Subject:  Pregnancy and Fibroids

Saturday, March 31, 2007    
Colon obstruction during pregnancy

Hi Mike and Hope,

Thanks for following up with Dr Umezurike.  I'm writing to give you an update on my wife's situation.  About 4 days ago, she had her first bowel movement in almost 3 weeks!  GoLYTELY (a laxative), did the trick and it even became a case of mild diarrhea.  She's feeling a lot better now and the colon obstruction seems to have been temporary.  The last 2 days, she was upgraded from a clear liquid diet to low fiber diets.  Today, she was discharged from the hospital and has been put under bed rest for a few weeks.  She has a ton of drugs to take in the interim but there's nothing better than seeing her smile and being able to move around freely with less pain.  The pain from the fibroid still exists but she has drugs to combat that until she's due.  A nurse will administer some of the drugs to her every week. 

I will keep you updated as things progress.  We're both thankful for your prayers and assistance.  Aurora, IL (Update Saturday, March 24, 2007)

Saturday, March 31, 2007  

Dear Hope,

"Thank you for seeking my opinion on the said case.  Here are my comments.

I have not encountered a case of colonic obstruction associated with fibroid in pregnancy before.  It is however rare for a 10cm fibroid to completely obstruct a large gut.  No mention was made about the other features of obstructed gut.  For instance is there abdominal distention, vomiting, distended loops of bowel and air-fluid levels above the point of obstruction.

If these features are not present the obstruction is most likely a partial one and the conservative approach currently adopted is appropriate.  If the obstruction is complete surgery will be required  before irreversible damage occurs to the gut.  Such a fibroid is most likely going to be a subserosal fibroid which can be removed without terminating the pregnancy.  There may be however a risk of premature labor which can even occur without surgery.  The pregnancy should not terminated.  The risk of premature labor is generally thought to be less in the second trimester."  -  Dr. CC Umezurike, Department of Obstetrics and Gynecology, Nigerian Christian Hospital, Aba, Nigeria

"Successful Myomectomy During Pregnancy: A Case Report"

Chisara Umezurike1 and Paul Feyi-Waboso2
1Department of Obstetrics and Gynecology, Nigerian Christian Hospital, Aba, Nigeria
2Department of Obstetrics and Gynecology, Abia State University Teaching Hospital, Aba, Nigeria

http://www.obgyn.net/fetal-monitoring/?page=/fm/articles/myomectomy 

Courtesy of OBGYN.net Fibroid Discussion Forum

Saturday, March 24, 2007 

Friday, March 23, 2007
Colon obstruction during pregnancy

Dear Hope and Mike, 

My wife is 20 weeks pregnant.  We discovered a large fibroid (7cm diameter) in her uterus 2 weeks before pregnancy so had little time to think about the complications that may arise from a pregnancy.  Things seemed normal for the first 17 weeks, however got significantly worse during the 19th week.  As a result of the severe pain, we went in to see the high risk pregnancy doctors, also to do an ultrasound which revealed the fibroid had grown to 11cm and was degenerating, thus causing the pain.  She was admitted and has been given a whole dose of drugs to relieve the pain, and these seem to be helping somewhat. 

The major problem now is that she hasn't had a bowel movement in the last 12 days.  The GI, after multiple exams, determined that the fibroid was obstructing her colon thereby preventing her from going to the bathroom.  From what I'm hearing, this is a very unusual case and given that she's pregnant, the options for us are very limited.  In fact, the way we understand  it now, the only option we have is to wait and see what happens.  They are hoping that once the baby grows bigger, it might be able to push the fibroid off the colon.  She has been placed on liquid only meals the last 1 week and there doesn't seem to be anything else they can do.  So far, we've been told that the baby is doing fine and is oblivious of what her mother is going through.  We sincerely hope this is the case and that the drugs she has been taking are not going to harm the baby or stunt growth.  She's taken Indocin, Morphine etc. so far. 

Can you please let us know if there have been similar cases?  We would also love to know what these people did to get their problems resolved? We would also want to get recommendations for physicians that are experts in these kinds of situations.  This is our first pregnancy and we're planning on having at least 1 more, so removal of the uterus is really not an option at this point.  My wife just turned 29 last month. 

Lastly, my wife and I are from African descents.  Thank you so much for your help.  We look forward to hearing from you soonest.  Regards, Aurora, IL   

=========

Francis L. Hutchins, Jr., MD, "Various forms of obstruction of the colon by fibroids are known to occur but are rare.  I believe that the liquid diet approach is likely the best under the circumstances.  What you seem to be occurring is partial obstruction which has caused a form of constipation.  Anything that can empty the lower colon including an enema or suppository may also help along with liquefying the stool through liquid diet and stool softeners.

The enlargement of the fibroid is also likely to decrease with time as the pregnancy progresses and this too should help."

  *****************

Monday, May 14, 2007 -  A Boy!   

