Fibroids and pregnancy - all the nuances of childbirth and childbearing. Restoration of reproductive health

Are fibroids and pregnancy compatible? According to gynecologists, every fifth woman aged 18 to 50 has a history of a tumor-like node on the uterus of a benign nature. By changing the cavity of the organ, the tumor causes infertility and habitual miscarriage, and also provokes complications during gestation and childbirth. However, the myomatous node cannot be considered an absolute contraindication for pregnancy. Is it possible to conceive and carry a baby with this disease? How to behave if uterine fibroids appear already during pregnancy?

what is a fibroid and why does it occur

Myoma is a hormone-dependent benign neoplasm that grows from the smooth muscle elements of the uterus.

Its main causes are considered to be an increase in the level of ovarian hormones and a violation of metabolic processes. This condition may occur when:

Physiological fluctuations in the synthesis of ovarian hormones: pregnancy, perimenopause.
Diseases of the endocrine glands: hormonally active tumors and ovarian cysts, pathologies of the adrenal glands, thyroid gland.
Central nervous system lesions affecting the hypothalamus and pituitary gland.
Obesity.
Smoking and alcoholism.
Chronic stress.
Long-term use of hormonal drugs.

Under the influence of adverse conditions, atypical cells appear in the muscular layer of the uterus, which begin to randomly divide, forming a knot. It can grow in the thickness of the myometrium (interstitial), come to the surface of the organ (subserous) or go into the cavity (submucosal).

For a long time, the disease is asymptomatic and is detected already when the node reaches 30 mm or more in diameter. The main manifestations of fibroids are:

Prolonged, profuse menstruation.
Pain and discomfort in the lower abdomen.
Compression by the tumor of the adjacent intestines and bladder, provoking a violation of defecation and urination.
Acute pain and signs of inflammation of the peritoneum in case of malnutrition in the nodes.

If these symptoms occur, the uterine neoplasm requires mandatory elimination.

Are fibroids and pregnancy compatible?

Myomatous nodes, located among the muscle fibers of the uterus, violate its architectonics. The uterus prevents the flow of spermatozoa into the organ cavity and fallopian tubes, where the process of fertilization of the egg should take place. Also, conception is impossible if the node grows, blocking the lumen of the fallopian tubes.

The tumor, making it difficult for the contractility of the uterine muscles, disrupts the normal menstrual cycle. At the same time, it is often accompanied by endometriosis - the growth of the epithelium of the uterus outside its inner layer. This minimizes the chances of successfully combining pregnancy with fibroids without medical treatment.

If fertilization does occur, submucosal nodes may prevent complete attachment of the blastocyst from which the embryo is formed and its location. This is the cause of miscarriages at different times and violations of intrauterine development of the child.

How do fibroids affect pregnancy

It is not always possible to identify myoma at the stage of preconception preparation. And if a woman with this pathology has already become pregnant, myomatous nodes can complicate its course.

And changes in the uterus during pregnancy

The gestation period is accompanied by restructuring throughout the body. The uterus undergoes significant changes: its epithelial lining thickens, muscle fibers elongate and hypertrophy, allowing the organ to greatly stretch as the size of the fetus increases.

These changes are controlled by hormones that are actively produced by the ovaries, and after 12 weeks of gestation, the placenta. And often this provokes an intensive growth of a hormonally dependent pathological structure.

About the complications of pregnancy against the background of fibroids

The percentage of spontaneous abortions during early pregnancy in women with this pathology is significantly higher than in women without nodes in the myometrium. At the same time, the risk of miscarriage is significantly increased with numerous myomatous tumors.

When the placenta adheres to the areas of fibroids, there are frequent cases of its detachment, which is accompanied by pain, profuse bleeding and subsequent death of the fetus.

For the same reason, delays and anomalies in the development of the fetus are often observed. Large nodes in the uterine cavity can squeeze the child, leading to various deformities.

The second third of the gestational period may be complicated by placental insufficiency, which provokes an insufficient supply of oxygen to the fetus (hypoxia). Placenta previa to the cervical canal contributes to frequent bleeding and the threat of spontaneous abortion. Also, with the further development of pregnancy, preeclampsia may occur. This is a pathological condition characterized by:

Increased pressure.
The appearance of protein in the urine.
Swelling of the face and limbs.
neurological disorders.

With the development of a hypertensive crisis and convulsions (eclampsia), urgent delivery is required, regardless of the timing of gestation.

In the third trimester of pregnancy, fibroids can cause an incorrect position of the child. Large nodes prevent him from taking the head position to the entrance to the small pelvis. The child is positioned transversely or feet first, which will greatly complicate the process of childbirth. This may be an indication for a caesarean section for myoma.

Is it possible to confuse fibroids with pregnancy

Often, myomatous nodes are symptomatically similar to the period of gestation. They can be confused with pregnancy by the following symptoms:

Delay next menstruation.
Bloody discharge during the intermenstrual period.
Enlarged belly.

If these symptoms occur, you should definitely consult a doctor for a correct diagnosis.

Diagnosis of a tumor during pregnancy

Most accurately, a uterine tumor can be detected by examining the uterine cavity with ultrasound. Confusion on ultrasound can only occur if the submucous myoma on the leg has a small volume.

It can be mistaken for a fetus. In such cases, it is necessary to determine the concentration of hCG (chorionic gonadotropin) in the urine or blood. This hormone is a marker of pregnancy and in fibroids its concentration is close to zero.

How to distinguish

Pregnancy from a myomatous tumor can be distinguished by the following features:

Weekly increase in the concentration of hCG in the blood and urine.
The appearance of a bluish tint of the vagina and cervix, softening of the tissues of the organ during probing.
On ultrasound: determination of the fetal heartbeat from 6-12 weeks, movements from 16 weeks of gestation.

Important! Delayed menstruation, bloody spotting from the genital tract, pain and discomfort in the abdomen, as well as an increase in its size are a reason for a mandatory visit to an obstetrician-gynecologist. Only a doctor can determine if a patient has fibroids or pregnancy.

