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Uterine Fibroids & Pregnancy: Understanding the Impact

Fibroids complicate 2–12% of pregnancies. Most women with fibroids have normal pregnancies—but location, size, and number determine risk. Knowledge enables proactive management.

How Fibroids Affect Conception & Pregnancy

MechanismClinical Impact
Cavity distortion (submucosal ≥FIGO 2–3)Impaired implantation, ↑ miscarriage (2–3x), ↓ IVF success
Tubal compression (cornual/broad ligament)Mechanical infertility, ectopic risk
Altered uterine contractilityPreterm labor, malpresentation
Vascular competitionPlacental insufficiency → IUGR, abruption
Red degeneration (pregnancy)Acute pain, fever, leukocytosis, contractions — 2nd tri peak
Space occupationMalpresentation (breech/transverse), C-section indication

Pregnancy-Specific Fibroid Behavior

  • Growth: ~60–70% grow (esp. 1st tri), driven by estrogen/progesterone + blood flow. Most stabilize 2nd tri.
  • Red degeneration: Outgrowth of blood supply → ischemic necrosis. Self-limited (days-weeks). NSAIDs, hydration, rest. Rarely needs surgery.
  • Postpartum: Involution with uterine shrinkage. May become more symptomatic temporarily.

Management During Pregnancy

  • Asymptomatic, small (<5 cm), non-cavity-distorting: Observation. Serial ultrasounds for growth/placental position.
  • Symptomatic (pain, red degeneration): Conservative: analgesics (acetaminophen), hydration, activity modification. Avoid NSAIDs >20 wks.
  • Submucosal distorting cavity + infertility/recurrent loss: Preconception hysteroscopic myomectomy (strong evidence).
  • Large (>6–8 cm) / multiple / prior myomectomy: C-section often planned (uterine rupture risk on labor).
  • Myomectomy during C-section: Feasible for accessible subserosal/pedunculated; avoids second surgery. Controversial for intramural (bleeding risk).
  • UAE / MRgFUS / Ablation: Contraindicated in pregnancy.

Delivery Planning

  • Vaginal birth possible if: no cavity distortion, favorable presentation, no prior classical incision, no large lower segment fibroid blocking descent.
  • C-section indicated for: malpresentation unresolvable, prior classical/myomectomy with full-thickness incision, placenta previa/accreta, maternal request after counseling.

Postpartum Surveillance

  • Reassess size/symptoms at 6–12 weeks.
  • Breastfeeding may delay regression (prolactin).
  • Contraception: LNG-IUS treats HMB + prevents pregnancy.

Fibroids in pregnancy = high-risk label, not high-fear. Specialized OB/MFM co-management optimizes the "most likely good outcome."

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