How did you give birth with uterine fibroids? The course of pregnancy and its features

Every woman should understand that any disease can affect conception, pregnancy and childbirth.

This is especially true for gynecological pathologies. Today we will talk in detail about uterine fibroids and the possibility of getting pregnant if you have this disease.

Before planning a conception, it is best to pay maximum attention to your own health and undergo a full examination. This approach will help avoid many problems in the future. It is important to diagnose possible pathologies and start treatment as quickly as possible. However, you need to understand that it is not always possible to fully recover.

Uterine fibroids are a fairly common disease that occurs in every fourth patient, regardless of age. What to do if a pathology is detected, and are there any chances of having a baby?

What is a myomatous node?

Myomatous node is a benign tumor localized in the muscular and mucous layers of the uterus. The formation of such a node occurs due to an imbalance hormonal system. Also, the appearance of fibroids can be provoked by artificial termination of pregnancy, surgical interventions and complications after delivery.

Symptoms of uterine fibroids

Very rarely, any symptoms appear with this disease. Most often, patients do not feel pain or discomfort. In this case, the node can only be diagnosed using ultrasound.

However, a third of the patients still experience bleeding, slight pain, problems with urination, etc. Symptoms depend on the location of the myomatous node. The following types are distinguished:

subserous (subperitoneal) fibroids;
submucosal (submucosal) tumor;
muscular or interstitial fibroids;
fibroids located in the interligamentous apparatus are intraligamentary.

Each of the classifications has its own characteristics, and the course of pregnancy is directly related to them.

Conception with uterine fibroids

Whether you can give birth with uterine fibroids or not depends on the impact of the node on the processes occurring in the woman’s body. It is very important to establish its exact placement. Nodes consisting mainly of muscle tissue, and subserous do not affect pregnancy. These types of fibroids do not interfere with the passage of the egg through the genital tract and do not modify the shape of the organ.

As for submucous fibroids, this is somewhat different. Such a tumor is often located in the corner of the uterus, and this prevents the passage of the egg into the organ cavity.

Myoma can cause the inability to attach ovum, if it is located near the fundus or on the back surface of the uterus. Attachment can also occur in the cervical area. In this case it happens great loss blood as a result of placental abruption, which is a reason for an abortion. In addition, spontaneous miscarriage may occur early stages.

As mentioned above, uterine fibroids are closely related to malfunction hormonal system. Hormones, in turn, are of great importance during conception and pregnancy. It is known that many patients with fibroids do not ovulate, without which it is impossible to conceive a child.

If nodes are not diagnosed large sizes, specialists most often prescribe drug treatment with hormones in order to normalize natural processes, such as menstruation and ovulation. If treatment gives positive effect, then the nodes resolve and hormonal background is being restored.

The course of pregnancy with uterine fibroids

The course of pregnancy is also closely related to the location of the fibroids. If the attachment of the fertilized egg occurs near the fibroid, then the chances of bleeding increase sharply. In addition, the placenta may be deformed due to which the fetus does not receive required quantity oxygen and nutrients. Node absorbs large quantity blood than the fetus itself. In such cases, artificial termination of pregnancy is usually prescribed.

Submucous fibroids are especially dangerous during pregnancy. Such a tumor grows inside the uterine cavity, reducing the space needed for the fetus. With submucous myoma, pathologies in the fetus associated with incorrect formation skulls If experts determine the possibility abnormal development brain, it is proposed to terminate the pregnancy by medication.

It is worth noting that there are cases when the resorption of nodes occurs under the influence of hormonal drugs. However, it is difficult to diagnose the complete disappearance of nodes using ultrasound screening, since they tend to stretch along the uterine cavity.

Treatment with hormones for uterine fibroids

The condition and changes of the myomatous node directly depend on hormones. Drug treatment prescribed if there is a risk of miscarriage. Most often, experts recommend taking medicines based on gestagens. These substances can provoke an enlargement of the node, but taking the drugs usually continues until the 16th week of pregnancy. However, if it is determined that the fibroid is growing, the dosage is reduced. Discontinue the drug after signs of threatened miscarriage have decreased.

Complications with myomatous node

During pregnancy, the myomatous node gradually changes: it grows or shrinks. In the process of stretching the uterus, disturbances in the blood circulation of the node often occur and, as a consequence, necrosis. This phenomenon is an absolute indication for abortion. If the fibroid leg is twisted or pinched, then artificial termination is also prescribed.

Pregnancy is categorically excluded in case of malignant processes, the presence of submucosal nodes and fibroids located in the cervical area. A large number of fibroids can cause poor uterine contractility during childbirth.

Every year, the cells of the uterus are renewed less and less. Doctors do not recommend planning a pregnancy after forty years if you have fibroids. Patients who give birth with fibroids usually develop diseases due to anemia. Changes in the body in such cases are also indications for abortion.

Uterine fibroids are increasingly being diagnosed in young women who want to have a child. Pregnancy and childbirth in such patients often occur with complications. Despite this, the answer to the question of whether it is possible to give birth with uterine fibroids is positive. Obstetricians use different tactics depending on the specific situation, to preserve the health of mother and child.

Features of the course of pregnancy and childbirth with uterine fibroids

The main danger of pregnancy in the presence of a myomatous node is the frequent threat of its termination. As this condition progresses, a miscarriage may occur. If premature birth occurs with multiple myomatous nodes, then curettage of the uterine cavity does not stop bleeding from the genital tract, and sometimes doctors are forced to remove the entire organ. This situation becomes catastrophic for a woman expecting a child. To prevent miscarriage, a doctor examines a patient with fibroids more often than healthy women, prescribes medications to maintain pregnancy in the early stages, and if necessary, hospitalization is performed.

Other complications of gestation that may affect labor management:

delayed fetal development;
rapid increase in size of the myomatous node;
necrosis of tumor tissue;
abruption of the placenta located above the tumor formation;
incorrect position and presentation of the fetus.