So happy to let you know that everyone is happy and healthy.  I have been waiting for my wife to post her version of events but we are both so short on time that I thought I would at least give you a quick update.  Our son was born on 1/26/07.  He weighed 8 pounds and 15 ounces.  He is happy and healthy as could be.  Started with an apgar of 7 I think and quickly moved up to a 9.  Over the last 3 and a half months he continues to thrive and is as dear to both of us as you can imagine.   I am as proud a father as there could be.  Against the warnings of the perinatologist, he was born vaginally.  Don't let anyone ever tell you there's 0% chance of it happening, our little one is proof that it can happen.  We are both very very grateful for our doctor who was willing to have a wait and see attitude.  As long as he was ok and mom was ok she was always willing to see if he could be born vaginally, even after all the other doctors she consulted with told her she should just have us schedule a C-section because there was no way he was coming out the usual way.  I'll let my Wife tell more of the story later.  Our Son is now 18 pound or so and somewhere around 25-26 inches tall.  He's a very big boy and he laughs and makes us laugh all the time.

I am very grateful for your site and the courage it gave us to continue in the face of great negativity.  I urge everyone to stay hopeful, stay wise and just be open to what will be, whatever course that is. -  Many many many thanks, Proud Pappa.  (Update from A loving Husband and Dad, Friday, November 3, 2006)

Friday, November 3, 2006   

I realized it had been quite some time since my last letter and I wanted to give folks an update.  The baby boy is healthy and growing well.  He's very active and should be due January 13th.  The doctor is hopeful that he will get his head down and be able to get to the birth canal.  This would avoid having to have a C-Section.  Fingers are all crossed.  Good news is that even if there is a C-Section she thinks there is a very good window for getting him out without having to go through the fibroid, which should mean much less bleeding.  My wife did have one bout of fibroid pain that she qualified as some of the worst pain she's ever had.  Doctor said she was pretty sure it was fibroid degeneration pain but the fibroid has not really changed shape recently.  The pain lasted about a week maybe 10 days at most and was managed mostly with Tylenol.  The doctor once we chose to proceed has been very supportive and has moved away from trying to scare us.  We have seen many beautiful pictures of him in utero and are very excited to see him when he comes.

I will send more info later, just wanted to let folks know how things are going.  Again, I am very grateful for your site and any good wishes people would like to send our way.

Sincerely,
A loving husband and dad to be... (Update from A loving Husband and Dad, Sunday, July 2, 2006)

Sunday, July 2, 2006

Dear Dr. Hutchins, 

Thank you for the work that you have done in helping to educate women and their spouses about fibroids.  My wife was diagnosed as having a fibroid about 3-4 years ago.  Up until recently she was mostly in a wait in see mode as the fibroid remained stable at about 5-7cm, was intramural and pain and bleeding were by no means severe.  In early May of this year to our great joy we found out that my wife was pregnant.  

This joy turned to anguish for my wife when the doctor (who was very sweet, compassionate and understanding) told her she was worried about the size of her fibroid which ultrasound indicated was a lobulated 10x6X6 fibroid.  She said she would recommend a D&C if she thought the pregnancy was unplanned but as she could tell it was not she said we would just have to wait and see how the pregnancy would go.  She also voiced understandable concerns about the possibility of premature labor, miscarriage and possible inability of the baby to have enough room to grow.  She was also concerned about the rapid growth of the fibroid.

She said we should seek a consultation with a perinatologists, which we did today. 

Your book has been of great solace to both myself and my wife.  She was quite fearful and distraught the first day she heard about the enlargement of the fibroid.  That night I was able to find your writings on the Hope For Fibroids site which helped to console her and give her hope. 

On a positive note, the baby implanted its placenta on the uterine wall away from the fibroid and in the time from first visit to the visit with the perinatologist seems to be flourishing well.  We got to see its heart beat as well as some kicking and wriggling, which I found breath taking.   

The perinatologist said there was 0% chance of a vaginal birth.  I do not have the greatest amount of faith in his diagnosis as he spent perhaps 10 seconds trying to get an image of the fibroid on his "old" machine.  He also did not spend much time palpating the uterus.  

I spend nearly every night before we go to sleep gently massaging the fibroid, which helps to relieve my wife's anxiety about it.  In the end the perinatologist also left us with wait and see which is understandable and said it was probably that the baby with find a way to make room for itself in the uterus but that depended on fibroid growth and there was no way to predict outcome. 

In the end I am left wondering if you know of any doctors in our area who you would recommend for a second opinion about the 0% chance of a vaginal birth also of a good surgeon to see about a c-section since this seems likely.  Any words of hopefulness you may have in this matter would also be appreciated.  I understand the difficulty in speaking to a case, which you have not seen with your own, two eyes.  With that in mind, any help you could lend in this situation would be greatly, greatly, appreciated. 

Eternally thankful for the work you have done in this field.  (A loving Husband and Dad, Sunday, July 2, 2006)