Can fibroids resolve on their own during pregnancy

In the practice of some obstetrician-gynecologists, there have been cases when the fibroid resolves in a pregnant woman. However, such situations are extremely rare.

As a rule, pregnancy gives impetus to a more intensive growth of the uterine nodes due to changes in the hormonal background.

Therefore, all women with a history of this pathology should plan pregnancy and, if necessary, treat the pathology at the stage of pregravid preparation.

Recommendations for maintaining pregnancy

About the main dangers during gestation

The most common complications of a tumor during gestation are:

Bleeding.
Low attachment and placenta previa.
Threats of miscarriage.
Underdevelopment of the placenta.
Compression of the fetus by tumor-like nodes, leading to deformities.
development of preeclampsia.
Incorrect (transverse, foot) position of the fetus to the entrance to the small pelvis, which complicates the process of birth.

How to behave correctly during gestation

Pregnant women with fibroids should not panic. The main thing that a woman can do to prevent the development of complications is to follow all the recommendations of an obstetrician-gynecologist.

In order to prevent the growth of the tumor, it is necessary to undergo an ultrasound of the pelvic organs and the fetus at the time prescribed by the doctor.

If you experience any disturbing symptoms (blood from the genital tract, abdominal pain, deterioration in general well-being), you should definitely visit a gynecologist.

Women with tumors, especially pregnant women, are not recommended to stay in the sun for a long time, to carry out warming procedures on the lower abdomen and lower back. You should adhere to proper nutrition and give up bad habits. And be sure to avoid stress and unnecessary worries.

Treatment of pathology during pregnancy

Hormone therapy prescribed to eliminate nodular uterine formations is not possible during pregnancy. Therefore, the treatment of the tumor is carried out only symptomatic in the event of clinical manifestations.

Important! Any drug therapy during pregnancy should be agreed with an obstetrician-gynecologist. Many drugs are forbidden to be taken during the gestation period.

When is surgery to remove a tumor performed?

During pregnancy, uterine nodes are removed according to the following indications:

Nodes of significant volumes and their intensive growth.
Twisting of the base of the myoma formation, accompanied by tissue death.
Lack of results from drug therapy.
Severe pain syndrome.

The optimal and safest term for myomectomy for the mother and fetus is 15-19 weeks of gestation. The operation requires a wide incision (laparotomy). The tumor is isolated and excised, and immediately after the intervention, ultrasound is performed to assess the viability of the fetus. during pregnancy, natural childbirth is contraindicated.

Is it possible to give birth with uterine fibroids

A knot in the uterus can complicate the process of childbearing. It violates the contractility of the organ, makes it difficult for the child to pass through the birth canal, with cervical myoma, its mobility and transformation for a successful birth are disturbed.

Complications

The main complications provoked by a uterine neoplasm during childbirth are:

Weakness or absence of contractions and attempts.
Discoordinated labor activity.
Bleeding.
High risk of uterine rupture.
Creating an obstacle to the birth of the fetus.
Delayed placenta separation.

E natural childbirth or caesarean section

Childbirth with fibroids can take place naturally with a small diameter of the node, its localization near the bottom of the uterus and the absence of mechanical barriers to the birth of the fetus.

Childbirth with myoma by caesarean section is carried out with the lower segment location of large nodes, the occurrence of complications and after myomectomy.

Childbirth and the postpartum period

It is possible to give birth safely with fibroids. The birth process must be supervised by qualified medical personnel. At the same time, contractions and the fetal heartbeat are constantly monitored. In the event of complications, emergency operative delivery is used. After childbirth, uterine bleeding and retention of the placenta are more common. Therefore, it also requires constant medical supervision.

Consequences for the child

The main thing for the fetus is its compression by large nodes, provoking deformations and deformities. And also, when the placenta is adjacent to pathological tissues, circulatory disorders between the uterus and the placenta are possible, leading to a delay in fetal development and oxygen starvation of varying severity.

However, with medical supervision over the course of the gestation period, such complications are extremely rare. Despite all the frightening possible consequences, fibroids and childbirth are compatible if the woman is under the supervision of doctors and follows all their instructions.

Myoma causes infertility

Tumor-like nodes of submucosal and intermuscular localization have the greatest adverse effect on the reproductive function. They prevent the full attachment of the blastocyst to the uterine wall, causing infertility. At the same time, myomectomy and hormonal therapy performed before pregnancy increase the chances of successful conception and childbearing.

Many women who are suspected of having uterine fibroids panic in search of answers to questions - what is it? Why me? Is it possible to conceive a child? Is it possible to give birth with uterine fibroids? Is it dangerous if diagnosed already during pregnancy?

To be honest, doctors have not yet given unambiguous answers to all these questions. However, they do have some information.

What is uterine fibroids and why does it occur?

Myoma is a benign tumor of muscle tissue. Occurs when uterine cells begin to actively divide. Doctors have not fully figured out why this begins to happen, but one of the most likely causes is associated with hormonal stimulation and increased secretion of estrogens. Thus, the growth of fibroids is stimulated by estrogen, and the reverse process is caused by progesterone. Nevertheless, this does not mean that if the balance of estrogen and progesterone is not disturbed in the body, then there is no fibroids. The problem is that usually a local change in the level of estrogen in the uterus is not reflected, or very slightly, on the content of hormones of this group in the blood.

In fact, fibroids are always represented by several nodes at once. They are of various sizes and can also develop in different parts of the uterus. The nodes that are located under the outer cover of the uterus are called subperitoneal or subserous. Those in the thickness of the uterine wall are intermuscular or interstitial. Nodes, the localization of which is under the lining of the uterine cavity, are submucosal or submucosal. It also happens that the uterine cavity is deformed by one large knot.

Uterine fibroids and conception

The first symptoms of fibroids are prolonged cyclic bleeding, which is often accompanied by uterine bleeding. Myoma is diagnosed through ultrasound.

