Fibroids and pregnancy - all the nuances of childbirth and childbearing. What is interstitial submucous uterine fibroids? Multiple uterine fibroids and pregnancy

One of the difficult problems of modern obstetrics is the combination of uterine fibroids and pregnancy. In many patients, this condition proceeds normally. However, there is always a risk of developing severe complications that can lead to the loss of not only the pregnancy itself, but also the uterus. Reasons for these complications:

the tumor itself (large node size, malnutrition, unfavorable location, scars after myomectomy);
the factors that caused it (hormonal imbalance, endometrial trauma, adnexitis, and others).

Women are often interested in the question: is it possible to get pregnant with uterine fibroids? The probability of pregnancy depends on the location of the foci of the tumor, their number and size. With small accumulations of cells located in the thickness of the uterine wall, the onset and development of pregnancy can proceed normally. With large nodes, especially located in the isthmus, in the mouths of the fallopian tubes, rapidly growing, the possibility of becoming pregnant is low. If the embryo has formed, the risk of complications and fetal pathology is high.

Changes in the uterus during pregnancy

The presence of uterine fibroids and the fact of pregnancy affect each other. During the bearing of a child, myomatous cells change, and the function of the placenta is also impaired.

There is a violation of the blood supply and nutrition of the tumor nodes. Especially often, such changes occur with small single foci located on the outside of the myometrium, that is, subperitoneally. Subserous myoma can be complicated by torsion of the tumor stem. The risk of such a condition increases with intense physical activity, uterine hypertonicity, preeclampsia of pregnancy with edema and increased blood pressure.

With hemorrhage in the myomatous node or its rapid growth, ahead of the growth of capillaries, degeneration of the fibroid tissue occurs.

The placenta is most often affected when it is located above a large myoma focus. In this case, the structure of the vessels of the placenta is disturbed, they become short, defective, often thrombosed. Chorionic villi are underdeveloped and dystrophic. As a result, placental insufficiency is formed.

The most pronounced circulatory disorders in the placenta in the late stages before childbirth. Therefore, such women are recommended to perform a planned caesarean section at 38-39 weeks of gestation.

Examination of pregnant women

First, a pregnant woman is interviewed, specifying the number of pregnancies and childbirth, the presence of abortions, operations on the uterus and other manipulations. Find out hereditary predisposition to this disease. The presence of undeveloped and induced pregnancies, miscarriages, the birth of unviable children is noted.

A general clinical examination evaluates the general state of health. Particular attention is paid to conditions such as diabetes mellitus, pyelonephritis, and hypertension.

Gynecological examination is designed to identify the location and size of myomatous nodes. It is necessary to clarify the obtained data with the help of an ultrasound examination. Ultrasound helps to determine the number, location and nature of the growth of tumor foci, their size, structure and location in relation to the placenta. In addition, with its help, the doctor monitors the development of the fetus.

Risk factors for pathology of pregnancy in uterine myoma

Factors that increase the likelihood of developing pathology:

aggravated obstetric history (the birth of a non-viable child in the past, infertility);
scars on the uterus after any surgery;
concomitant diseases, in particular, varicose veins of the small pelvis;
features of the location of the nodes - intermuscular, cervical, isthmus, in the lower segment, with centripetal growth);
the size of the largest focus is more than 8 cm;
pronounced myomatous changes, that is, the presence of five or more nodes;
centripetal (directed inwards) tumor growth or submucosal node, leading to deformation of the organ cavity;
the location of the placenta above the node;
edema, necrosis, degeneration of the myoma focus;
age over 30-35 years, when there is a decrease in the ability of myometrial cells to stretch and contract.

So, there is a low probability of complications in young women without scars on the uterus and concomitant diseases, who have up to 5 nodes up to 8 cm in size. These formations are located in the body and bottom of the organ, do not cause discomfort in a woman and grow towards the peritoneum, i.e. outside. The placenta is located away from the node. Small uterine fibroids during pregnancy usually do not progress. The development of the fetus usually proceeds without complications. Sometimes, as the embryo grows, the myomatous nodes move to the side, towards the peritoneum, or vice versa, closer to the uterine cavity, deforming it.

In other cases, the pregnant woman belongs to the high-risk group. She may be offered an abortion.

Complications of pregnancy on the background of fibroids

High-risk patients may develop specific and non-specific complications.

Specific:

violation of the blood supply to myomatous nodes;
isthmic-cervical insufficiency as a result of the cervical-isthmus location of the tumor;
rapid growth of neoplasm (proliferating fibroids);
fetoplacental insufficiency;
pelvic vein thrombosis;
rupture along the scar after myomectomy.

Non-specific:

miscarriage or premature birth;
premature;
ingrowth of chorionic villi;
preeclampsia;
anemia.

The frequency of miscarriages in women at high risk is up to 60%, preterm birth occurs in a quarter of these patients. With the threat of termination of pregnancy, conventional treatment regimens are used, including antispasmodics, antiplatelet agents, vitamins, Duphaston. Half-bed or bed rest is prescribed, it is recommended to abandon sexual activity and physical activity.

With isthmic-cervical insufficiency, sutures are not applied to the neck in order to avoid damage to the myomatous nodes. Bed rest is used, the introduction of Ginipral.

With the rapid growth of the tumor, antiplatelet agents (Kurantil) are prescribed, which improve the nutrition of the node. In more severe cases, antispasmodics, tocolytics, fresh frozen plasma, hepatoprotectors are indicated.