Why is fibroid dangerous during childbirth?

It can cause the following complications:

premature rupture of amniotic fluid;
weakness of ancestral forces;
fetal distress syndrome;
tightly attached placenta;
atonic bleeding in the 3rd stage of labor;
insufficient reduction() in postpartum period and others.

In connection with all of the above, the protocol for childbirth complicated by uterine fibroids provides for frequent surgical delivery, that is, a cesarean section. Often the myomatous nodes themselves are removed at the same time, or there is a need for hysterectomy (removal of the organ). The decision on the method of delivery is made in each case individually.

Is natural childbirth possible or is caesarean inevitable?

This depends on the size and location of the tumor, complications during pregnancy and childbirth, the equipment of the maternity hospital, the experience of doctors and many other factors. Here are the statistics from one of the largest Russian research institutes of obstetrics and gynecology:

At 16-18 weeks of gestation, 16% of women, for certain indications, underwent myomectomy - removal of myomatous nodes; in 60% of them, the pregnancy was preserved and completed by cesarean section.
Surgical delivery was performed in 31% of patients, usually when fibroids were combined with other obstetric pathology or extragenital diseases.
53% of women with fibroids, with their small size and no signs of impaired blood supply to the node, were able to give birth naturally with a favorable outcome for mother and child.

You can read about uterine fibroids, its types, causes of the disease and principles of treatment in.

Tactics for managing the gestational period and childbirth with giant fibroids

Delivery in the presence of large fibroids is often accompanied by complications that develop prematurely. It is with giant fibroids, which are accompanied by signs of compression of the pelvic organs and impede the development of the fetus, that conservative myomectomy (removal of the tumor) may be indicated at 16-19 weeks of the gestational period (maximum up to 22 weeks). Then the pregnancy is prolonged, and at 37-39 weeks it ends with a caesarean section.

This operation often serves the only way save the pregnancy or at least the uterus. However, not all experts share this opinion. Many doctors believe that even with a large tumor, the fetus can be saved, whereas during pregnancy it often ends in termination.

The question of treatment tactics for large fibroids is decided individually. Great importance here the doctor has experience in carrying out such interventions.

C-section

In approximately one third of patients, labor with uterine fibroids is completed by surgical intervention. Of these, in ⅔ cases the operation is planned, in ⅓ it is performed after the start labor activity. Elective intervention is prescribed for patients with high obstetric risk. Their natural birth process can result in severe complications, including uterine rupture.

Indications for planned caesarean section:

The location of the neoplasm in the isthmus, lower segment or cervix, which prevents the normal movement of the child along the birth canal.
Significant increase in fibroids by later pregnancy with the appearance of signs of nutritional disturbances.
Suspicion of a malignant tumor: its rapid growth, large size, soft consistency, pain, signs of anemia.
Multiple large intermuscular nodes.
The diameter of the tumor is more than 10 cm, if it was not removed in the 2nd trimester.
A scar on the uterus after a previous myomectomy, especially if it was performed laparoscopically. At the same time, the consistency of such a scar is difficult to assess.

In a third of patients, birth with uterine fibroids is completed by caesarean section

In many cases, surgery is performed due to a combination of several factors. If only one of the following reasons is present, childbirth can be natural, but a combination of them significantly increases the risk of complications:

endometriosis and adenomyosis;
cervical immaturity;
fetoplacental insufficiency;
age over 35 years;
previous long-term infertility;
high myopia.

Natural childbirth with uterine fibroids ends in cesarean section with the development of weakness or other anomalies of labor, as well as with fetal hypoxia.

The operation is performed under epidural anesthesia or general anesthesia. For multiple or large nodes, a longitudinal or transverse incision is required abdominal wall, providing good access to the uterus. It's necessary:

For complete removal fibromyoma nodes along with their capsule;
for safe and free removal of the child.

In these cases, cosmetic results are of secondary importance, but surgeons still try to maintain a balance between the health of the mother, child and subsequent appearance abdominal wall. If the tumor is small, an incision is made in the lower abdomen and a cosmetic suture is applied.

The condition of newborn children in 70% of cases is satisfactory, in the rest there are signs of mild hypoxia, which then quickly stops under the influence of treatment.

IN postoperative period complications are usually not observed. Only in isolated cases uterine subinvolution or wound infection develops.

Read more about performing a cesarean section.

Expanding the scope of the operation

In many cases, after the baby is removed, the volume surgery expand. Myomectomy may be performed in in rare cases– supravaginal amputation or extirpation of the entire organ.

Cases when, after cesarean section, myomatous formations are removed (myomectomy):

nodes on legs located under the peritoneum;
the largest of several myomatous nodes;
single node;
insufficient blood supply to one of the nodes.

This operation is not performed if the patient is over 40 years old, or with multiple small nodes. It is dangerous due to the development of bleeding if the ligation or coagulation of the vessels is not good enough. Therefore, after it antibiotics are prescribed, agents for contracting the myometrium in combination with antispasmodic drugs. On days 3-5, ultrasound control is performed.

Cases when, after cesarean section, it is possible to remove the uterus for fibroids:

multiple nodes in women over 40 years of age (with the patient’s consent);
node necrosis;
renewed tumor growth after a previously performed myomectomy;
location of the tumor in the area of large choroid plexuses, in the lower segment, between the ligaments, under the mucous membrane;
growth of formation in the direction from the periphery to the center of the uterus;
low location of nodes;
malignancy of the tumor, confirmed by urgent histological examination.

How is uterine fibroid removal performed? rehabilitation period And possible consequences. About this in.

Spontaneous labor

More than half of patients with fibroids can give birth on their own. Even multiple myomatous nodes, if they are small, located in the outer layer and do not interfere with delivery, are not an indication for cesarean section. The natural birth process is also possible in women over 35 years of age, with hypertension, increased thyroid gland, myopia and other extragenital diseases without signs obstetric pathology. However, in all these cases the obstetric risk should be low.