Uterine fibroids are not the cause of infertility, however, it can be very difficult to conceive with such a diagnosis. The fact is that fibroids can compress the fallopian tubes, which greatly complicates the movement of spermatozoa and disrupts ovulation.

The ideal option is to cure or even remove fibroids before pregnancy. True, if the nodes (or node) are no larger than a 12-week pregnancy. If the fibroid is larger and deforms the uterine cavity, it will be very difficult to maintain the ability to bear children when it is removed: often such an operation is accompanied by severe bleeding, in which the uterus can be removed.

uterine fibroids and pregnancy

Of course, there is nothing good in uterine fibroids during pregnancy. Firstly, it is usually accompanied by placental insufficiency, and secondly, by the threat of termination of the pregnancy itself. It is especially dangerous if the placenta is located next to the myomatous node: it disrupts its structure and often functions, and, accordingly, much less oxygen and nutrients enter the baby. Such an arrangement is also dangerous in that premature bleeding can occur, which will also be accompanied by severe bleeding.

Some doctors say that during pregnancy, fibroids begin to grow, while others say that this is actually due to the growth of the uterus, but this is actually not dangerous for either the mother or the baby. Another thing is dangerous - if the fibroid degenerates, that is, it collapses. This process is usually associated with the necrosis of the tissues of the node and, as a result, the formation of edema, cysts and bleeding in a pregnant woman. Worst of all, degeneration can occur at any stage of pregnancy.

According to recent statistics, doctors are increasingly discovering fibroids in pregnant women, primarily because in our time more and more women give birth after 30, that is, when hormonal disorders begin. Of course, the possibilities of modern medicine also influence - in particular, early diagnosis, thanks to which it is possible to immediately diagnose a woman with fibroids.

Myoma is not a reason to terminate a pregnancy, but it is a weighty argument to be under the close supervision of the attending physician. For many women, pregnancy with fibroids proceeds absolutely normally and without any complications. True, only in cases where the size of the nodes is not too large.

childbirth

In half of pregnant women with uterine fibroids, doctors note protracted. Can the doctor and recommend giving birth by caesarean section. Although, in fact, the fibroid itself does not in any way prevent the baby from passing through the birth canal. The problem is that fibroids often entail anomalies in the position and presentation of the fetus.

Specially for- Maria Dulina

From Guest

At the age of 25, I was diagnosed with multiple uterine fibroids, but the doctor said that it was not at all scary. No one directed or offered to remove it. She got pregnant at 31. At 11 weeks pregnant, the uterus was at 19 weeks. At 18 weeks my stomach started hurting. It was found that 4 nodes grew to 5-6 cm in diameter. From 18 weeks, almost all the time she lay on the conservation, and at 28 weeks there was a premature birth. Now everything is fine with the baby, but there were a lot of experiences. Doctors say that fibroids pulled out the fetus ...

From Guest

At 6 weeks I was diagnosed with an undeveloped pregnancy. After found myoma about 12 mm. Perhaps she was the cause.

From Guest

I gave birth at the age of 37 and I had a fibroid. No complications, I gave birth myself. I went well throughout the pregnancy, and the tests were excellent, even the hemoglobin was surprisingly high for the doctors. I think if everything goes smoothly, there is no worry. Always think only about the good and about your baby.

From Guest

With Myoma, you can also give birth to a healthy baby. The main thing is to see a good doctor. I was observed at the Clinic of Gynecology and New Reproductive Technologies. Normally endured, gave birth

From Guest

Before pregnancy, myoma was 30 mm. At week 16, it grew to 12 cm - I was shocked! At the end of pregnancy, the fibroids decreased to 5 cm. Sometimes the fibroids swelled and caused pain like contractions, although no threats were found by ultrasound. Bleeding was once every 2 months. Childbirth also began with bleeding. Despite all the difficulties, the baby was born full-term and healthy. So girls, do not panic - just see a good specialist. I was referred for a consultation at Moniag

01 August 2018 4574 0

What is the danger of fibroids during pregnancy and childbirth are interested in women who are diagnosed with this disease. With myoma, tumor-like formations develop from the smooth muscle tissue of the uterus, which can have different localization. A distinctive feature of this disease is the development of a single node from a particular cell.

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

Subserous fibroids develop in the outer part of the reproductive organ and grow into the pelvic cavity. This neoplasm during pregnancy is the cause of complications, but a woman should be observed by a gynecologist who can assess the possible risks.

In modern medicine, various methods of treating fibroids have been developed. Uterine artery embolization is recognized as a safe and effective procedure among gynecologists, which is performed with enlarged and multiple formations. Myoma during pregnancy and childbirth in many cases does not require complex treatment.

Is pregnancy possible

Pregnancy is an important event in the life of women, when planning it, you should get rid of all diseases that can affect the condition of the fetus and worsen its course. Uterine fibroids are detected in 80% of women of reproductive age. Small fibroids during pregnancy can occur due to various reasons.

The most susceptible to the development of the disorder are women who have not given birth before or have a small number of pregnancies. In addition, experts associate the development of the disease with injuries to the tissues of the uterus obtained during curettage, surgical manipulations and abortions. The risk of formation of myomatous nodes increases due to infectious diseases and hereditary predisposition.

New ideas about this pathology, which have been confirmed in the course of numerous studies, have allowed specialists to develop effective methods of diagnosis and organ-preserving therapy. For a long time, experts believed that the tumor is hormone-dependent, as a result of which drugs were used that cause the progression of the disease. In the treatment of most patients, the uterus was removed, after which women could not experience the joy of motherhood.

There is a widespread belief that subserous uterine fibroids and pregnancy are incompatible, since the tumor can prevent conception. However, subserous nodes are rarely the cause of infertility. There are active discussions among specialists about the relationship between infertility and fibroids. The most reasonable is the opinion that infertility occurs not so much because of fibroids, with this disease, its causes are:

obstruction of the fallopian tubes;
hormonal imbalance;
insufficiency of the corpus luteum phase of the menstrual cycle;
endometrial damage.