For the prevention of placental insufficiency in the high-risk group, Aspirin, Curantil, multivitamins and folic acid are used. Treatment of placental insufficiency is carried out in a hospital. Reopoliglyukin, fresh frozen plasma, Trental, Actovegin, Eufillin, Magne B6, Curantil are prescribed.

Uterine fibroids during pregnancy can be complicated by malnutrition of the node. There are pains in the lower abdomen of a different nature, the body temperature rises, the general condition of the woman worsens. There is a threat of abortion. Treatment includes antispasmodic, antibacterial, desensitizing agents. In the absence of the effect of therapy within 3-5 days, the node is removed (myomectomy). This is possible only in the case of subserous fibroids.

Cases when it is necessary to resort to surgical intervention:

necrosis (purulent fusion) of the node;
peritonitis;
malignant transformation of fibroids;
infringement of the uterus in the pelvic cavity;
node capsule rupture.

Tactics of pregnancy management

persistent desire of the patient;
treatment in terms of more than 24 weeks, when there is a viable fetus;
prolonged infertility when the child is long-awaited;
the ability to terminate the pregnancy only by a small caesarean section.

Indications for termination of pregnancy with myoma:

suspicion of a malignant neoplasm in any organ;
submucosal uterine fibroids;
node necrosis;
the location of the focus in the cervix with the development of isthmic-cervical insufficiency, intrauterine infection of the fetus, bleeding, miscarriage;
the size of neoplasms is more than 15 cm or there are a large number of them;
a woman's age over 45 combined with risk factors;
severe comorbidities.

Childbirth and the postpartum period

A pregnant woman is hospitalized at 37-38 weeks. Examine the indicators of blood coagulability, the state of the placenta and fetus, determine the maturity of the cervix. Taking into account risk factors, choose the tactics of childbirth. In low-risk women, natural childbirth is possible. In more complex cases, a caesarean section is preferable. If such patients try to give birth naturally, severe complications can be caused - placental abruption and uterine rupture.

A planned caesarean section is performed in the following cases:

nodes located in the lower sections that prevent the progress of the fetus;
multiple or very large nodes;
scar on the uterus;
malnutrition of the nodes, which can intensify during childbirth and lead to necrosis;
pelvic presentation of the fetus;
suspicion of necrosis or malignant degeneration;
accompanying illnesses.

Cases when the uterus is removed during a caesarean section:

multiple lesions in women over 40;
necrosis of the node in the thickness of the myometrium;
tumor recurrence after myomectomy;
submucosal or interligamentous nodes, centripetal growth and other unfavorable location features.

After pregnancy, in most women, the growth of fibroids slows down or stops. This is facilitated by breastfeeding and the use of hormonal contraceptives. Prevention of the growth of fibroids is repeated pregnancy and childbirth after two to three years.

Uterine fibroids today is a fairly common phenomenon, especially the frequency of its diagnosis during pregnancy has increased. It is quite logical that a woman of childbearing age increasingly has questions about the possibility of becoming pregnant in the presence of uterine fibroids or after its removal, about its effect on the course of pregnancy and methods of its treatment during childbearing.

The effect of fibroids on pregnancy.
It must be said right away that fibroids are a benign tumor that occurs against the background of the growth of muscle fibers of the walls of the uterus. I’ll clarify right away that any tumor formation in the uterine cavity sooner or later leads to its increase. The growth of fibroids can be very fast, but may not be observed at all, and for quite a long time. During gestation, the uterus also increases in size, corresponding to a particular period. That is why the increase in the uterus is initially associated with pregnancy, and only according to the results of ultrasound is an accurate diagnosis made.

Myoma really complicates the process of conception, because its size puts pressure on the fallopian tubes, putting obstacles for the movement of spermatozoa, and also disrupts ovulation. As such, it does not cause infertility, but its removal significantly increases the chances of conceiving a baby, unless, of course, its size exceeds the twelve-week gestation period. With a larger size, the tumor leads to deformation of the uterine cavity, as a result of which, after surgery, it is rather difficult to preserve the childbearing function, since the removal of a large fibroid is often accompanied by severe bleeding, and in some cases, specialists are forced to simply remove the uterus.

In the first months of pregnancy, complications may occur against the background of fibroids, this happens mainly when the tumor is close to the placenta. In this case, the size of the tumor is no less important. With small myomatous nodes, pregnancy proceeds without complications, and the tumor itself does not manifest itself in any way.

Fibroids in the second and third trimester of pregnancy increase the risk of miscarriage as well as premature birth. This happens as a result of the fact that the myomatous nodes leave less and less free space for the fetus, in addition, they stimulate the contractile activity of the uterus. In this situation, the location of the fibroids and its distance from the placenta (is there any contact) also play an important role.

Large tumors can interfere with normal growth and development of the fetus. Often there are cases of the birth of children with low weight, with a changed shape of the skull, curvature of the neck, etc.

Most experts agree that uterine fibroids affect the birth process, significantly delaying it. Also, if it is available, specialists more often decide on a caesarean section. In this situation, it is not the myoma itself, as such, that prevents childbirth, but a significant size of myomatous nodes in combination with pathologies of the position and presentation of the fetus (transverse, pelvic and facial presentation). Sometimes, if the cesarean section incision matches the location of the fibroid, the doctor may remove it.

It should be noted that in pregnant women in the presence of fibroids, placental abruption often occurs, especially with the retroplacental (behind the placenta) location of the tumor. During the birth process, doctors take into account this feature of the tumor.

In the postpartum period, fibroids can also give complications, both immediately (bleeding against the background of low uterine tone), and after a rather long period of time (infectious diseases, the uterus does not reach its original size).