Most patients are hospitalized at 37-38 weeks. Preparations for labor begin with the use of sedatives, antispasmodics, and prostaglandin preparations.

Antispasmodic drugs are prescribed in the form of suppositories, tablets or injections. They are necessary to reduce the tone of the myometrium in order to avoid compression and disruption of nutrition of the myomatous formation.

Since when fibroids are localized by back wall a tumor cannot always be detected during pregnancy; each such patient is examined in depth, including for possible surgery. Doctors monitor the following indicators:

data from blood tests, coagulograms, ECG;
state of uteroplacental blood flow;
fetal position and presentation;
correspondence between the sizes of the fetal head and the mother’s pelvis;
degree of maturity of the cervix.

How is childbirth?

During the entire period, additional monitoring of the condition of the woman and fetus is carried out, as indications for emergency surgery. Can be used. Average duration birth process with fibroids it is 17 hours.

Features of the flow natural birth with uterine fibroids:

Prescription of antispasmodics in active phase 1st period until the cervix opens by 5-8 cm to avoid disruption of the blood supply to the nodes.
Limiting or refusing to stimulate labor with oxytocin.
If necessary, such stimulation is carried out using prostaglandin preparations, which not only prepares the cervix well, but does not disrupt the blood supply to the uterus.
Prevention of fetal hypoxia.
Prevention of bleeding in the 3rd and early postpartum period by administering methylergometrine.

Childbirth with is observed quite rarely, since with this location of the node, pregnancy is usually terminated on its own in the 1st trimester.

Of the complications, in 43% of cases there is premature rupture of water, in 5% - bleeding in succession period. After labor is completed, there are usually no complications. 70% of children are born in satisfactory condition, the rest show signs of hypoxia. Discharge occurs within 5-7 days. Only in rare cases is additional hospital care required for the newborn.

Long-term results

Pregnancy has a beneficial effect on the course of uterine fibroids. Long-term hormonal effects on tumor tissue, gradual stretching of the myometrium, normalization of its structure and blood supply contribute to the fact that favorable conditions for the formation of new nodes are absent.

For most women, fibroid growth stops for at least 5-8 years after childbirth. Tumor enlargement is recorded in 10% of patients, with the main causes being:

refusal to breastfeed during the first six months of a child’s life;
taking hormonal contraceptives;
abortion by curettage of the uterine cavity.

The only remedy for FIBROID and its prevention, recommended by Natalya Shukshina!

As shown medical practice, in cases of slight progression of the disease, patients with uterine fibroids are quite capable of becoming pregnant. At the initial stages of its occurrence, fibroma is not able to influence reproductive function. The only exceptions that can be noted are those formations that directly block the path of sperm through the fallopian tubes. The egg loses the ability to be fertilized, and accordingly the woman loses the opportunity to become pregnant. This disease can be detected using radiography or ultrasound.

The nature of the female body is designed in such a way that during the period of bearing a child, the uterus is mechanically rebuilt, it begins to stretch and enlarge. To supply the enlarged organ with blood, new vessels begin to grow into the muscles, thereby increasing the volume of blood flow. An increase in myomatous nodes can be observed only in the first and second trimester. After the third trimester, the size of the fibroids should become smaller.

When receiving a consultation at the clinic, ask yourself the following questions:

Does this clinic have all existing methods treatment for fibroids or only surgery is available to them.
How objectively were you told about the effectiveness? surgical method treatment (the likelihood of complications, relapses and, most importantly, what is the likelihood of pregnancy and its safe bearing).

If you did not plan a pregnancy, and it happens, do not make hasty conclusions. You should not have an abortion and blame it on your diagnosis. In gynecology, cases have been recorded where abortion irrevocably and negatively affected the woman’s condition and led to even more complex consequences.

For some women, childbirth gives them a chance to get rid of fibroids forever. When a gynecologist sees that a woman will not be prevented from carrying an illness and giving birth on her own healthy baby, she is always dissuaded from “killing” the fetus. A preserved pregnancy can not only play a key role in overall recovery, but also bring a feeling of motherhood, which also plays an important role for a woman.

General symptoms during the development of myomatous nodes

Pulling painful sensations, feeling of heaviness in the lower abdomen.
Uterine blood loss.
Frequent urge from the urinary organs.
Problems with stool.

Myoma tends to develop without causing any trouble to the woman, so advanced situations can only be cured by surgical techniques.

The influence of uterine fibroids on pregnancy and childbirth

Myomatous nodes always affect the entire period of pregnancy, to put it mildly, not the best way. In a patient with large uterine fibroids, the space in the uterus itself for the development of the embryo is significantly reduced. In such cases, miscarriages may occur in later stages, even after the eleventh week of pregnancy. You may also face the risk of premature birth, which will also not have a beneficial effect on the child’s health. He will be born underweight and quite weak.

Sometimes it is difficult to save a child if he was born before seven months. This is due to the fact that vital important organs they did not have time to fully develop for a full-fledged existence. To save a child, you need highly qualified doctors, modern equipment and the invaluable help of the mother in labor. Large myomatous nodes on the walls of the uterus during pregnancy can affect the position of the fetus in the womb. Of course, a woman is able to carry a pregnancy regardless of how the baby is positioned. But in the future, incorrect presentation of the child will greatly complicate the delivery process.

When labor takes too long and is exhausting female body, doctors perform a caesarean section. It is especially dangerous when myomatous nodes are located too low in relation to the cervix. They represent some kind of obstacle to the passage of the baby's head. Another dangerous point with uterine fibroids is the hormonal status expectant mother. After all, while carrying a child, it completely changes. hormonal levels in the blood, thereby increasing the amount of estrogen. A large amount of estrogens can provoke the growth of myomatous nodes.