With a combination of certain factors, a dangerous consequence of myomatosis is that pregnancy with myoma and endometriosis can suddenly end. Gynecologists recommend that patients before conception treat nodes, regardless of their size, in order to exclude the possibility of negative consequences of the disease.

If the tumor is diagnosed at the stage when a woman is planning a pregnancy, it is necessary to cure the disease in advance, which can cause complications. For the treatment of fibroids, it is recommended to contact, whose specialists use reasonable and generally recognized methods.

In the early stages of the development of a benign tumor, the patient is under the supervision of specialists, she is prescribed the intake of modern drugs, the load of which on the body is reduced. If a large fibroid is detected and pregnancy does not occur, the node is surgically removed.

An alternative to surgery is uterine artery embolization, which does not require a long period of rehabilitation. The procedure does not adversely affect the organs of the reproductive system, therefore, after embolization, the patient successfully becomes pregnant and gives birth to healthy children.

The EMA method complies with the world standards of medicine. The procedure is performed in comfortable conditions in a special operating room. Embolization requires special knowledge and skills possessed by endovascular surgeons. This method allows you to successfully treat both single and multiple myomatous nodes.

Changes in the uterus during pregnancy

In the body of a woman during pregnancy, there are serious changes that allow you to bear the baby. The most significant transformations in this period occur in the uterus. Pregnancy with small uterine fibroids can develop without complications, in some cases there is a deterioration in the condition of the woman and a threat to the child, which is due to the anatomical features and features of the development of the disease.

The structure of the uterus

The development of the fetus occurs in the uterine cavity, as it has a structure that ensures the maintenance of pregnancy. A feature of the genital organ is the ability to increase in size and good extensibility; after childbirth, the uterus returns to its original state after a few weeks. Multiple uterine fibroids and pregnancy are combined in that a woman has an increase in the size of the uterus, the cause of which is established by gynecologists.

The uterus consists of three parts: the body of the organ, the neck and the isthmus. The fundus of the uterus is the highest part of the body of the organ. During gynecological examinations, the gynecologist controls the location of the fundus of the uterus, this indicator allows you to identify possible pathologies of pregnancy. The pear-shaped form of the uterus ensures that the fetus takes the correct position during pregnancy and childbirth.

The uterine walls are formed by three layers:

The endometrium is the mucous membrane that lines the inside of the uterus. During pregnancy, this membrane thickens;
myometrium or muscle layer, which, in the absence of pathologies, is in a relaxed state. In the process of labor activity, it begins to contract intensively. Increased uterine tone during pregnancy can be a dangerous disorder that occurs during stress, inflammation, underdevelopment of the uterus and hormonal imbalance;
the serosa or perimetrium covers a significant part of the uterus.

When planning a pregnancy, a woman should pay special attention to reproductive health, the state of which is determined by a gynecologist during the examination. During the diagnosis, subserous myoma of the poppy and pregnancy can be detected. Many women may not know about the development of the disease for a long time, since at the initial stages there may be no symptoms of the pathology.

Changes during pregnancy

Myoma 3 cm and pregnancy at the initial stage can develop asymptomatically, the process of fetal formation in the early stages is indicated by deterioration and the absence of menstruation. Changes that occur with the organs of the reproductive system are noted by a gynecologist during the examination. These transformations may not be noticeable to a woman, as they occur gradually.

A noticeable increase in the uterus occurs by the 5th week of pregnancy, and the organ also takes on a spherical shape. At the initial stage of pregnancy, the tissues of the uterus soften. The increase in the uterus in size in the first trimester is negligible. An increase in the circumference of the abdomen can cause subserous fibroids and pregnancy, an experienced gynecologist will be able to establish the cause of the changes.

When implanting a fetal egg, a woman may experience spotting, in which there is no pain syndrome. This symptom can occur when a 5 cm fibroid develops in the uterus during pregnancy, a woman should immediately contact her doctor, as discharge may indicate an incipient miscarriage.

Preparing for pregnancy

Preparing for pregnancy is a responsible task, in the implementation of which a woman needs the help of an experienced gynecologist. When a woman contacts a medical institution on this issue, a comprehensive diagnosis is carried out, and problems that worsen reproductive health are identified.

Myomatosis is a common disease that is detected in patients who have not given birth, or women who have a small number of pregnancies. Myoma during pregnancy can cause complications or provoke a miscarriage, therefore, regardless of its complication and size, treatment is carried out. If the tumor is diagnosed during the period when the woman is carrying a child, the doctor may perform a caesarean section and removal of fibroids at the same time.

A pregnant woman should regularly undergo examinations and visit a gynecologist who can identify possible violations and save the fetus. Modern medicine has safe methods to restore reproductive health. Each patient can get a preliminary and visit a specialist at a convenient time.

The effect of fibroids on the course of pregnancy

Every woman who is preparing for the birth of a child needs to be attentive to her well-being if pregnancy develops with large uterine fibroids. Myoma is not an obstacle to the birth of a healthy child, but it can complicate the course of pregnancy.

The main causes of problems during fertilization, miscarriage and the development of complications in myoma are:

the tumor blocks the entrance to the fallopian tubes, as a result of which the sperm cannot fertilize the egg;
deformation of the cervix with benign formations;
endometrial diseases caused by multiple fibroids;
deformation of the uterine cavity and a decrease in its size can cause 8 cm fibroids, and the pregnancy can be terminated.

If conception occurs with this disease, then complications can occur in any trimester, so a woman should regularly visit a gynecologist.

Pregnancy with small uterine fibroids

If a woman has a 6 cm fibroid in the uterus and less intense manifestations of the disease are absent, and pregnancy in most cases proceeds without complications. The growth of small nodes in this period stops. However, some women who have benign tumors in the uterus may experience minor pain accompanied by nausea. Pain is typical for the first and second trimesters.

Pregnancy with large uterine fibroids

The question of the influence of myomatous formations on the course of pregnancy has not been fully developed. However, experts have established possible complications that develop when carrying a child against the background of myomatosis.