Planning pregnancy in the presence of uterine fibroids.
At the conception planning stage, it is necessary to take into account such facts as the location of the fibroid, its growth trends, and the size of the nodes. If the location of the nodes leads to the deformation of the uterine cavity, then in principle it is impossible to get pregnant, since the spermatozoa, not reaching the fallopian tubes, settle on their surface without meeting the egg. In this case, the nodes are subject to mandatory removal.

If the nodes are small and located in the thickness of the uterine wall or outside, that is, there is no deformation of the cavity, then the probability of pregnancy is quite high. It should only be said that in the case of fertilization, a woman may have problems associated with bearing a fetus.

If a woman has a myomatous node on a thin stalk, then there is a high risk of its torsion during pregnancy, and this, as a rule, leads to surgical intervention and often to miscarriage. In this situation, at the stage of pregnancy planning, such nodes are urgently recommended to be removed.

It is also important to note that if, according to ultrasound, a predisposition of the tumor to rapid growth (doubling within six months) was established, then pregnancy planning is prohibited. This is due to the high risk of an increase in fibroids during gestation, which provokes malnutrition in the node, and this is already fraught with miscarriage. At the stage of conception planning, such a tumor must also be removed in advance.

In the case of large uterine fibroids (4 cm in diameter and above), it is also worth postponing conception, because, firstly, this is unlikely (against the background of endometrial pathology), and if it happens, it is fraught with miscarriage, since the likelihood of miscarriages and malnutrition of the fetus, which will lead to surgery. Nodes are also subject to removal at the planning stage of the child.

Fibroids growth during pregnancy.
No physician can reliably answer how the tumor will behave during pregnancy (if it is present before conception). The genetic factor plays an important role here. In most cases, the growth of fibroids is observed in the first two trimesters of pregnancy, and in the third, on the contrary, their decrease is noted. As a rule, during gestation, fibroids shrink in size by an average of thirty-five percent, but there is still a small percentage of cases of fibroids that double in gestation, but this practically does not complicate or complicate pregnancy. However, the destruction or degeneration of fibroids can contribute to various complications. This process is combined with tissue necrosis of the collapsed fibroids, bleeding, cyst formation, etc. Such a phenomenon can occur, frankly, at any stage of pregnancy and after delivery. In this case, the location of the fibroids matters.

Why the destruction of fibroids occurs during pregnancy is not fully known. This can be facilitated by hormonal (increase in progesterone), vascular and mechanical changes (impaired blood supply to the neoplasm due to thrombosis). This process is accompanied by pain in the node location area, an increase in uterine tone, an increase in body temperature, an increase in the level of leukocytes in the blood and an erythrocyte sedimentation rate. Fibroids degeneration is diagnosed by ultrasound. Initially, the patient is recommended bed rest and analgesics are prescribed, while maintaining severe symptoms, she is hospitalized for further inpatient treatment.

Surgical treatment is prescribed in exceptional cases in the presence of absolute indications (severe fever, leukocytosis, deterioration in general condition, acute abdominal pain, uterine bleeding). Often, with surgery, it is possible to save the pregnancy.

I note that fibroids that grew in the first months of pregnancy, after childbirth, may not declare themselves at all. After childbirth, as the uterus returns to its original state, the location of the myomatous nodes may change.

Treatment of fibroids during pregnancy.
Initially, fibroid therapy is conservative in nature and is aimed at stopping the growth of a benign formation. Methods in each case depend on the individual characteristics of the tumor and the causes of its development. During childbearing, iron deficiency anemia in a pregnant woman can become a factor provoking the growth of fibroids. It is this fact that serves as one of the arguments for the constant study of a woman's blood during this period.

Therapeutic and preventive measures for uterine fibroids are taking iron supplements, ascorbic and folic acids, B vitamins, a diet with a predominance of protein foods. Vitamins E and A are also recommended, which have a beneficial effect on the neuroendocrine system and reduce the sensitivity of the genital organs to estrogens.

If lipid metabolism is disturbed in a pregnant woman with fibroids, her diet is adjusted: they severely limit the intake of carbohydrate foods, exclude any animal fats (they are replaced by vegetable ones), include more freshly squeezed juices from vegetables and fruits in the diet.

After delivery, a woman is prescribed hormonal agents with progesterone, which reduces the ability of cell division, preventing tumor growth. If it is impossible or unsuccessful attempts to stop the growth of fibroids, a decision is made on surgical treatment (conservative myomectomy - removal of nodes while preserving the uterus).

The laparoscopy technique (an operation performed using an endoscope and instruments, under the control of a video camera installed in the abdominal cavity) significantly reduces the risk of developing adhesions in the small pelvis, which in the future helps to maintain the patency of the fallopian tubes, and this is one of the main factors for pregnancy. The method of treatment with the help of laparotomy (abdominal operation, the surgeon does everything manually) is associated with a high risk of adhesion formation, and their formation can occur both in the small pelvis and in the abdominal cavity. In the future, this leads to infertility, and sometimes to complications from the digestive system (for example, adhesive intestinal obstruction). However, the large size of the nodes with the laparoscopy technique does not allow the uterus to be sutured, as required, due to the peculiarities of the technique, the angle of the abdominal instruments, and some technical points.

As a result, laparoscopy is performed for women planning a pregnancy, if the size of the nodes does not exceed 5-6 cm. In this case, the skill and experience of the surgeon is required to suture the uterus. To remove large nodes, there are new technologies for suturing the uterus, but this significantly increases the risk of uterine rupture along the scar.

