage pain.
Miscarriage: larger fibroids, especially those that distort the uterine cavity, can increase the risk of miscarriage. This risk is more pronounced in the first trimester, as the fibroids can interfere with the embryo's ability to securely implant and develop [6].
Loss in the second trimester: the risk of pregnancy loss extends into the second trimester for women with large fibroids. This is often due to the fibroids causing significant changes in the uterine environment, which can disrupt the pregnancy [5].
Understanding and managing risks
In Mr Naji’s view it is often better for women with large fibroids to avoid pregnancy. Women with large fibroids need to understand these potential risks and the importance of regular monitoring. Key points to consider include:
Pre-conception counselling for women with fibroids
Pre-conception counselling is a crucial step for women with fibroids who are planning to become pregnant. This process involves a detailed evaluation and discussion with a gynaecologist to address potential risks and develop a strategy to ensure the best possible outcomes for both the mother and the baby.
Importance of seeing a gynaecologist
For women with large fibroids, consulting a gynaecologist before conception is essential. Fibroids, which are benign overgrowths of muscle tissue in the uterus, can complicate pregnancy in various ways. These complications can include increased risk of preterm birth, foetal growth restrictions, and concerns during labour and delivery, such as the need for a caesarean section if the fibroids obstruct the birth canal [16][17].
Assessing and managing risks
During pre-conception counselling, a gynaecologist will assess the size, number, and location of fibroids through imaging techniques like ultrasound or MRI. This assessment helps in identifying specific risks and determining the most appropriate management strategy before pregnancy. Treatment options might include medication to manage symptoms, hormonal therapies to reduce fibroid size, or surgical procedures such as myomectomy, which can remove fibroids while preserving fertility [16][18].
Individualised care plan
Each woman's situation is unique, necessitating a tailored pre-conception care plan. This might involve lifestyle modifications, dietary adjustments, and the use of supplements such as folic acid to prevent neural tube defects. Additionally, minimally invasive treatments like hysteroscopic resection of submucosal fibroids might be recommended to shrink fibroids while preserving fertility [16][18].
Potential complications during pregnancy
Understanding potential complications is vital. Fibroids can cause early/incomplete cervical dilation or postpartum haemorrhage due to poor uterine contractions. These risks highlight the importance of a well-structured plan and close monitoring throughout pregnancy [16][17].
Pre-conception counselling thus provides an opportunity to discuss these risks, explore treatment options, and plan for a healthy pregnancy and delivery. By addressing fibroid-related issues beforehand, women can significantly improve their chances of a successful pregnancy outcome [19][17].
Women with fibroids should prioritise seeing a gynaecologist before attempting to conceive to ensure they receive comprehensive care tailored to their needs.
Regular monitoring
Frequent ultrasound scans and prenatal visits are vital for monitoring the size and growth of fibroids and assessing their impact on the pregnancy. Regular monitoring helps in early detection of complications and timely intervention.
Delivery planning
Planning the mode of delivery is essential. In many cases, a scheduled caesarean section might be recommended to avoid complications associated with vaginal delivery, such as obstructed labour or postpartum haemorrhage.
Pain management
Safe pain management options should be discussed and made available. This might include medications and lifestyle adjustments to help manage the discomfort caused by large fibroids.
Emergency preparedness
Women should be informed about the signs of potential complications, such as severe pain, heavy bleeding, or decreased foetal movement, and should know when to seek immediate medical attention.
Individualised care
It is important to note that not every fibroid poses a risk. The management of fibroids during pregnancy should be individualised based on the size, number, and location of the fibroids, as well as the overall health and pregnancy history of the woman. By understanding these risks and having a clear management plan, women can better navigate their pregnancies, even in the presence of large fibroids.
Location-dependent complications
The impact of fibroids on pregnancy largely depends on their location within the uterus. Different types of fibroids, such as submucosal, intramural, and subserosal, can lead to varying complications. Here is the significance of fibroid location and its associated complications:
Submucosal fibroids
Submucosal fibroids, which grow into the uterine cavity, have a strong association with infertility and a higher risk of miscarriage due to their interference with the implantation and growth of the embryo. Surgical removal of these fibroids has been shown to improve pregnancy outcomes [9].
These fibroids can also cause heavy bleeding, which can lead to anaemia and other pregnancy complications [10].
Intramural fibroids
Intramural fibroids, located within the muscular wall of the uterus, can lead to an increased risk of preterm birth, miscarriage, and complications during delivery. They can affect the uterine cavity if they grow large enough, leading to similar complications as submucosal fibroids [11].
These fibroids can restrict uterine space and reduce blood flow to the placenta, potentially leading to intrauterine growth restriction (IUGR) [12].
Subserosal fibroids
Subserosal fibroids, which develop on the outer wall of the uterus, generally have less impact on pregnancy compared to submucosal and intramural fibroids. However, they can still cause complications such as pain and pressure on surrounding organs, which may necessitate medical intervention. Large subserosal fibroids can occasionally lead to complications such as preterm labour and malpresentation of the foetus, although these cases are less common [13].
In conclusion, the location of fibroids significantly influences the type and severity of complications during pregnancy. Submucosal fibroids are most associated with adverse outcomes such as miscarriage and infertility, while intramural and subserosal fibroids can also cause complications, albeit to a lesser extent.
At the Rylon Clinic, we prioritise the health and safety of both mother and baby by providing thorough assessments and advanced monitoring. Understanding the potential risks associated with larger fibroids allows us to tailor our care and management strategies effectively, ensuring the best possible outcomes for our patients.
Other potential problems with fibroids during pregnancy
In addition to the issues previously mentioned, larger fibroids can lead to several other complications that may affect the pregnancy. Understanding these potential problems is essential for managing and mitigating risks effectively.