The main conditions of pregnancy with myoma are:

a high probability of birth before 37 weeks is noted with multiple nodes or a close location of the tumor to the placenta;
miscarriages with submucous myoma;
placental abruption and spotting;
deformation of the uterine cavity, as a result of which the fetus is located incorrectly;
caesarean section is performed for women with fibroids quite often. However, uterine mima is not among the indications for this operation;
weakness during childbirth and postpartum bleeding occur in women with myomatosis quite rarely. Data on these complications are considered by highly qualified specialists to be contradictory.

Pregnancy with small uterine fibroids is rarely accompanied by complications. Due to hormonal changes in the body, the growth of nodes can occur.

Symptoms of the disease during pregnancy

Benign tumors in the uterus can develop without symptoms or have pronounced signs. Unpleasant manifestations of the disease are observed in 30% of patients. Often the disease is detected during a routine examination. Women who rarely visit a gynecologist may develop a 10 cm fibroid, and pregnancy in this case will not occur or will be accompanied by serious complications.

In today's world, you can call and visit the clinic at a convenient time. The success of treatment for myomatosis depends on the adequacy of therapeutic measures and their timeliness. During a pregnancy complicated by this disease, there are situations when patients need urgent, emergency care, which is provided by specialists from the best clinics.

If signs of fibroids appear, it is necessary to consult a gynecologist to undergo an examination and determine possible treatment options. During pregnancy, the disease is characterized by the following symptoms:

frequent urination, impaired defecation. These signs during pregnancy appear with the growth of the fetus, but the cause of their development may be the pressure of the tumor on the bladder and rectum;
intestinal disorders;
increased sweating;
pain in the vaginal area, in the lower abdomen;
an increase in the volume of the abdomen in early pregnancy;
vaginal discharge that has an unpleasant odor;
headaches and dizziness;
fainting;
low blood pressure;
cardiopalmus;
pale skin;
high fatigue.

These signs can be mistaken by a woman for manifestations of pregnancy. However, if you feel worse, you should immediately contact a medical institution to receive quality care. If uterine fibroids develop, the symptoms during pregnancy depend on the type of tumor, its location, size, and individual characteristics of the body.

Pregnancy with multiple large fibroids

Numerous myomatous formations have a negative impact on both the onset of pregnancy and the process of bearing a child. The symptoms of multiple myomatosis and the behavior of the nodes vary. The main signs of the disease are pain and vaginal discharge, with the progression of the disease, the general condition of the patient worsens.

If multiple uterine fibroids and pregnancy are detected, then a woman needs to be examined frequently. Fever and intense pain rarely occur during pregnancy, these symptoms may indicate twisting of the leg and death of the node, which poses a serious danger to the fetus.

Treatment of multiple nodes requires an integrated approach, which is not possible for pregnant women. Uterine artery embolization is highly effective. This procedure allows you to reduce the size of all nodes and eliminate the likelihood of recurrence. The positive effect of the procedure is noted by patients and endovascular surgeons in the first hours after the procedure, then the symptoms and size of the formations gradually decrease.

Risks for mother and fetus

Uterine fibroids 9 cm during pregnancy is a danger to the fetus and mother. Large tumors before pregnancy planning are removed by various methods, as they can cause spontaneous miscarriage, and also prevent pregnancy. If conception occurs with this pathology, then there is a serious obstacle to normal delivery, to eliminate which various methods of modern medicine are used.

Myomatous node in the first trimester of pregnancy

Many patients turn to gynecologists with the question of whether pregnancy is possible with multiple fibroids and large nodes. In this case, conception is possible, but if a woman with a tumor in the uterus has it, then she needs to contact a specialist for examination and consultation. The need for complex diagnostics lies in the fact that the tumor deforms the uterine cavity, disrupts the tissues and blood supply to the affected area.

In the first trimester of pregnancy, the hormonal background changes, which can provoke the rapid growth of a benign tumor. By the end of the first period, the growth of nodes stops. If the pathological process continues to progress, complex therapy is carried out, the selection of components of which takes into account their degree of negative impact on the fetus.

When the placenta is attached near the myomatous node in the first trimester, the probability of abortion is high. In addition, the disease negatively affects the general condition of the expectant mother, as she experiences excessive fatigue, heaviness in the lower back, and pain is possible.

Removal of fibroids during pregnancy is carried out in exceptional cases, for example, with a caesarean section. In the first trimester, the patient may be prescribed drug therapy to eliminate symptoms and stop the growth of nodes.

Features of the course of the disease in the second trimester of pregnancy

In the second trimester, a tumor in the uterus can cause pathologies in the development of the fetus. Large knots compress the fetus, resulting in spinal disorders. In addition, the volume of nutrient intake decreases, since neoplasms absorb substances in the blood.

With myomatosis, the fetus is more likely to develop certain disorders:

skull deformities;
curvature of the spine, in particular, the cervical region;
violation of the structure of the limbs;
increased intracranial pressure;
reduced weight of the child;
disorders in mental development.

The risks for the mother during pregnancy against the background of fibroids are that uterine bleeding may occur, as well as placental abruption. A rare type of tumor is calcified myoma, and pregnancy can also develop successfully with this form.

The death of the node in the absence of pregnancy is considered by experts to be a favorable outcome of the disease, however, when pregnancy occurs, it can pose a serious danger to both the baby and the mother.

Uterine fibroids during pregnancy: third trimester

The third trimester of pregnancy is characterized by intensive development of the child. With fibroids in this period, the fetus may take the wrong position due to a large tumor in the uterus. The risk of preterm birth in the third trimester is extremely high, so monitoring by your doctor is a must.

Many patients undergo a caesarean section for uterine myoma, during which neoplasms are removed. This procedure in some cases is redundant, since the treatment of the disease after childbirth is possible by embolization of the uterine arteries. During the procedure, the large blood vessels that feed the tumor are blocked, while the blood supply to the organ is carried out through a developed network of vessels. Gradually, the size of the formation decreases, within a year the tumor is replaced by a safe connective tissue, so relapses are completely excluded.