If the nodes exceed 9-10 cm in diameter, the risk of uterine rupture along the scar is much higher than the risk of adhesions due to laparotomy. Therefore, it is recommended to abandon laparoscopy and perform an opening of the abdominal cavity to excise the tumor.

After removal of uterine fibroids, regardless of the technique used, it is possible to plan conception only after eight to twelve months, it all depends on the size of the removed tumor.

It should be noted that after the removal of the fibroids, the delivery of a woman can be carried out in a natural way, if the removed nodes were no more than four centimeters in diameter, if there are no complications during pregnancy and after childbirth, if the scar on the uterus is in satisfactory condition. The age of the woman also plays a huge role. In other cases, a caesarean section is indicated.

Multiple uterine fibroids.
It also happens that several myomatous nodes are formed in the uterus at once, and they are different in size. It is very difficult to plan a pregnancy in this situation, since the removal of such formations can lead to the fact that there is no healthy tissue left on the uterus. In such situations, doctors prescribe the removal of only those nodes that interfere with the attachment of the embryo, tend to grow, interfere with the bearing of the fetus and can cause complications, etc. after delivery, you can do the excision of the remaining nodes, or this can be done by doctors during a caesarean section.

Submucosal uterine fibroids are benign tumors. It develops in the muscular tissue of the uterus under the mucosa, the growth of the formation is directed inside the cavity of the organ.

When submucosal uterine fibroids are diagnosed, what is it - a question that worries a woman. This tumor according to ICD 10 has a benign nature.

Unlike other types of fibroids, submucosal fibroids are characterized by a rapid increase in size, severe symptoms, and a fairly frequent transition to a malignant form.

According to statistics, submucosal fibroids account for about 30 percent of the total number of uterine tumors. It develops more often in women of reproductive age.

The exact causes of the development of pathology cannot be named, but the most common culprit is a violation of the hormonal balance.

Submucosal uterine fibroids: symptoms and signs

Myoma with a submucosal location of the node often develops latently in the initial stages. And only when acquiring large sizes, a woman has the following:

that lasts longer than usual;
during menstruation;
, which gives to the lower back and lower abdomen;
general weakness and malaise;
inability to conceive when planning a pregnancy;
an increase in the circumference of the abdomen with large tumor sizes.

Myoma with submucosal growth of a small nodule practically does not give any symptoms.

Is this disease scary? A sharp increase in body temperature with acute pain in the lower abdomen may indicate a rupture or twisting of the myomatous node. In this case, urgent medical attention is required.

Pregnancy

- concepts that are quite compatible with the small size of education. The answer to the question, in the presence of a submucosal tumor, is positive, again with a small size of the latter. In this case, the formation does not interfere with the passage of male germ cells into the uterine cavity.

But if the submucosal tumor rapidly increases in size, then it gradually fills the uterine cavity. When conception occurs, it will interfere with the growth of the embryo. Why is such a pathology dangerous? First of all, a miscarriage, which occurs most often at periods of more than 11 weeks.

The reasons

Submucosal uterine fibroids, the treatment of which should be carried out without delay, can develop in women for the following reasons:

diseases that cause hormonal imbalance;
inflammatory and infectious diseases of the reproductive system;
long-term use of hormonal contraception;
a sharp decrease or increase in body weight;
constant stressful situations;
hereditary factor;
absence of childbirth and lactation until the age of 30.

One cause or a combination of several can cause the development of a submucosal tumor. Only a doctor can determine the exact cause based on the examination data.

Diagnostics

Diagnosis of education in the uterus in most cases occurs during examination by a gynecologist.

ultrasound. The study is carried out transabdominally or transvaginally.
Hysterosonography or intrauterine echography. It is carried out if a woman has heavy uterine bleeding.
Three-dimensional echography. This technique makes it possible to obtain the most objective information.
Dopplerography. Allows you to identify structural changes in the tissues of the uterus and predict the further growth of the myomatous node.

After the diagnosis and obtaining data, the doctor will choose the necessary treatment tactics.

Treatment Methods

Some time ago, surgery for large submucosal uterine fibroids was the only treatment. In most cases, when the tumor was removed, the uterus was also removed.

Today, not only surgical treatment is used, but also conservative.

If submucosal uterine fibroids are diagnosed, treatment without surgery is possible under the following conditions:

small size of submucosal fibroids - no more than 12 weeks;
lack of rapid node growth;
the patient has children and the desire to have them in the future.

The main goal of conservative therapy is to preserve reproductive function and stop the growth of myomatous nodes.

For this, hormonal treatment is prescribed:

Antigonadotropins. Used for small tumors. The goal is to stop the growth of fibroids. It is also appointed at the stage of preparation for the operation. An effective drug is Gestrinone.
GnRT agonists. The drugs stop the growth of nodes, and also help to reduce their size. Such therapy relieves pain, and also stops bleeding. Prescribed drugs - Buserelin, Zoladex, Triptorelin, Goserelin. Reviews after such therapy are usually positive.

In parallel, the doctor prescribes symptomatic therapy:

painkillers;
sedatives;
remedies for anemia;
vitamin complexes.

When undergoing conservative treatment, a woman should visit the attending physician at least twice a year.

Surgical intervention

Depending on the diagnostic data, the patient may be offered surgery as the only way of therapy. It must be understood that surgical treatment is often the most effective technique in the presence of submucosal fibroids.

Refusal of surgery in the initial stages of tumor development can lead to the fact that at a later date a hysterectomy is required, that is, not only the removal of the formation, but also.