The influence of uterine fibroids after childbirth

Of course, medium, large or multiple nodes bring many problems not only to the mother and child, but also leave the following complications after childbirth:

The growth of an organ that carries out communication and metabolism between the mother’s body and the embryo during intrauterine development (placenta).
Incomplete separation of the placenta.
Tight attachment of the placenta.
Low uterine tone, leading to heavy bleeding.
Development of infections.

By the later postpartum complications can also be attributed to an incomplete return to normal state organ of the female reproductive system. After delivery, the uterus is simply not able to return to its original size, remaining enlarged. Myoma is a direct provocateur for infection of the cavity of the organ of the female reproductive system.

Every year the number of women who have to give birth with fibroids increases. This disease has not yet been fully studied, but it is known for sure that fibroids do not have a beneficial effect on pregnancy and childbirth, lead to difficulties in conception by squeezing the fallopian tubes, occur during and before pregnancy, tend to enlarge and bring significant complications, and lead to spontaneous abortions . An irresponsible attitude towards one's condition leads to the inability to give birth or the removal of an organ of the female reproductive system.

It is possible to carry a pregnancy to term with uterine fibroids, and in some cases, women are able to give birth on their own. But you need to treat your health and that of the newborn baby with care. full responsibility and be under constant supervision of your gynecologist. In this way, further growth of uterine fibroids can be prevented. If you want a favorable pregnancy outcome, see your doctor even more often than scheduled.

The formation of myomatous nodes is a fairly common phenomenon in women, but it is not always an insurmountable obstacle to bearing and giving birth to healthy children. In any case, childbirth will occur with some complications. Some women are even at risk of premature water rupture and possible bleeding. Any disease can be cured by initial stage by prescribing effective drug treatment.

By secret

Incredible... You can cure fibroids and other tumors forever!
This time.
Without taking antibiotics!
That's two.
Results in a week!
That's three.

Follow the link and find out how Natalya Shukshina did it!

IN last years V obstetric practice more and more women are found reproductive age suffering from uterine fibroids and planning to conceive a child. The doctor observing such a patient has to decide complex issue: Is pregnancy permissible with this pathology and will bearing a baby turn out to be an impossible task? To answer this question unambiguously, it is necessary to assess the woman’s health status, determine the severity of the disease and find out other factors that can interfere with the implementation of reproductive function.

We hasten to clarify: uterine fibroids and pregnancy are quite compatible, but only if certain conditions are met and all doctor’s recommendations are followed. After all, if some women manage without medical intervention carry and give birth healthy child, then other preliminary treatment cannot be avoided. How does fibroid affect the course of pregnancy, and what should every woman know about this problem?

General information about the disease

Before we talk about possible risks for a woman and her baby, it should be understood. This diagnosis is made when detected in muscle layer benign uterine tumor. Pathology is detected during a gynecological examination or ultrasound, the diagnosis is confirmed by hysteroscopy or laparoscopy. Other names for the disease are leiomyoma, fibromyoma (fibroma).

This is what a pedunculated uterine fibroid with dimensions of 6.8 x 5.3 cm looks like during ultrasound examination.

On a note

Uterine fibroids are more common between the ages of 35-45 years. In young patients during menopause - with endometrial hyperplasia.

According to localization, there are three variants of nodes:

Subserous - grow towards the outer lining of the uterus;
Submucosal – deform the uterine cavity;
Interstitial - does not extend beyond the muscle layer.

Violation menstrual cycle;
Acyclic uterine bleeding;
Chronic pelvic pain.

The treatment of the neoplasm is carried out by a gynecologist. When the first symptoms appear, you should make an appointment and get detailed advice. The sooner a diagnosis is made and treatment is started, the greater the chances a woman has for favorable outcome pregnancy.

Under influence hormonal changes Myomatous nodes can increase in size, so the earlier a fibroid is detected and the smaller its size, the greater the chance of treating the tumor conservatively.

Pregnancy with fibroids: what you need to know

Some statistics designed to shed light on some aspects of pathology:

Uterine fibroids sooner or later occur in almost all women (up to 85%);
Clinical manifestations of the disease occur in only 30% of patients;
During pregnancy, the tumor is observed in 0.5-4% of cases;
In 60% of patients there is a slight change in tumor size (in any direction), in 40% the diameter of the node does not change;
In 20-25% of cases, growth of formation is observed (typical for - from 5 cm);
Maximum height fibroids occur in the second trimester, minimal - after 24 weeks;
The total diameter of the tumor increases by no more than 25% (on average 10-12% compared to the original size);
In 8-27% of cases, regression or decrease is observed;
In 60% of expectant mothers, medium-sized nodes (2.5-5 cm) are not detected by ultrasound at the end of pregnancy;
Small tumors (up to 2.5 cm) often stabilize (do not grow or shrink);
Complications during pregnancy in the presence of fibroids occur in 15-40% of cases.

So, it is possible to bear and give birth to a child with uterine fibroids, but this period will not be the easiest in a woman’s life. Of course, in the background full health pregnancy is much easier, but this does not mean that if you have a tumor you need to give up on yourself and give up the opportunity to become a mother. Modern medicine allows patients with rather severe diagnoses to give birth, and uterine fibroids are not the most difficult case in obstetric practice. If you follow the doctor’s recommendations, a woman has every chance of going through this difficult stage without significant problems and complications.

Uterine fibroids are not a contraindication to pregnancy, but their presence can complicate pregnancy.

How does a neoplasm behave during pregnancy?

The condition of the tumor directly depends on the gestational age and the level of hormones during this period.

In early pregnancy there is gradual increase myomatous nodes in size. This phenomenon is associated with the rapid growth of progesterone, the main hormone responsible for the possibility of bearing a fetus. Maximum growth occurs up to 8 weeks due to tissue proliferation and hypertrophy. It is at this time that spontaneous miscarriage most often occurs as a consequence of growing fibroids.