Myoma during pregnancy and childbirth

With the development of fibroids in the uterus, the course of pregnancy and childbirth can be complicated. Common complications during pregnancy against the background of myomatosis are:

death of nodes;
untimely discharge of water;
violations of the contractile activity of the uterus;
uterine bleeding.

Timely embolization of the uterine arteries can prevent negative consequences. This procedure has no contraindications, since it uses a hypoallergenic drug.

When a pregnant woman who develops fibroids is contacted, a gynecologist conducts an examination, the results of which are necessary to develop treatment tactics and maintain pregnancy. When choosing the most optimal methods, the age of the patient, the size and direction of growth of neoplasms, and their number are taken into account.

Managing childbirth with this disease is a difficult task. During labor, the ability of the uterus to contract can sharply decrease due to the development of a large benign tumor. The location of the node in the cervix prevents the child from passing through the birth canal, to solve this problem, the removal of fibroids during cesarean section is prescribed.

Removal of fibroids during pregnancy

When carrying a baby, intensive treatment of myomatous formations is not carried out, since there is a high probability of spontaneous miscarriage, organ rupture, or premature birth. To reduce the manifestations of the disease, the attending physician may prescribe drugs that have a weak effect, which reduce pain and other symptoms.

An important factor affecting the development of the fetus is the psychological state of the mother. Highly qualified specialists in the course of interaction with the patient help her overcome the anxiety associated with childbirth and illness, and also teach self-regulation techniques in stressful situations.

Removal of fibroids during caesarean section is considered by gynecologists to be the best way of delivery. With this combination of surgical interventions, the likelihood of complications and the need for long-term rehabilitation is high.

Myomectomy is an organ-preserving operation, however, when the swelling is removed in this way, patients experience relapses. Surgery is recommended when planning a pregnancy so that a tumor in the genital organ does not cause complications when carrying a child.

In modern clinics, endovascular surgeons perform uterine artery embolization, in which intervention is minimal. Replacement of the tumor with connective tissue occurs gradually, so a year after the procedure, conception is possible. Experts note the high efficiency of this method in multiple neoplasms and large nodes that are not amenable to conservative therapy. If a woman is diagnosed with a large fibroid and pregnancy does not occur, embolization is recommended, reviews of which are positive.

Removal of fibroids during caesarean section

A caesarean section is a surgical intervention in which an incision is made on the anterior abdominal wall and the body of the reproductive organ, through which the child is removed. Caesarean section for uterine fibroids involves the removal of fibroids or the uterus. The preservation of the genital organ is an important task, for which various methods have been developed in modern medicine, one of which is uterine artery embolization.

Surgical removal of mima during cesarean is practiced by many gynecologists and surgeons. However, this operation has certain indications:

death of the tumor before childbirth;
inflammation of the peritoneum as a result of torsion of the tumor stem;
the presence in the uterus of a large submucosal node;
large myomatous nodes that prevent free access of the hearth to the birth canal;
the age of the patient exceeding 35 years;
dysfunction of nearby organs caused by a large benign tumor;
suspicion of degeneration of fibroids, the probability of this process is almost zero;
large fetus, partial placental attachment and other factors that complicate the process of childbirth.

Caesarean section for myoma can be prescribed by a gynecologist also for multiple nodes and anomalies in the development of the female genital organs. Cesarean section together with myomectomy is performed under anesthesia or anesthesia. Rehabilitation is an important step after the operation. For the most effective recovery, safe methods are used, which are shown to the patient in this condition.

Caesarean section for myoma: features of the operation

The initial stage of the operation is an incision in the anterior abdominal wall and examination of the reproductive organ. After that, the child and afterbirth are removed from the uterus. If during the examination a large tumor is detected, then it is immediately removed and the integrity of the damaged tissues is restored.

A sterile bandage is placed on the suture area, in addition, regular wound treatment is necessary for the rapid healing of wounds. If a myomectomy was performed during a caesarean section, then the recovery period is the longest. For successful rehabilitation, it is necessary to comply with the diet, the use of dietary products that are easily digested, the observance of work and rest times, and the limitation of physical activity.

After surgery, the patient is placed in the ward, where the medical staff regularly monitors her condition and performs the necessary procedures.

When carrying out embolization of the uterine arteries, the patient does not require a long recovery, since the damage is minimal. This procedure allows you to successfully treat myomatosis both at the stage of pregnancy planning and after the birth of a child. The feedback from patients who underwent embolization is positive, they managed to endure and give birth to a healthy baby.

In the conditions of modern society, women can get a preliminary, as well as make an appointment with specialists. When treating patients with the problem of developing fibroids during pregnancy, specialists choose the most effective methods to reduce the manifestations of the disease, maintain pregnancy and reduce the negative impact on the mother and fetus.

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.

The reasons

It is known that the occurrence of uterine fibroids in the first place can be associated with prolonged abstinence from the first birth, prolonged contraception and termination of the first pregnancy. In other words, almost every woman who postpones the birth of a child for later may be at risk.

Uterine fibroids result from the fact that uterine cells suddenly begin to actively divide. The reasons for this phenomenon have not been fully elucidated, however, it has been established that it is hormonally stimulated, and the onset of a tumor is associated primarily with increased secretion of estrogens - female sex hormones. Another female sex hormone - progesterone, on the contrary, causes its reverse development.

Despite the close and diversified study of fibroids for many decades, the exact causes of the disease in each case remain unknown. However, in general, the following predisposing factors can be distinguished:

hereditary predisposition. Myoma occurs 2-3 times more often in relatives of women suffering from this disease.
Conditions that lead to changes in the hormonal background in the body. Thus, uterine fibroids predominate in nulliparous women, in overweight women who have had abortions and who suffer from menstrual irregularities.

Symptoms of the disease

Approximately 50% of women with uterine fibroids have no symptoms. The clinical picture depends on the size and, to a greater extent, on the location of the nodes.

