When fibroid co-exists with pregnancy
Dr. Samuel Adebayo
Uterine fibroid, also known as Leiomyoma, is a benign (non-cancerous) tumour of the uterus (womb). Fibroids are the most common benign tumours in females and they occur during the reproductive years. They occur in up to 50 per cent of women.
The exact cause of this tumour is unknown; but some factors are associated with increased chance of developing uterine fibroid.
A family history is a factor. History of fibroid developing in women of the same family or race plays a role in a woman’s life. African women have between two and three times chances of developing fibroid than white women. Also, African women develop fibroid at a younger age, usually in their 20s and above, unlike white or caucasian women where fibroid may occur in their 30s or 40s.
No pregnancy or low pregnancy rate increases the risk, just as early onset of menses may also increase the risk of developing uterine fibroid. Obesity, alcohol consumption, and hypertension may also increase the chance of developing uterine fibroid.
Most women with fibroids have no symptoms. They may not even be aware that they have it. The most common symptom is abnormal bleeding when the tumours are near the uterine lining (that is womb lining). It can cause heavy periods, prolonged periods, or spotting or even bleeding between menses.
This excessive bleeding may lead to shortage of blood. It may also cause severe abdominal pain. Fibroid may also cause other symptoms, depending on their sizes, location and their closeness to other pelvic organs.
Because fibroid occurs during the reproductive age of women, fibroid and pregnancy may co-exist. Usually, because of the hormones of pregnancy, the fibroid tends to get bigger in pregnancy, though may also remain unchanged. In a few cases, they may even reduce in size. However, fibroids can complicate about two per cent of pregnancies.
Most women whose fibroids are co-existing with pregnancy will not develope any complication throughout the pregnancy and delivery, but about 20-30 per cent will develop one form of complications or the other from the onset of the pregnancy up to the time of delivery and afterwards.
A pregnant woman with co-existing firboid may be aware of the fibroid prior to pregnancy, or it may be detected during a routine early pregnancy ultrasound scan. It may even be a clinical observation during routine antenatal clinic when the womb appears far bigger than the age of the pregnancy.
In early pregnancy, presence of multiple uterine fibroids may be associated with increased risk of miscarriage. In late pregnancy, it could predispose to abnormal presentation of the baby, especially when the fibroid is occupying the lower segment of the womb. In other words, the fibroid may occupy the space where the head or the buttocks of the baby are supposed to be if the mother must have easy vaginal delivery.
The presence of multiple uterine fibroids in the womb may prevent the baby from turning at the right time; hence, the baby may be in an abnormal position from the beginning of the pregnancy to the onset of labour.
The presence of fibroid co-existing with pregnancy may present with an unusual pain during pregnancy. This is as a result of what is called “red degeneration of the fibroid mass” that occurs in pregnancy. The pain may be severe enough to require hospital admission during the pregnancy.
Also, presence of fibroid in the lower part of the womb may obstruct the labour process, making delivery very difficult or even impossible.
Multiple uterine fibroids may make labour process slow or ineffective. The presence of uterine fibroid increases the rate of operative delivery such as Cesarean Section.
After delivery, presence of multiple fibroids in the womb may make the womb contract poorly; thus increasing the chance of post-partum haemorrhage (that is excessive bleeding after delivery).
Treatment of fibroid in pregnancy depends on the presenting complaints and the gestational age. If pain is present, strong pain-killer that is safe in pregnancy is used. If presented with pre-term contraction, a group of drugs called Tocolytics are used to stop the womb from contractions that may lead to premature labour and delivery.
Multiple uterine fibroids may prevent the baby from presenting normal for normal vaginal delivery. In this case, surgery will be a better option. For example, fibroid in the lower part of the womb may obstruct labour and require surgical intervention.
After delivery, either by normal vaginal delivery or Cesaerian Section, medications are usually given to contract the womb adequately to reduce excessive bleeding that may complicate the delivery.
The removal of fibroid during Casearian Section is called Casearian Myomectomy. This procedure is still controversial, though; and it has been carried out successfully in some centres, but it still not a common practice.
Any pregnant woman with co-existing fibroids must register early and have a standard antenatal care, with skilled attendants at delivery to reduce or even avoid the likely complications that may arise during labour or after delivery.
Culled from Punch
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