This document discusses fibroids complicating pregnancy. It notes that the incidence is 1 in 1000 pregnancies and prevalence is highest (18%) in black women and lowest (8%) in white women. Fibroids can cause issues like abortion, pressure symptoms, malpresentation, preterm labor, and obstructed labor. Effects on labor can include uterine inertia, dystocia, postpartum hemorrhage. Effects on the puerperium include subinvolution, inversion of the uterus, and sepsis. While fibroids may increase slightly in size during pregnancy due to increased vascularity and edema, most do not. Ultrasound and MRI can be used to diagnose fibroids during pregnancy when findings are unclear. Treatment during pregnancy often

1. FIBROIDS COMPLICATING
PREGNANCY
BY
R.MADHAVA MANOJ

2. INCIDENCE AND PREVALENCE
Incidence : 1 in 1000.
Prevalence : Highest in black women -18 percent
Lowest in whites - 8 percent

3. EFFECTS OF FIBROID ON
PREGNANCY
 May be none
 Abortion (submucous fibroid)
 Pressure symptoms due to impaction of
(a) Bladder - retention of urine
(b) Rectum - constipation
 Red degeneration
 Malpresentation (Four fold risk)
 Preterm labor and prematurity
 Non-engagement of the presenting part

4. EFFECTS ON LABOR
 May be unaffected
 Uterine inertia
 Dystocia
 Obstructed labor
 Postpartum hemorrhage due to atonicity or adherent
placenta
 Difficult cesarean section (Eight fold risk)

5. EFFECTS ON PUERPERIUM
 Subinvolution
 Inversion of uterus
 Secondary PPH
 Sepsis
 Lochiometra and pyometra.

6. EFFECTS OF PREGNANCY ON
FIBROID
 Changes in size – increases (?)
 Changes in position
 Changes in shape - becomes flattened
 Degenerative changes specially, red degeneration
 Torsion of pedunculated subserous fibroid
 Infection and polypoidal changes are more in
puerperium.

7. EFFECTS OF PREGNANCY ON
FIBROID
 Changes in size – increases (?)
 Fibroid is an estrogen dependant tumor.
 Pregnancy is a progesterone predominant state.
So how does fibroid increases in size during pregnancy?

8. EFFECTS OF PREGNANCY ON
FIBROID
 Actually, most fibroids do not increase in size during
pregnancy.
 69% - had no increase in fibroid volume throughout
pregnancy
 31% - noted increase in fibroid volume, greatest increase
before 10th week of gestation and a reduction to baseline
value 4 weeks after delivery

9. EFFECTS OF PREGNANCY ON
FIBROID
 The main reason for the fibroid to increases in size
during pregnancy is due to
 Increased vascularity
 Edema
 Hypertrophy and hyperplasia of the fibromuscular
tissues.

10. It is often difficult to diagnose a fibroid during pregnancy
because of
 Marked softening
 Alteration in the shape (flattening)
 In early months, fibroid is diagnosed but pregnancy is
missed whereas in later months, pregnancy is
diagnosed but the fibroid is missed.
DIAGNOSIS

11.  Ultrasonography
confirms the diagnosis with
certainity.
DIAGNOSIS
USG showing uterine fibroid

12. If ultrasonographic findings are
unclear,
 Magnetic Resonance
Imaging can be done
DIAGNOSIS
MRI showing degenerating fibroid

13. In uncomplicated tumor, fibroid is often confused with
 Ovarian tumor
 Retroverted gravid uterus
 Non gravid half of uterus didelphys
DIAGNOSIS

14. BASIC PRINCIPLE
 Avoid treatment whenever possible.
TREATMENT

15. DURING PREGNANCY
Uncomplicated :
Usual antenatal care is followed.
All cases to be assessed at 38 weeks to
formulate the method of delivery.
 Acute pain following red degeneration
Conservative management
TREATMENT

16. DURING LABOR
Fibroid situated above the presenting part:
Usually results in uneventful vaginal delivery
Fibroid situated below the presenting part:
Spontaneous vaginal delivery may occur.
If it fails, cesarean section is to be done.
TREATMENT

17.  Fibroid in lower uterine segment
 Cervical fibroid, even if it is small
 Fibroid impacted in pelvis
 Malpresentation
 Obstetric complications
INDICATION FOR ELECTIVE
CESAREAN SECTION
Cesarean delivery for a large leiomyoma in
the lower uterine segment

18. TECHNICAL ASPECTS ON
ELECTIVE CESAREAN SECTION
Myomectomy should be avoided during cesarean section
Be alert for postpartum hemorrhage and retained placenta.
Reverts to a smaller size during puerperium