The following manifestations (they are complications) of the disease are distinguished:

Uterine bleeding (menorrhagia) with the subsequent development of anemia (decrease in the amount of hemoglobin). Most often, this complication occurs in the presence of a submucosal node or many large intramural nodes.
Nutritional disorders of the mammary node. Due to a violation of the blood supply to the node, the processes of its necrosis (death) develop, followed by the addition of infection and inflammation. In some cases, this can be life-threatening. There is a complication of pain of greater or lesser intensity. In this case, conventional painkillers do not help. There may be nausea, vomiting, fainting, chills, fever.
Compression of neighboring organs. If the fibroids are large, the tumor can compress the bladder, ureters, and rectum. There are pains in various parts of the abdomen, difficulty or increased frequency of urination, constipation, kidney disease due to a violation of the outflow of urine.
Birth of a submucosal node. This is also a very dangerous condition. It begins with the appearance of cramping pains in the lower abdomen (more often during menstruation), similar to labor pains, after which a rather painful birth of the node occurs. The process can take several hours.
Infertility. With small sizes, intramural and subserous forms of fibroids do not affect the likelihood of pregnancy. Submucous (submucosal) nodes can cause infertility, as they interfere with the normal attachment of the fetal egg to the uterine wall. Difficulties in conception caused by fibroids are explained by a variety of factors, including compression of the fallopian tubes, which impedes the movement of spermatozoa, impaired ovulation - the release of an egg from the ovary. By itself, fibroids are not considered a cause of infertility, however, if all established causes of infertility are eliminated, removing the fibroids greatly increases the likelihood of conception. True, this applies to fibroids, the size of which is less than a 12-week pregnancy. If the fibroid is large and deforms the uterine cavity, it is quite difficult to maintain the ability to bear children when it is removed, especially since the operation to remove the nodes in this case may be accompanied by bleeding, sometimes requiring removal of the uterus.

Preparing for pregnancy

If the diagnosis of "uterine fibroids" was made to a woman before pregnancy, you should definitely consult a doctor about the need and possibility of using certain methods of treatment.

Conservative hormonal therapy for uterine fibroids (treatment with pills) is aimed at preventing the growth of the tumor, reducing its size, as well as eliminating the symptoms of the disease. Complete regression of the tumor is not achieved.

Indications for conservative treatment of uterine fibroids are tumor sizes up to 12-13 weeks of gestation with nodes located in the thickness of the uterine wall and growing outward, if the disease is not accompanied by bleeding; clinically asymptomatic and asymptomatic course of the disease; absence of anemia (decrease in the amount of hemoglobin). Such treatment is also carried out as a preliminary stage of preparation for surgical treatment.

In the absence of urgent indications, hormonal therapy for uterine fibroids can be performed as an alternative to surgical treatment.

In young women with uterine myoma and infertility, a 3-month course of treatment with tablets (for example, ZOLADEX) allows you to perform laparoscopic myomectomy, which ensures less traumatic intervention, quick rehabilitation. With such an operation, several holes are made in the anterior abdominal wall, optical devices and surgical instruments are inserted through them, with the help of which only fibroid nodes are removed.

Complications of pregnancy and childbirth

Pregnancy, which occurred against the background of uterine fibroids, requires special monitoring, since complications are possible, both from the side of the tumor itself and from the side of pregnancy.

Complications from the tumor include rapid tumor growth and malnutrition of the nodes, which is extremely dangerous for both the fetus and the mother.

If doctors cannot cope with the situation in the next few hours after a malnutrition in the node, they have to resort to surgery (from removing the node to removing the uterus with the fetus). If nutrition in the node is not restored, then the node dies and the peritoneum becomes inflamed - a thin film covering the abdominal organs. This is a formidable complication that requires a major major operation with a long recovery period. Therefore, pregnant women with uterine fibroids should be especially attentive to themselves and, if any unusual sensations occur, immediately consult a doctor.

Complications of pregnancy and childbirth associated with the presence of uterine fibroids can be divided into early, middle and late. An important role in the development of pregnancy complications is played by an increase in the contractile activity and excitability of the myomatous uterus with its insufficient ability to relax. To date, a clear dependence of the frequency of spontaneous abortion on the characteristics of the tumor, its size, location, number of myomatous nodes has not been established.

In the early stages, the likelihood of miscarriage (miscarriage) is increased. A miscarriage can also occur in the second trimester. Subsequently, fibroids can cause premature birth, fetal growth retardation, anomalies of placental attachment, when the placenta is attached at the site of exit from the uterus (placenta previa), which is fraught with bleeding, the formation of an incorrect position of the fetus. Sometimes the location of the nodes (especially cervical) can interfere with childbirth through the natural birth canal.

It is believed that the presence of fibroids increases the risk of spontaneous abortion and premature birth. This is associated with a decrease in free space for a child in the uterus due to myomatous nodes, as well as with an increase in the contractile activity of the uterus. As a general rule, the larger the fibroids, the higher the chance of preterm birth. In this case, again, the location of the fibroids and the presence of its contact with the placenta matter. Large fibroids have a certain effect on the growth and development of the fetus. So. there are cases of the birth of children with a deformity of the skull, apparently due to the pressure of the fibroids. Pregnant women with large fibroids are more likely to have low birth weight babies.

The issue of maintaining pregnancy in women with uterine fibroids is decided strictly individually. This takes into account the possibility of dysfunction of the placenta with a pronounced myomatous change in the uterus or localization of the placenta in the region of the intermuscular node of the tumor, the risk of circulatory disorders in the myomatous nodes, the need for only operative delivery in case of an unfavorable location of the tumor.

What are fibroids?

Myomatous nodes can be single and multiple. Their sizes range from microscopic to gigantic, the size of a full-term pregnancy and weighing up to 10 kg.

