It has commonly been thought that most fibroids will increase significantly in size under the influence of the large amounts of female hormones produced in early pregnancy.  Careful study, however, has demonstrated that most fibroids do not increase in size during pregnancy and those that do will tend to return to their pre-pregnancy size after delivery. 

Fibroids in a minority of cases can be associated with severe complications during pregnancy.  A  patient of mine, who was 38 at the time, began what appeared to be a normal pregnancy.  She and her husband were quite elated. Both had been previously married and divorced and this marriage seemed to be just the right match for both of them.  It became apparent in the early months of the pregnancy that she had several fibroids in her uterus.  During the middle months of the pregnancy these fibroids seemed to enlarge which caused her a significant amount of pain that was successfully treated with mild pain relievers.  At about seven months, she called me complaining of some cramping pain similar to menstrual pain.  I referred her immediately to the hospital where she was found to be in premature labor.  Despite efforts to control the labor, her water broke after several hours in the hospital. Attempts to delay delivery were further complicated by the development of an infection in her uterus.  She subsequently went into full-blown labor and delivered a premature, one pound baby which developed severe infection and several other problems in the nursery. She unfortunately continued to show signs of serious infection in her uterus, which required aggressive treatment with multiple antibiotics.  Her infection resolved and she was able to be discharged after a ten-day hospitalization. 

The baby, meanwhile, was having extensive problems and required long term support on a respirator to help him to breathe.  He also developed infection and experienced multiple convulsions.  After several months in the neonatal intensive care unit, his problems resolved and he was discharged.  Unfortunately, he had experienced extensive brain damage with quadriplegia and blindness.  Although, most pregnancies with fibroids are uneventful, a small percentage can result in these extreme and devastating consequences. 

Such a premature infant has an increased risk of brain damage and other injuries because of incomplete development of various organ systems.  Although premature delivery is increased in association with myomas during pregnancy, the majority of women, as stated before, will not have this problem. 

Because the tumors may be growing in the lower part of the uterus it is possible for them to cause partial blockage of the birth canal, which may require a cesarean section in order to deliver the baby. 

In the late 70' s I was a supervising resident in a teaching service when I was presented with a 32 year-old Chinese immigrant who was pregnant with her first child.  She had a very large myoma in the lower part of her uterus.  As the pregnancy enlarged, the tumor became firmly wedged in the bony entrance to the birth canal.  As a consequence, the canal was blocked and the baby was held high in the uterus.  The dilemma was, how are we going to deliver this baby if the tumor is blocking the birth canal.  The tumor could not be safely removed safely during pregnancy and it could not be shrunken by any mechanism.  A Cesarean section would be necessary.  At the time of surgery, the fibroid was found to occupy the lower half of the uterus making it extremely difficult to find a location to cut into the uterus to remove the baby.  When a site was found and the incision was made, the baby was removed, but the mother hemorrhaged profusely because of the myoma's distortion of the blood supply to the uterus.  During and after the operation she required transfusions with multiple units of blood.  Fortunately both mother and baby survived this experience with no long-term complications. 

Proper understanding of the hazards of pregnancy in the presence of fibroids is very aptly demonstrated in another of my patients who was advised to have her pregnancy aborted because a fibroid had been incidentally diagnosed at her first prenatal visit. Unfortunately, this advice was followed and she underwent an abortion.  Once a pregnancy has been established in a woman who has fibroids, there is no way to distinguish those women who will ultimately have complications from those who are not likely to have complications.  Thus, the best approach is to assume that all of these pregnancies will be uncomplicated.  It is not justifiable without any other indication for the pregnancy to be terminated.  There is every reason to believe that had the pregnancy been allowed to proceed undisturbed, it would have resulted in the birth of a healthy baby at term. – Francis L. Hutchins, Jr., M.D. 

Uterine Artery Embolization and Pregnancy -  refer to “PREGNANCY AND UTERINE FIBROID DISEASE”:  Part 1 and Part 2. – Robert Worthington-Kirsch, M.D.


 

Fibroids:  Pregnancy & Contraception (Page 1)