In the presence of submucosal uterine fibroids, the dimensions for the operation are determined by the attending doctor. Indications for surgical intervention:

large size education - more than 12 weeks;
rapid increase in the size of nodes;
severe pain;
profuse bleeding from the uterus.

With the surgical removal of a submucosal tumor, the following methods are used:

. The goal is to stop the nutrition of the tumor and its gradual resorption. For this, a medicinal substance is injected by inserting a catheter.
Laparoscopic myomectomy. Removal of the tumor is carried out using a laparoscope.
Laparotomy myomectomy. A full-fledged operation in which the removal of the myomatous node is carried out by cutting the tissues of the peritoneum.
Hysteroresectoscopy. Removal of the node using a hysteroscope.
Hysterectomy. With this type of operation, not only the myomatous node is removed, but also the uterus.

ethnoscience

The question of the treatment of submucosal uterine fibroids with folk remedies is of interest to those women who are categorically against traditional treatment.

The opinion about the greater effectiveness of herbal preparations, in contrast to medications, is not always true.

When taking herbal remedies, a doctor's consultation is required. At the same time, it is necessary to understand the possible consequences of refusing the therapy prescribed by the doctor.

Every woman who is faced with a pathology such as uterine fibroids should understand that even after a successful surgical intervention, there is always a risk of relapse. Therefore, it is so important to periodically visit a gynecologist for examination and ultrasound. Such measures allow you to learn in a timely manner about the re-development of education and minimize the risk of possible complications.

On the treatment video

Article outline

Many women who plan their pregnancy often face various obstacles in the form of benign tumors of the uterine muscles. If a fibroid is found and the pregnancy has been going on for several months, then you should not panic. A sufficient number of examples that a woman during pregnancy found out about the presence of a tumor, but her child was born healthy. For the normal course of this period, it is necessary to know the danger of fibroids for the uterine cavity.

Expectant mothers begin to worry when they hear the diagnosis of uterine fibroids during pregnancy. Is the presence of uterine fibroids dangerous when it is discovered when carrying a baby? This question is still open. But, despite this, doctors know how to act when such a diagnosis is detected.

What is uterine fibroids and why does it occur

This formation is considered benign, is a tumor that grows on the muscles of the uterus. Experts have not yet been able to give specific answers why this is happening. But there are suggestions - it may be increased hormonal stimulation and increased secretion of estrogens. In other words, the tumor is formed due to low levels of progesterone in the body and grows due to an excess balance of estrogens.

But if a violation of hormones is not found in the blood, this does not mean that a tumor cannot form. The level of estrogen in the uterus may rise slightly and not be displayed in a blood test. In almost all cases, the formation consists of several nodes in various sizes of seals. A tumor of this type is considered common, but it is highly undesirable for a future mother.

The reasons

This disease occurs as a result of hormonal imbalance. The amount of estrogen increases, which contributes to the rapid division of cells and the formation of unwanted nodes. The nodes can grow in different places on the uterus in multiple numbers. If the tumor is detected and treated in time, then it does not pose any danger.

Reasons for the rapid production of estrogen by the ovaries:

genetics (if women had such a disease, then it is difficult for the next generation of women to avoid it);
infections that inflame the genitals;
intentional termination of pregnancy;
cyst on the ovaries;
birth control pills;
excess weight;
chemotherapy.

Uterine fibroids often cause infertility. But there are cases when pregnancy is still possible. Practice suggests that this disease affects each organism in different ways. Doctors cannot fully answer why some women give birth with the formation of fibroids in the uterus, while others are not able to conceive a child with this benign multiple formation.

Symptoms

Education on the uterus is accompanied by the following symptoms:

the menstrual cycle is very painful;
women very often feel a slight pressure in the lower abdomen;
abdominal pain intensifies and has a pulling character;
sexual intercourse for a woman often becomes painful;
the bladder often makes you want to go to the toilet;
disruption of the gastrointestinal tract;
belly growth.

To be able to give birth to a baby, you need to contact a specialist for examination at the first sign of these symptoms. He will prescribe an ultrasound to detect fibroids on the muscular layer of the uterus. Ultrasound examination will help to detect tumor formations in time. Also, the doctor will use this procedure to find out:

the number of nodes that have formed on the uterus;
condition of myomatous nodes;
their place of growth;
the exact size of the fibroids;
the exact location of the foci;
tumor structure.

These characteristics are necessary to determine the answer to the question - is it possible for a woman to give birth to a child. Conception can occur if nothing blocks the entry of sperm into the uterus, and does not disrupt the process of ovulation. For a successful pregnancy, the cervix must not be blocked by this tumor formation. As you can see, there is a chance of pregnancy with this diagnosis.

Diagnostics

At the very beginning of the diagnosis, doctors ask the woman a number of questions. They find out how many times a woman has been pregnant and how many times she has terminated a pregnancy. Also, specialists need to find out if there were operations on the uterus or miscarriages. One of the questions may be about the birth of a still child. After clarifying all the nuances, the woman is sent for research, in which various diagnostic methods are used.

General clinical examinations and tests are carried out. Doctors find out the main aspects of this disease. Diabetics and hypertensive patients are examined very carefully, because these diseases have a great influence on the entire treatment process. In addition to general research, the woman goes to the gynecologist.

The gynecologist must clarify, thanks to research, all the sizes of the formed nodes and changes in the fibroids. Also, the exact location of fibroids. In addition, with the help of an ultrasound device, the specialist monitors the development of the fetus if a pregnant woman is diagnosed. Ultrasound also determines the places where the tumors are located.