After 8 weeks of pregnancy, cell hyperplasia is blocked, and further increase in fibroids is explained by tissue edema and hemodynamic disturbances. The next surge in node growth is observed in the second trimester (12-24 weeks), when the placenta is formed and the blood supply to the tumor changes. At the same time, it is possible that the corresponding symptoms of an acute abdomen will appear.

In the third trimester of pregnancy, myomatous nodes stabilize in size. This is explained by a decrease in progesterone levels and its stabilization until the end of the gestational period. In some women at 36-38 weeks, the tumor is not detected by ultrasound. This does not mean that the node is completely gone - it has only decreased to a size that is invisible during ultrasound examination.

After the birth of a child, the fibroids remain in the same state for some time, then begin to grow again and within 1-2 years return to their previous size. It has been noticed that long-term breast-feeding And lactational amenorrhea slow down tissue proliferation and tumor activity. In some women, the nodes are not detected even several years after the birth of the child. It is almost impossible to predict in advance how the tumor will behave in a particular patient. We discussed the question in another article.

Each case of pregnancy with fibroids is individual and requires special approach and control the growth of myomatous nodes.

On a note

Uterine fibroids are unlikely to completely resolve during pregnancy, but can shrink to a clinically insignificant size.

An interesting video dedicated to this problem will help you understand what complications of pregnancy can arise from fibroids in the uterus:

Conception with pathology: are there any chances?

Fibromyoma, as the only pathology, rarely causes such a complication as infertility. The tumor does not affect hormonal levels and usually does not interfere with conception. Problems arise later: at the stage of implantation of the fertilized egg, during gestation from the earliest stages. Many women succeed repeatedly, but it is not always possible to carry such a pregnancy to term.

In what situations does infertility occur due to fibroids?

A benign tumor is located at the mouth of the fallopian tubes. Myoma blocks the lumen and mechanically prevents sperm from meeting the egg. Natural conception is not possible; IVF is indicated. In the article “” we looked at the main aspects of this procedure for pathology;
The tumor is combined with other diseases of women reproductive sphere: endometriosis, ovarian cyst. In this case, the tumor occurs as a concomitant pathology. It affects the possibility of conceiving a child, but is not a key factor;
Myoma occurs against the background of significant hormonal disorders. It's about about endocrine infertility, while the tumor itself is only one of the factors preventing pregnancy.

Myomatous node may block the lumen fallopian tube, which causes infertility.

It also happens that when examined for infertility, nothing is revealed except fibroids. In such a situation, the doctor, of course, will suggest getting rid of the tumor, because other obvious reasons he doesn't see the problem. After taking hormones or surgery, many women manage to conceive and carry a child to term. If even after removal of the fibroids the issue remains unresolved, you should look for another cause of infertility.

Diagnosis of a tumor during pregnancy

Ultrasound helps detect fibroids in a pregnant woman. This is the simplest, safest and most accessible method used to identify a tumor and its complications. Ultrasound can be performed at any stage of pregnancy without harm to the baby. Quite often, a neoplasm is first discovered during gestation.

Echo signs of the disease do not differ from those outside pregnancy. located in the fundus or body of the uterus. The following variants of fibroid localization deserve special attention:

Submucosal node - can deform the uterine cavity and lead to spontaneous miscarriage;
A tumor located near the site of attachment of the fertilized egg can also cause miscarriage. After 16 weeks, fibroids, localized near the placenta, interfere with the supply of nutrients to the fetus and can cause delayed development and hypoxia;
or close to the external os is a reason for a planned cesarean section.

Uterine fibroids on ultrasound during pregnancy

Important aspects that concern many women:

Is it possible to confuse fibroids and a developing fetus?

Yes, at gynecological examination. Increase the uterus is coming both during pregnancy and during the growth of the myomatous node. If the tumor does not grow to serous membrane, the surface of the uterus remains smooth, in which case one condition can be confused with another.

On a note

During pregnancy, certain changes are observed in the cervix and vaginal mucosa, which does not occur during the formation of a tumor. An attentive doctor will most likely notice the difference and suspect fibroids.

When performing an ultrasound, distinguishing between fibroids and pregnancy is not difficult. The fertilized egg has distinctive echo signs, and already at 6 weeks the heartbeat of the embryo is detected. These conditions can only be confused in the very early stages, when both the tumor and pregnancy are visible as some formations in the uterine cavity (and also with poor resolution of ultrasound equipment).

This is what a fibroid looks like on an ultrasound (25 x 13 mm) and a 6-week pregnancy.

What to do if a tumor is first detected during pregnancy?

It happens that the diagnosis is made only during the first ultrasound screening at 12-14 weeks or even later. After the examination, the doctor will give his recommendations on further tactics.

When identifying fibroids in a pregnant woman, attention is paid to the following points:

The number of nodes and their location. It is very important to find out where fibroids grow: into the uterine cavity or outward to the pelvic organs. This is a key aspect that determines the further course of pregnancy and childbirth;
The location of the neoplasm relative to the fertilized egg (placenta);
Blood flow around the node;
The condition of the fetus: correspondence to the gestational age, heartbeat, presence of defects.

If fibroids appeared during pregnancy, this is also not a reason to panic. In this case, the node is still too small to seriously harm the fetus. According to gynecologists, a small tumor usually does not interfere with the successful gestation of the fetus and does not interfere with spontaneous childbirth.

Can pregnancy be missed due to fibroids?

Yes, if the tumor is large enough and the embryo is still too small. In this case, it is recommended to repeat the ultrasound after 1-2 weeks.

Can a pregnancy test show a tumor?

Pharmacy test strips react to the content of hCG in the urine, a hormone released after the conception of a child. It has been noted that in rare cases, chorionic gonadotropin is detected in fibroids, but more often in malignant tumors uterus. If the test shows a positive result, you need to donate blood to determine hCG, do an ultrasound and get an appointment with a gynecologist.