Depending on the growth of the myomatous node, the following types of fibroids are distinguished:

subserous (subperitoneal) nodes, in which the growth of the tumor occurs in the direction of the serous layer of the uterus (the tumor grows outward);
interstitial (intramural) nodes - the growth of the myomatous node occurs in the thickness of the uterine wall;
submucosal (submucosal) nodes - there is a growth of the node in the uterine cavity;
atypical forms of nodes - the tumor is located in the thickness of the cervix and grows in different directions: towards the rectum, uterine ligaments.

There are also multiple uterine fibroids, i.e. the nodes are located in different parts of the uterus and at different levels of the thickness of its walls, which leads to an irregular shape of the organ.

Indications for surgery during pregnancy

The optimal time for conservative myomectomy - the surgical removal of myomatous nodes - is considered to be 16-19 weeks of pregnancy, when the concentration of progesterone produced by the placenta (the hormone that ensures the course of pregnancy) increases by approximately 2 times. Under the influence of progesterone, the contractile activity of the uterus decreases, the tone and excitability of the uterus decrease, the extensibility of muscle structures increases, and the obturator function of the cervix increases. All this creates the most favorable conditions for the operation.

The surgical tactics of conservative myomectomy during pregnancy differ significantly from the tactics of treatment performed outside of pregnancy. This is due to the following conditions during the operation:

1) minimal trauma to the fetus and minimal blood loss;

2) the choice of a rational incision on the uterus, taking into account the subsequent delivery by caesarean section;

3) suture material with sufficient strength, minimal allergenicity, capable of forming a full-fledged scar on the uterus.

An important point of surgical tactics during pregnancy is the expediency of removing only large nodes (from 5 cm in diameter or more) that prevent the bearing of a real pregnancy.

The removal of all nodes (smaller ones) creates unfavorable conditions for the blood supply to the muscles of the uterus, the healing of a wound on the uterus and the development of the fetus.

Taking combined oral contraceptives does not increase the risk of developing fibroids, and, according to some reports, it even prevents this disease, but it does not prevent the growth of existing nodes.

Conducting childbirth with fibroids

According to various studies, the frequency of complications in childbirth in women with fibroids is high and ranges from 35-80.5%. Complications during childbirth and the postpartum period are most often observed with large tumor sizes and the location of nodes in the pelvic cavity.

Childbirth in patients with uterine fibroids is often complicated by untimely discharge of amniotic fluid and anomalies of labor activity. In a third of cases, prenatal rupture of amniotic fluid, discoordination of labor activity, weakness of labor activity are observed (at the same time, the contractions are weak, ineffective, the cervix does not open). Premature detachment of a normally located placenta (especially if the fibroid is located behind the placenta) may be an indication for a caesarean section.

Other complications include abnormal contractile activity of the uterus, tight attachment of the placenta, which leads to difficulties in separation of the placenta, increases the likelihood of manual removal of the placenta, bleeding due to poor uterine contraction. It is also possible to slow down the contraction of the uterus in the postpartum period, inflammatory complications of the uterus, etc. Doctors must take this into account when managing childbirth.

Approximately half of pregnant women with fibroids have prolonged labor. In addition, in the presence of fibroids, the need for delivery by caesarean section often arises. Although the myoma itself, as a rule, does not represent a true obstacle to the birth of the fetus, myomatous nodes (especially large ones) are often combined with anomalies in the position and presentation of the fetus (transverse position, breech and facial presentation), in which natural delivery is not possible. In some cases - for example, if the incision site for a caesarean section is on a fibroid, the doctor may remove the tumor during this operation.

However, not everything is so bad. First, in mothers with uterine fibroids, children are usually born with normal weight, well adapted to extrauterine life. Secondly, the changes that occur to a woman's body during pregnancy (in particular, this concerns the production of hormones) often lead to a cessation of further growth of uterine fibroids. Often, pregnancy and childbirth in women with uterine fibroids occur with little or no complications or with minimal complications, especially if during pregnancy the woman received therapy aimed at normalizing the tone of the uterus and preventing fetal-placental insufficiency (injections, pills). Childbirth in such pregnant women can be either natural (almost a third of cases) or by caesarean section. In this case, again, comorbidity plays a significant role. A woman with uterine myoma may be delayed with discharge from the hospital for several days.

When is an operation needed?

Surgical treatment with removal of the uterus is carried out in the following cases:

Bleeding and anemia.
Large uterine fibroids - more than 12-14 weeks of pregnancy.
Rapid growth of fibroids.

Node power failure. After the operation, the possibility of surrogate motherhood remains - when using this technology, an egg is taken from a woman, and sperm from a man. Fertilization occurs in a test tube - in the laboratory, and another woman bears the pregnancy. After birth, the baby lives with his biological parents.

Indications for operative delivery

The complicated course of pregnancy and childbirth determines the high frequency of surgical interventions and obstetric benefits in pregnant women with uterine tumors. As already mentioned, caesarean section in the presence of uterine fibroids, as a rule, ends with an expansion of the volume of surgical intervention (myomectomy is performed - removal of myomatous nodes, removal of the uterus).

Indications for surgery may arise in situations where prolongation of pregnancy is almost impossible due to the location of the node (in the cervical region, or between the uterine ligaments, or the growth of fibroids in the uterine cavity, or the large size of the tumor).

Pregnancy in these women, as a rule, proceeds with a pronounced threat of interruption, but with a miscarriage that has begun, curettage of the walls of the uterus is sometimes technically impossible (cervical-isthmus node location). Gynecologists have to resort to radical operations (removal of the uterus along with the fetal egg), which is a great tragedy for women, especially those who do not have children. At the same time, in many women with a small tumor size, no signs of malnutrition of the nodes, pregnancy proceeds favorably and, as a rule, ends in spontaneous childbirth.

In any case, expectant mothers who are diagnosed with uterine fibroids will have to scrupulously fulfill all the doctor's prescriptions, both in terms of examinations, and in terms of taking medications and hospitalizations at a specific time. Women with fibroids are usually sent to maternity hospitals a few days before the expected birth. However, despite the presence of uterine fibroids as one of the risk factors, the fetus in women with uterine fibroids most often develops normally and the child is born healthy.