Treatment

At the very beginning of the treatment of a woman who has a tumor, doctors try to stop the further growth of the formation. All ways to stop the development of a benign tumor depend on the individual characteristics and structure of the fibroids. Also, an important role is played by the reason for which the disease was diagnosed. Pregnant women often experience iron deficiency in the body, and this can lead to tumor growth. Therefore, due to such a factor, during the gestation of the fetus, it is necessary to constantly take a blood test.

Prevention

Prevention consists in taking iron, ascorbic acid and various vitamins. Proper nutrition, which includes food with a lot of protein. Carbohydrates need to be limited, also stop eating animal fats. Fresh juices, vegetables and fruits have a positive effect on disease prevention. After giving birth by caesarean section, a woman may be prescribed a drug with progesterone. Thus, the process of cell division in the uterus is significantly reduced. The tumor does not grow under such conditions.

How fibroids affect pregnancy

It is no secret that such education is negative during pregnancy. It can be the cause of a miscarriage of deficiency due to the placenta, because the fetus must be surrounded by the placenta. A baby due to fibroids can receive little oxygen and all the nutrients. The consequences can also cause severe bleeding due to placental abruption. The worst thing is that all these processes can happen both in the early stages of pregnancy and in the last months. Therefore, uterine fibroids affect pregnancy negatively.

But if uterine fibroids are detected, you should not immediately terminate the pregnancy. After all, this disease and pregnancy are compatible. You just need to constantly be examined by a specialist. There are many examples where women bore a healthy child, while the pregnancy period proceeded absolutely calmly. But it’s better not to take risks, because a child can be born with a small weight or a deformed body. The negative impact of fibroids on pregnancy is not at all excluded, even despite many successful cases.

After 40 years, pregnancy is more difficult, because at this age hormonal failure is very likely. Also, the rapid growth of fibroids can significantly outpace the capillaries, which causes bleeding. If no violations were observed for 12 weeks, this does not mean that after 20 weeks there will be the same result. The first trimester may pass without any symptoms. But complications can appear at any time. There is a high probability that in the later period blood circulation will be disturbed, because myomatous nodes grow. Therefore, it is recommended to perform a caesarean section when the 39th week of pregnancy is in progress.

Nowadays, most women give birth after 30. At this age, hormonal disruptions begin to progress. Therefore, before conception, it is necessary that doctors find the location and size of the formation. If they reach 4 cm or 5 cm, then pregnancy is possible. But if the fibroid is 7 cm or 8 cm, then this greatly complicates the process of treatment and pregnancy.

How does the disease manifest itself in pregnant women

There can be many symptoms in a pregnant woman. When the process of bearing a baby passes, the tumor can disrupt the placenta and its functions. A woman may have a stomach ache. These pains in the lower abdomen are due to impaired blood circulation in the nodes. Also, there is high blood pressure. A benign tumor can be easily recognized using the echo signs of an ultrasound examination.

Conception during illness

When a woman plans to conceive a baby, you need to take into account all the characteristics of the tumor. It is important to know how it is located and where. Also, an important role is played by the size of the nodes and their predisposition to growth. If the uterus is deformed due to education, then conception is impossible. In this case, it is necessary to remove the nodes. Fibroids when planning pregnancy should be carefully examined.

If the nodes are small and do not affect the uterus, then the likelihood of pregnancy becomes high. But during pregnancy, problems can arise. A woman may not bear a fetus. A miscarriage or termination of pregnancy is more likely.

Can a doctor remove fibroids during a caesarean section?

Removal of fibroids by a doctor during a cesarean section is possible:

in the case of a single formation;
an abdominal tumor that has a stalk;
if there are structural changes in the tumor;
intermuscular formation of large size.

But it happens that after a caesarean section, it is necessary to completely remove the uterus. This is required for women over forty years of age. Also, with necrosis of fibroids and recurrence of tumors. If during cesarean it was possible to remove the formation, then the woman can safely plan another conception of the child.

Natural birth or caesarean section

For each woman in the presence of a tumor, the choice of childbirth is individual. Natural childbirth can take place in the absence of contraindications. For example, education does not grow, and will not interfere with the birth process. For such childbirth, only painkillers are used. But often the doctor recommends a caesarean section to his patient. During a caesarean section, fibroids can be removed by a doctor.

Cesarean is necessary:

if the tumor is located low;
many nodes;
if there is a scar on the uterus after surgery;
the blood circulation of the tumor is disturbed.

Contraindications

The growth of fibroids while carrying a child can carry many complications. The development of all kinds of pathologies and diseases sometimes has to be stopped by emergency delivery or termination of pregnancy. Therefore, the bearing of the fetus must be taken very seriously. It is necessary to constantly check with specialists so that there are no unpleasant unexpected situations.

With this disease, gynecological massage is contraindicated. Also, the lower abdomen should not be allowed to warm up in any way. That is, a bath, solarium, sauna, etc. are contraindicated. You can not lift weights from 3 kg and drink plenty of water before bed. The latter can lead to uterine edema.

postpartum period

It is worth noting that tumors after childbirth can stop growing and developing. The uterus returns to its original position, and accordingly, fibroids and nodes also change. Uterine leiomyoma is found in almost every fifth woman, so the process of bearing a child and the postpartum period can be complicated by various processes.

Multiple uterine fibroids and pregnancy

In the uterus, fibroids often form with many nodes. After removing all the nodes, healthy tissue may not remain on the uterus, so planning for conception and pregnancy may be accompanied by difficulties. But doctors can remove the nodes that interfere with the development of the fetus, which will lead to various complications. Pregnancy with fibroids after the removal of such nodes can proceed calmly. And after the birth, the doctor will remove the rest of the formed nodes.