Symptoms of fibroids in pregnant women: how the disease manifests itself

If a woman is diagnosed with fibroids during gestation, she needs to know how this pathology progresses and pay attention to the following signs:

Lower abdominal pain. A tumor in the muscle layer can give an unpleasant pulling sensation over the pubis, radiating to the back, perineum, and thigh. Such pain is often mistaken for signs of an impending miscarriage, which leads to unnecessary hospitalization;
. Scarlet or brown discharge can be either a manifestation of fibroids or a sign of an incipient miscarriage. Consultation with a gynecologist is required. It is worth noting that the tumor rarely manifests itself as bleeding during pregnancy;
Signs of compression of the pelvic organs: frequent and difficult urination, constipation. Such symptoms occur in almost all pregnant women even without fibroids, so it is quite difficult to differentiate these signs.

On a note

In 50% of all expectant mothers, the pathology is asymptomatic.

If you have fibroids during pregnancy, you need to be wary of some symptoms (pain in the lower abdomen, bleeding), as they may indicate not only the manifestation of a tumor and its possible growth, but also the threat of termination of pregnancy.

Alarming symptoms during pregnancy:

Cramping strong pain lower abdomen;
Bloody discharge of any intensity;
Acute urinary retention;
Leakage of amniotic fluid;

The appearance of such symptoms indicates the development of complications and requires urgent medical attention.

Is it worth planning a pregnancy if you have fibroids?

Is it worth giving birth with fibroids or are the risks too high? Before answering this question, you should evaluate all the available factors:

Localization of nodes (in the fundus, body or neck, along the anterior or posterior wall). Interstitial tumors with centrifugal growth and subserous fibroids usually do not interfere with conception and pregnancy. Problems arise mainly with fibroids that deform the uterine cavity and interstitial fibroids with centripetal growth;
Node sizes. The larger the tumor, the higher the likelihood of complications;
The number of formations in the uterus. With multiple nodes, the prognosis is worse;
The state of blood flow in the uterus. If there are signs of fibroid necrosis, the tumor should be disposed of before pregnancy;
Presence of concomitant pathology. The simultaneous development of endometriosis or endometrial hyperplasia complicates the course of pregnancy;
Age: The older the woman, the higher the likelihood of complications. After 35 years (when fibroids are usually detected), the number of other types increases gynecological pathology, overlap somatic diseases, which increases the risk of complications. It is important to understand that a woman’s reproductive period is limited. It also happens that after long-term treatment the patient can no longer have children due to the onset of menopause;
Reproductive history. A history of miscarriages is another reason for preliminary treatment of fibroids.

Planning a pregnancy with fibroids should begin with a comprehensive examination to identify risk factors for miscarriage and the development of complications

What should I do? First treat the tumor, and then get pregnant, or is it the other way around? It is impossible to give a definite answer to this question, and tactics are determined individually for each woman after full examination. The patient’s reproductive plans are also of great importance. If a woman does not want to become a mother in the coming years, there is no point in prescribing hormones or performing surgery to stabilize the nodes. After 3-5 years, when the patient decides to conceive a child, the nodes may grow again, and another course of therapy will be required.

It is important to know

We are talking exclusively about stable and asymptomatic fibroids. If the tumor grows or bothers the woman, treatment is carried out as soon as possible.

In the treatment of uterine fibroids before pregnancy, the following methods are practiced:

before conceiving a child. COCs and gonadotropin-releasing hormone agonists help stabilize the nodes;
Uterine artery embolization is the method of choice for women planning pregnancy with fibroids;
Conservative myomectomy. After surgery, a scar remains on the uterus, which will be an indication for a caesarean section.

On a note

According to reviews from women and gynecologists, UAE is the best option for the treatment of fibroids. If such a technical possibility exists, doctors refer their patients specifically for embolization. The procedure is well tolerated, does not interfere with fertility, and pregnancy occurs within the next few months. After UAE, the tumor does not grow, and pregnancy occurs without complications. The most important thing is that there are no scars on the uterus, and a woman who has undergone UAE can give birth to a child through natural birth canal.

The UAE procedure does not require any incisions and is a minimally invasive operation.

You can plan a pregnancy immediately after stopping hormones and restoring the menstrual cycle. It is recommended to wait at least 3 months after the operation.

Complications: what the pathology threatens the expectant mother and baby

Uterine fibroids lead to the development of the following undesirable consequences:

Threat of miscarriage, which can lead to early miscarriage or premature birth (after 22 weeks);
Isthmic-cervical insufficiency. Occurs when the tumor presses on the cervix. The uterine os cannot cope with the load, opens prematurely, and a miscarriage occurs;
Placental insufficiency when fibroids are located near the fetal site or with multiple nodes. Threatens chronic hypoxia fetus and delay in its physical development;
Premature placental abruption with massive bleeding. State, life-threatening women and children;
Low attachment of the placenta. During implantation, due to a tumor, the embryo cannot find its own comfortable spot and is attached too close to internal os. Threatens bleeding and miscarriage;
Placenta previa is a condition in which the fetal site blocks the exit from the uterus. The causes and consequences are similar to the previous paragraph. Is an indication for caesarean section;
Compression of the child by the tumor and development of deformities (with large submucosal nodes);
Incorrect position of the fetus (oblique or transverse), breech presentation as a result of deformation of the uterine cavity by a myomatous node;
Compression of the pelvic veins and their thrombosis (relevant for large subserous nodes).

On a note

Fibroids are not the cause of a non-developing (regressive) pregnancy, although it may increase the risk of its occurrence (if the nutrition of the uterine tissue is impaired).

This is what pregnancy looks like in the presence of a large fibromatous node.

Not only fibroids have a bad effect on pregnancy, it is also noted Feedback. The period of gestation negatively affects the condition of the tumor, which threatens the development of complications of the disease:

Necrosis of the node. More often noted and occurs as a result of impaired blood flow in the myometrium;
Torsion of the tumor stalk with a subserous location of the node;
Rapid growth of fibroids under the influence of progesterone.