Placental problems
Fibroids can interfere with the proper formation and function of the placenta. This can result in placental insufficiency, where the placenta does not provide adequate nutrients and oxygen to the growing baby. Additionally, fibroids can cause the placenta to attach abnormally, potentially leading to conditions such as placenta previa, where the placenta covers the cervix, increasing the risk of bleeding and complications during delivery.
Higher risk of pre-eclampsia
Women with fibroids are at a higher risk of developing pre-eclampsia, a condition characterised by high blood pressure and signs of damage to another organ system, often the kidneys. Pre-eclampsia can lead to serious, even fatal, complications for both the mother and baby if not managed properly. The presence of fibroids may contribute to the development of this condition by altering the uterine environment and affecting blood flow [14-15].
At the Rylon Clinic, we are dedicated to providing thorough assessments and advanced monitoring to manage the risks associated with fibroids during pregnancy. Our approach includes individualised care plans to address the unique needs of each patient.
Understanding and anticipating these potential complications allows us to offer proactive and effective management strategies, ensuring the best possible outcomes for both mother and baby. Our expert team, led by Mr Osama Naji, is committed to supporting women through their pregnancy journey, even in the presence of larger fibroids.
Considering getting pregnant with fibroids
If you are planning to get pregnant and have been diagnosed with fibroids, it may be beneficial to consider a myomectomy, a surgical procedure to remove fibroids, before conception. This proactive approach can help mitigate potential complications and improve the chances of a healthy pregnancy.
Benefits of myomectomy prior to pregnancy
Removing fibroids before pregnancy can offer several advantages:
Fibroids can interfere with conception by distorting the uterine cavity, blocking the fallopian tubes, or affecting the normal hormonal environment. A myomectomy can remove these obstacles, potentially enhancing fertility and increasing the likelihood of a successful pregnancy.
Large or numerous fibroids can cause significant issues during pregnancy, such as preterm labour, placental abruption, foetal growth restriction, and increased pain. Removing fibroids before pregnancy reduces the risk of these complications, promoting a smoother pregnancy journey.
By removing fibroids, the uterine environment becomes more conducive to embryo implantation and growth. This can lead to better pregnancy outcomes and reduce the likelihood of miscarriage, especially in cases where fibroids distort the uterine cavity.
When to consider myomectomy
A myomectomy is typically recommended in the following scenarios:
Symptomatic fibroids: If fibroids cause significant symptoms such as heavy bleeding, pain, or pressure, their removal can alleviate these issues and improve overall quality of life.
Large fibroids: As previously discussed, fibroids larger than 5-7 centimetres are more likely to cause complications during pregnancy and may be best addressed through surgical removal.
Multiple fibroids: The presence of multiple fibroids can collectively impact the uterus and increase the risk of pregnancy-related complications. Removing multiple fibroids can enhance the chances of a healthy pregnancy.
Risks and considerations
While myomectomy can offer significant benefits, it is important to be aware of the associated risks and considerations:
As with any surgery, myomectomy carries risks such as infection, bleeding, and complications related to anaesthesia. You will need to discuss these risks with your healthcare provider.
Recovery from a myomectomy can take several weeks. It is important to plan for sufficient recovery time before attempting to conceive.
In some cases, myomectomy can lead to scarring or weakening of the uterine wall. This may affect future pregnancies and could increase the likelihood of requiring a caesarean section.
If you are considering getting pregnant and have fibroids, consulting with a specialist at the Rylon Clinic can help you make an informed decision. Mr. Osama Naji and our team of experts can evaluate your specific situation, discuss the potential benefits and risks of myomectomy, and develop a personalised care plan to optimise your chances of a successful pregnancy. By addressing fibroids proactively, you can take important steps toward ensuring a healthy and positive pregnancy experience.
Conclusion
Pregnancy with fibroids can present unique challenges, but with the right care and management, a successful and healthy pregnancy is entirely achievable. Understanding the impact of fibroids on fertility and pregnancy, as well as the potential complications that may arise, allows for proactive and informed decision-making.
At the Rylon Clinic, we prioritise comprehensive assessments and advanced monitoring to ensure the best possible outcomes for both mother and baby. From the initial evaluation of fibroids' size, number, and location to the careful management of pregnancy-related risks, our approach is tailored to meet each patient's unique needs.
For women considering pregnancy, addressing fibroids through procedures like myomectomy can enhance fertility and reduce pregnancy complications. During pregnancy, regular prenatal visits, detailed ultrasounds, and individualised care plans help manage any issues that arise, ensuring a smooth and healthy pregnancy journey.
By staying informed and working closely with healthcare providers, women with fibroids can confidently pursue their pregnancy goals. At the Rylon Clinic, our commitment is to support and guide you every step of the way, ensuring that both you and your baby receive the best care possible.
References
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Mayo Clinic. (2023, September 15). Uterine fibroids diagnosis and treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/diagnosis-treatment/drc-20354294.
Mayo Clinic News Network. (2015, October 10). Mayo Clinic Q & A: Fibroids. Retrieved from https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-fibroids-and-pregnancy/.
Mayo Clinic News Network. (n.d.). Can uterine fibroids affect a healthy pregnancy? Retrieved from https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-can-uterine-fibroids-affect-pregnancy/.
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Author: Mr Osama Naji
Mr Naji offers a “one-stop” gynaecology clinic for instant detection of various gynaecological cancers as well as providing all the diagnostic and treatment services needed under one roof.
Mr Naji provides advanced gynaecology scanning which is essential when conducting any gynaecology consultation, he is bilingual in English and Arabic and has an NHS base at the highly reputable Guy's and St Thomas' Hospital in London.
He is passionate about raising awareness of various subtle signs and symptoms of gynaecological conditions that are often overlooked by patients.
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