Forecast

Pregnancy with a tumor can proceed calmly. But the tumor can reveal itself in the later stages. This will lead to premature birth or the need for a caesarean section. Also, a miscarriage may occur. Therefore, when planning a pregnancy with this disease, you need to think about all the consequences.

Complications

What is dangerous myoma:

insufficient power supply of nodes;
neoplasms begin to grow rapidly;
insufficiency of the placenta;
vein thrombosis;
miscarriage;
anemia.

Myoma during pregnancy threatens miscarriage. The risk is pretty big. The percentage reaches the mark of sixty. 25% of women give birth prematurely. To prevent the threat, patients take vitamins and special products. Doctors recommend staying in bed and limiting yourself to physical activity to prevent the occurrence of various complications.

Surgery to remove uterine fibroids during pregnancy

For the treatment of fibroids, an operating method is used. Laparoscopy is an operation that is performed with the necessary instrument and camera to shoot video in the abdominal cavity. This operation prevents the formation of adhesions and increases the patency of the tubes, so that a woman can become pregnant. This technique is safer than, for example, laparotomy.

The operation to remove fibroids called "laparotomy" involves a manual process, which may be accompanied by the risk of adhesions. This can lead to consequences such as infertility and even intestinal obstruction. But with the first type of operation, if the fibroids are large, it will not be possible to sew the uterus. This is solely due to the use of a specific technique.

Therefore, women undergo laparoscopy, remove fibroids if the nodes are small - no more than six centimeters. An experienced surgeon is able to suture the uterus under such conditions. To suture the uterus, which had large knots, there is the latest technology, but it also has some nuances. There is a risk that the scar on the uterus will simply burst. Removal of fibroids during pregnancy is undesirable because there is a risk of miscarriage. Often, fibroids are removed during childbirth during a caesarean section.

But is it necessary to remove fibroids before pregnancy? Yes, because then the pregnancy can proceed in the most ordinary way, without any intervention. But this is provided if the nodes were small in size. Also, it is necessary to undergo a gynecological examination before planning conception to make sure that the scar is in good condition. The age of the pregnant woman also plays an important role in this matter.

Treatment of infertility in myoma

To cure infertility when a tumor is found, surgery is necessary. If the size of the fibroids is large, then it can interfere with the process of conception. After its removal, there is a chance to conceive a child. But if the dimensions were large, which led to the deformation of the uterus, then it is possible that the fibroids will be removed along with the uterus itself. It is necessary to detect the tumor in time, so as not to entail such consequences.

How pregnancy affects fibroids

Doctors cannot guarantee exactly how the formation on the uterus will change during pregnancy. It has not yet been determined exactly why education decreases during pregnancy, which happens in most cases. But there is a small percentage that the tumor can almost double in size. However, it does not always interfere with the bearing of the baby and childbirth. Perhaps progesterone increases and the development of fibroids decreases. But until the end, scientists can not answer this question.

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The appearance of symptoms of this pathology causes panic in women. When a fibroid is found in the uterus and pregnancy has already begun, this can have dangerous consequences for the expectant mother and fetus, especially if the tumor is large. Why a neoplasm develops, what it is, whether it can become a problem for conception - it is important to know for women of childbearing age.

What is myoma

When hormonal disorders occur in the body associated with an excess of estrogen and a deficiency of progesterone, a benign tumor process, fibroids, is born in the muscle tissues of the walls of the uterus. Its growth provokes an abnormal division of cellular structures, which begins asymptomatically. With the progression of the process appear:

prolonged menstruation with severe blood loss;
sharp cramping pains in the lower abdomen, in the lower back;
frequent urination if the node is located on the isthmus of the uterus;
constipation;
an increase in the size of the abdomen.

Neoplasms during the period of expectation of a child can develop on any part of the organ and have dangerous consequences. Often there are multiple fibroids. According to the location of the tumor, there are:

subserous (subperitoneal) - under the outer cover of the body of the uterus;
interstitial (intermuscular) - in the thickness of the wall;
submucosal (submucosal) - in the layers under the endometrium.

Is pregnancy possible with uterine fibroids

It is good if a neoplasm in a woman is discovered during pregnancy planning. It is advisable to treat or remove the node during this period. Deformation of the uterus by a tumor can affect conception:

prevents sperm from getting to the egg - the lumen of the fallopian tubes narrows;
prevents ovulation;
makes it difficult for a fertilized egg to attach to the walls;
at large sizes rejects it, causing infertility.

If pregnancy with fibroids does occur, it must be terminated if necessary:

submucosal form of the tumor;
suspicion of a malignant neoplasm;
with sizes over 15 cm;
multiple nodes;
degeneration or necrosis of tumor tissues;
severe comorbidities;
woman's age after 45 years;
localization of the node in the cervical region, complicated by uterine bleeding;
miscarriage threats.

How is myoma diagnosed?

When symptoms of an illness appear, a woman needs to visit a gynecologist. The tumor is detected by probing through the anterior abdominal wall. More precisely diagnosed with ultrasound, which reveals the localization, number of nodes, size, location relative to the placenta. Ultrasound is performed in two ways:

transvaginally - by inserting a sensor through the vagina into the uterine cavity - in the absence of a fetus;
transabdominally - through the anterior wall of the peritoneum.

There are diagnostic methods that are not used when fibroids and pregnancy are established at the same time. This may pose a risk to the development of the embryo. These include:

hysterography - X-ray examination using a contrast agent;
hysteroscopy - examination of the organ cavity with a special device inserted through the vagina.

