Uterine fibroids are a common phenomenon among women, and there can be problems relating to the presence of a uterine fibroid during pregnancy. Complications can affect both the mother and her unborn child and need to be dealt with under careful obstetric guidance.
Fibroids: How They Present
A fibroid is a benign growth affecting the uterine muscle. Women's experiences of fibroids vary dramatically with some having a fibroid as small as a plum while others have multiple fibroids that take up a large part of the abdominal cavity.
Fibroids are commonly identified when the following symptoms present:
- Heavy bleeding - the menstrual cycle itself does not tend to be affected, however, the extent of bleeding when a fibroid(s) is present can be excessive and unmanageable.
- Urinary problems - womem who have large or multiple fibroids may experience urinary problems due to the increased pressure in the abdominal space. This pressure exerts itself on the bladder and can cause incontinence or urinary 'urgency' in some women.
- Backache - again, for those with large or multiple fibroids, they may find some discomfort with back ache. This can be due to the sheer weight of the growing mass or due to positional problems of it pressing against spinal nerves.
- Infertility - although fibroids tend to affect women coming toward the end of child-bearing years, younger women are affected, too. Due to decreased space in the abdomen and invasion of the uterine space, the fibroid can (dependant on its location) cause a physical barrier hindering the implantation process of fertility.
- Abdominal mass - for women with large fibroids, distension of the abdomen is not uncommon. Fibroids can grow to a size where they take over the abdomen and are clearly visible from the outside.
Uterine Fibroid During Pregnancy: Complications and Risks
Uterine fibroids in a non-pregnant woman can be uncomfortable enough without the additional complication of uterine space being used for the growth of a fetus.Fibroids in non-pregnant women tend not to cause pain or impact too much on lifestyle, however, discomfort and other serious issues can occur when there is the presence of a uterine fibroid during pregnancy. Complications during pregnancy include:
- Bleeding - this is a common problem in non-pregnant women, but the risk of blood loss during pregnancy can be substantial, as can any cause of vaginal bleeding at this time. Unexplained bleeding may occur throughout the pregnancy, therefore, it is paramount that the obstetrician keeps a check on the pregnant woman's iron levels and blood count.
- Pain - pregnancy can be uncomfortable enough due to the ever increasing bump. With the addition of a uterine fibroid adding to pressure in the abdomen and on the spine, a pregnant woman can find this condition very uncomfortable as the pregnancy progresses. Unfortunately, apart from finding positions that are comfortable, there is nothing that can be done to reduce the pain caused by the presence of the fibroid. Some women find alternative remedies helpful when dealing with pain and discomfort of this nature.
- Cesarean - depending on the size and location of the fibroid, a woman may need a caesarean section at the time of delivery. If the fibroid is believed to be low near the uterus, then it is likely a caesarean will be necessary due to restrictions made on the size of the birth canal, making a vaginal delivery potentially impossible. The decision about delivery will be made following close monitoring via ultrasound scanning of the fibroid and its relationship to the uterus throughout the pregnancy.
- 'Red Degeneration' - this is a complication which can occur in the middle months of pregnancy causing increased risk of miscarriage or early labor. Due to pressure in the abdomen, the blood supply to the fibroid can be restricted or cut off, causing it to eventually die. This can cause severe abdominal pain and possible contractions in the uterus. Urgent medical help should be sought in the event of such symptoms.
In cases when a caesarean section is required, some women experience severe bleeding during the procedure. Although this is a rare occurrence, it is one that all women must be made aware of since bleeding could cause a threat to the life of the mother and/or her newborn. In some cases, it may be necessary to perform a hysterectomy at the same time. Women will be counseled as to the risks involved prior to surgery since it is common that consent forms require the pregnant woman to give authority in the event of a surgical complication.
Placental abruption is another rare yet possible risk when there is the presence of a uterine fibroid during pregnancy. Complications of this pose a dangerous risk to the life of the infant and the mother. Placental abruption happens when the placenta begins to detach from the uterus, thus, over time starving the baby of vital oxygen and nutrients needed to survive. The presence of the fibroid and the increased pressure in the abdomen can be a possible cause of placental abruption.
Pregnant woman who are have a uterine fibroid should attend all prenatal appointments to monitor fetal growth and discuss with the doctor how the fibroid may affect the pregnancy and subsequent birth.
Some women only discover the presence of a fibroid during routine pregnancy investigations, therefore, it is essential that full education of the risks is given to ensure a safe pregnancy continues, causing no harm to mother or infant.