First birth after 35 years;
The duration of the disease is more than 5 years;
Submucosal nodes that deform the uterine cavity;
Interstitial tumors of large sizes (initial size of the uterus - from 10 weeks);
Location of fibroids in the cervix;
Development secondary changes, signs of necrosis;
Location of the placenta on the myomatous node;
Concomitant pathology (gynecological and extragenital);
Induced pregnancy.

For your information

The chances of a favorable pregnancy outcome are very high in women under 35 years of age without severe chronic diseases, with subserous fibroids and node sizes up to 5 cm.

Tactics of pregnancy management with uterine fibroids

Pregnancy due to fibroids occurs with complications, but this does not mean that all women with this pathology are sent for an abortion. It is possible to carry a child to term (if there are no obvious contraindications), but to do this you need to follow all the doctor’s recommendations:

Register for pregnancy as early as possible (preferably immediately after the test shows two lines);
Complete all screening ultrasounds and other examinations on time;
Monitor your condition and consult a doctor if you have any complaints.

Pregnancy is contraindicated in the following situations:

Suspicion of a malignant tumor;
Rapid growth of fibroids;
Development of complications (necrosis, torsion of the leg);
Thrombophlebitis of the pelvic veins.

After the age of 40 and in the presence of fibroids, it is also not recommended to continue pregnancy.

During gestation Special attention is given to the sizes of nodes and their possible growth. Monitoring of the neoplasm is carried out using ultrasound in a regulated time frame:

6-10 weeks;
12-14 weeks;
18-24 weeks;
32-34 weeks;
38-40 weeks.

From the 32nd week, weekly CTG (cardiotocography) is indicated to assess the fetal heartbeat and timely detection hypoxia.

For fibroids, a weekly cardiotocography procedure is mandatory starting from the 32nd week of pregnancy.

If complications develop, the woman is hospitalized in a hospital, where she receives all necessary help taking into account gestational age.

On a note

To prevent placental insufficiency and fetal hypoxia, drugs that improve uterine blood flow can be prescribed. Tocolytics and antispasmodics are used according to indications. Hormonal drugs in the early stages (Duphaston, Utrozhestan) are prescribed with caution, since there is a risk of rapid growth of the node.

There is no conservative treatment for uterine fibroids during pregnancy. The woman is observed, but no hormones are prescribed. Surgery(myomectomy) is possible according to strict indications:

Necrosis of the node and the appearance of corresponding symptoms;
Compression pelvic organs and severe pain;
A threatened or incipient miscarriage if it is impossible to perform curettage of the uterine cavity (if the node is located cervically);
Giant fibroids and lack of prospects for bearing a fetus.

As planned, it is carried out at 16-19 weeks. During development acute conditions The operation is possible at any time.

What's the best way to give birth?

Childbirth through the birth canal is possible if the following conditions are met:

Full-term pregnancy (from 37 weeks);
Normal pelvic size;
The size of the myomatous node is up to 5 cm;
Successful location of the tumor (does not block the exit from the uterus).

On a note

Based on reviews from women who have had a pregnancy with fibroids, we can say: small nodes usually do not interfere with pregnancy and do not interfere with natural childbirth. Pregnancy with a subserous tumor is easiest: childbirth occurs at term without complications, and the postpartum period is uneventful.

Childbirth in women with uterine fibroids is complicated by premature rupture of water, placental abruption and bleeding. Quite often, weakness of labor occurs as a result of changes in the structure of the myometrium. If complications develop, an emergency caesarean section is indicated. During surgery after the fetus is removed, a myomectomy is often performed. IN special cases hysterectomy is indicated.

Indications for elective caesarean section:

Fibroids more than 5 cm in diameter;
A large number of interstitial nodes;
Scar on the uterus after conservative myomectomy;
Localization of the node that prevents the normal movement of the fetus along the birth canal (in the cervix, with deformation of the cavity);
Suspicion of malignancy;
Complications from the fetus and conditions that threaten its life.

The final choice of delivery method is made after a complete examination of the woman and assessment of the condition of the fetus.

Many women with fibroids try to choose a competent doctor who will help them bear and give birth to a healthy child. Increasingly, patients are turning to private clinics. It is worth noting that the price for pregnancy management with fibroids will be increased due to additional examinations. average cost Observation by a gynecologist for fibroids from registration to childbirth ranges from 80 thousand rubles in Moscow and from 60 thousand rubles in the regions.

Uterine fibroids and infertility

08 February 2018 11637 0

Pregnancy is a very important period in a woman’s life. It is better to prepare in advance for this event and cure all diseases that may interfere normal development pregnancy and childbirth. Many women are interested in the question: is it possible to carry a healthy child and can you give birth with fibroids? Anything is possible, but in this case pregnancy is accompanied by a certain risk. Therefore, it will be safer to treat fibroids in advance.

Please note that this text was prepared without the support of our website.

Using modern methods treatment, fibroids can be removed without surgery. In gynecology it is gaining quite popularity effective method Uterine artery embolization (UAE). This is a minimally invasive procedure that allows you to eliminate all fibroids without injuring the uterus itself. If you have fibroids, the expert council of our website advises you to use and find out all your questions about the treatment method in a particular case. You can also contact a leading specialist.

Types of fibroids

Myoma is benign tumor, which grows from cells of the muscular layer of the uterus. The presence of fibroids causes a woman a lot of trouble, including problems with pregnancy. In some cases, pathology can only be observed if it does not cause discomfort and is small in size. However, when planning a pregnancy, it is rational to completely cure the disease to exclude possible complications. Only the attending physician can answer questions about whether a woman is able to bear a child or whether it is possible to give birth with uterine fibroids, assessing the situation in each individual case. Practice shows that a woman can give birth to a child with fibroids even without the help of a cesarean section. At the same time, she should be regularly observed by a gynecologist to monitor her condition.