Consequences of fibroids during pregnancy

A woman with symptoms of a neoplasm should be registered to maintain pregnancy. The tumor can cause serious problems, affect the development of the child, the health of the mother. Myoma during pregnancy threatens:

placental insufficiency;
tumor pressure on the fetus;
violation of the supply of nutrition and oxygen to the embryo;
placental abruption;
premature birth;
spontaneous abortion;
tissue necrosis in violation of the blood supply to the tumor;
squeezing of the veins, the appearance of blood clots;
iron deficiency anemia;
rupture of the body of the uterus.

Myoma during early pregnancy

A woman should be careful in the first trimester, especially in the presence of hereditary factors. If small nodes are identified, the disease may be asymptomatic. Myoma during early pregnancy is dangerous when it is large. In this situation:

bloody discharge appears;
increased risk of missed pregnancy;
there is a possibility of miscarriage if a submucosal form of the tumor is observed;
circulatory disorders occur;
contact of fibroids with the placenta causes an increase in uterine tone and miscarriage.

Second and third trimesters of pregnancy

At later dates, a large knot leaves little space for the growing fetus. It is dangerous when it is located next to the placenta. This development is fraught with consequences:

the risk of preterm birth;
the emergence of a threat of termination of pregnancy;
the birth of a baby with low weight;
the likelihood of placental abruption;
deformity of the skull in a newborn.

Pregnancy with small uterine fibroids

Many women who are diagnosed with neoplasms in the uterus feel good during the period of expectation of the child, they do not experience any complications. This is due to the small size of the tumor. Problems for mom and unborn child appear in cases where:

there are many nodes deforming the uterus;
the tumor is close to the neck;
the placenta is located in the area of the myomatous node.

Pregnancy with large uterine fibroids

When the neoplasm grows to a huge size, it can adversely affect the course of pregnancy. Blood circulation in the uterus is disturbed, which can provoke the degeneration of fibroids. At the same time, prostaglandins are released from it, causing contraction of the uterine muscles. In such situation:

premature birth occurs;
high risk of miscarriage.

For the development of the fetus, a huge tumor is no less dangerous. She takes on most of the blood supplying the uterus with the embryo, giving oxygen and nutrition. In addition, the tumor puts pressure on the growing organs. All this leads to serious problems:

deformities of the skull, neck;
small weight of the newborn;
underdevelopment of organs;
death of the fetus.

Tactics of pregnancy management

Women with symptoms of a neoplasm in the uterus should be registered as soon as possible. The doctor conducts a complete examination, determines the size of the tumor. If it has large volumes, is poorly located or many nodes are noted, an important task is solved - to terminate or maintain the pregnancy. A positive conclusion is accepted if:

prolonged infertility ending in conception;
woman's desires
more than 24 weeks when the fetus is viable.

In the presence of a benign tumor in the uterus, increased attention of the gynecologist and the woman to the state of health is necessary. An important role is played by the prevention of the destruction of fibroids and uterine tone. Expectant mothers are recommended:

regularly undergo an ultrasound examination of the placenta and nodes when they are close;
exclude physical activity;
to sleep more;
provide sexual rest;
avoid stressful situations.

Childbirth with uterine fibroids

When diagnosing myomatous nodes, gynecologists recommend hospitalization for a period of 37-38 weeks in order to prepare for delivery. A woman can give birth naturally through the birth canal under certain conditions. This happens in case:

if the entire period has passed without complications;
the fetus developed correctly;
his position and the placenta are normal.

A caesarean section is necessary when a subserous uterine myoma is diagnosed during pregnancy, complicated by tissue necrosis. Indications for operative obstetrics are:

pelvic presentation of the fetus;
the presence of a scar on the uterine body;
large neoplasms;
the presence of complications;
the fact of multiple nodes;
low position of the tumor, preventing the opening of the cervix.

To avoid late complications, doctors can carry out when performing a caesarean section:

removal of fibroids, if it is single, subserous on the leg, there are secondary structural changes in the neoplasm;
perform a hysterectomy - remove the uterus completely, when the tumor is multiple, localized under the mucous membranes near the vascular bundles, there is necrosis of muscle tissue, recurrence of neoplasms.

Treatment of uterine fibroids during pregnancy

To alleviate the condition of a woman, to exclude the occurrence of complications, gynecologists carry out therapeutic measures. Removal of fibroids during pregnancy is an exceptional case when there is a threat to life. For treatment use:

with the rapid growth of nodes - antiplatelet agents that improve microcirculation;
for anesthesia - No-shpu;
with the threat of miscarriage - bed rest, hormonal drugs;
in the case of uterine hypertension - infusion therapy;
vitamin complexes.

How pregnancy and childbirth affect fibroids

Hormonal changes taking place in a woman's body affect the development of a neoplasm in different ways during the period of expectation of a child. According to experts, childbirth does not affect the tumor - it is removed during a cesarean section or subsequently. While waiting for a child, myoma formations can:

increase in size in the first two trimesters;
remain unchanged;
decrease in the third trimester;
dissolve;
degenerate - break down with the appearance of edema, necrosis, bleeding.

Pregnancy after uterine fibroids

If an operation was performed to remove the neoplasm, there are no complications after it, gynecologists recommend planning conception in a month. A woman needs to register at an early date, undergo all examinations. After surgery, a scar remains on the uterine wall, which can cause problems:

the threat of spontaneous abortion;
pathology of the placenta;
rupture along the seam during the growth of the fetus with bleeding;
occurrence of hypertension.

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The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.