To find out whether it is possible to give birth with fibroids, the doctor evaluates many characteristics of the tumors. It matters where the nodes are located. Based on location, fibroids are divided into the following types:

Submucosal: neoplasms grow towards the uterine cavity and may have a stalk;
Intramural: neoplasms grow strictly in the thickness of the uterus;
Subserous: nodes are located on the outer layer, growing towards the abdominal cavity;
Cervical: nodes grow in the cervical area.

The number of neoplasms and their size also significantly influence the course of pregnancy. Multiple fibroids or nodes big size cause difficulty in conceiving and become a factor in infertility. The presence of several fibroids interferes with the normal development of the fetus, which can be considered a risk factor for miscarriage or miscarriage.

Is it possible to give birth with fibroids?

It is possible to carry a child with fibroids. The presence of fibroids is not a significant contraindication to pregnancy and childbirth. When the time comes to give birth, a woman may be offered two options for delivery:

Natural childbirth;
C-section.

A woman with fibroids can give birth on her own. There are many examples from practice of positive outcomes of pregnancy and natural childbirth with fibroids. The main thing is that there are no contraindications for natural childbirth. To exclude complications, a woman should undergo regular examination by a doctor, including ultrasound, hormone tests, etc. Based on the examinations, the doctor will assess the condition expectant mother and the child, after which he will suggest the safest option for childbirth.

During pregnancy, it is important to control the size of myomatous nodes and their growth rate. As the level of sex hormones increases, changes in the size of fibroids can be observed. They can increase and even decrease. This happens because fibroids are sensitive to female sex hormones, the level of which determines their growth. For example, before in vitro fertilization(IVF) strongly recommend completely treating the pathology. In the presence of neoplasms, the likelihood of positive result after the fertilized egg is transferred to the uterus. IVF is also accompanied by strong hormonal support, which can provoke a sharp increase in nodes.

In some cases, the final choice of birth method occurs in the delivery room. If a woman goes into labor and her condition changes during this time, the obstetrician-gynecologist will make a decision about further delivery based on the current situation.

Is it possible to give birth with subserous uterine fibroids?

The subserous location of the node is the most favorable for the development of the child. The neoplasm is located outside the uterine cavity and grows towards the peritoneum. It does not affect the fetus and does not interfere with its normal development. In this case, you can give birth with fibroids if there are no other complications. With a subserous tumor, you can give birth on your own. You can give birth by caesarean section if there are contraindications to natural childbirth.

Subserous localization may place additional pressure on bladder and squeeze the intestines. These organs are already affected by the growing fetus, and additional compression can only worsen the situation.

Do they give birth with submucosal uterine fibroids?

In a submucosal position, the tumor grows into the uterine cavity. This arrangement is unsafe for the development of the fetus. Submucosal tumor may compress amniotic sac, preventing the child from developing normally. A large tumor deforms the uterine tissue, which also negatively affects the development of the baby.

This type of fibroid often has a stalk, on which the tumor can descend into the neck. In this case, you cannot give birth on your own. Also, the leg can twist, causing the development of necrosis. This may be an indication for termination or premature birth, depending on the stage of pregnancy.

The submucosal location of the tumor is a risk factor for bleeding during childbirth. Uterine bleeding very dangerous, happening big loss blood in a short period of time, which is unsafe for life. When woman walking give birth with submucous myoma, the obstetrician-gynecologist must be well prepared, thoroughly study the patient’s medical history, and take into account all the characteristics of the woman in labor.

Cervical uterine fibroids: can you give birth or not?

This position of the tumor is also unfavorable. A cervical tumor usually does not interfere with the development of the child, but becomes a problem for childbirth. Of course, it all depends on the size of the education. When answering the question whether it is possible to give birth with fibroids with a cervical location, they usually give preference to a cesarean section. A tumor in the cervix blocks the birth canal and the baby either will not be able to come out or will be injured.

Caesarean section for cervical tumor is prescribed in advance. If all goes well, the due date is set at approximately 38 weeks. It is undesirable to allow a woman to give birth on her own. The expected risks significantly exceed the likelihood of a favorable outcome.

Is it possible to perform UAE on nulliparous women?

To exclude a possible unfavorable outcome of pregnancy, fibroids should be completely treated in advance. For nulliparous patients, it is necessary to choose a treatment method that will have the least impact on reproductive organ. The method of choice for treating pathology is uterine artery embolization. It allows you to eliminate all fibroids in one session. This leaves no scars that could hinder the formation of the child. After embolization of the uterine arteries, you can give birth on your own.

The essence of the method is that tumors are left without nutrition after blocking certain blood vessels. New growths receive nutrition through the uterine arteries, which supply them with blood. When the vessels are blocked, the fibroid is left without nutrition and begins to gradually die. The nutrition of the uterine tissue remains unchanged. The body continues to receive sufficient quantity blood through other vessels: ovarian arteries and large network capillaries.

Not used for UAE general anesthesia, the procedure is performed without incisions on the uterus, and therefore does not require long-term hospitalization. The recovery period takes about 24-48 hours. Then you can return to usual life. During UAE, a small incision is made on the thigh (only 1.5 cm), through which a special substance is injected. The drug contains microscopic polymer balls (emboli), which are absolutely harmless to the body. Emboli penetrate to uterine arteries, which nourish fibroids and block them. So the nutrition of the fibroids stops.

After UAE, the tumors begin to “shrink,” eventually becoming clinically insignificant. Large pedunculated nodes can break away from the muscle layer and come out. In this way, you can “give birth” to fibroids after UAE. Myomatous nodes decrease gradually. After 2-3 months their size decreases by 40%, and after a year by 60%. It is recommended to start planning pregnancy one year after the procedure.

To perform UAE, you should contact specialized ones. They have the necessary equipment and a staff of specialists who are proficient in this treatment technique. The procedure is successfully performed by endovascular surgeon B. Yu. Bobrov and obstetrician-gynecologist D. M. Lubnin.