Uterine fibroids are benign smooth muscle tumors of the uterus, common in females of reproductive age. They can cause pain during pregnancy and may slightly increase the risk of obstetric complications such as early pregnancy loss, preterm labor, fetal malpresentation, and placental abruption.
Epidemiology
The prevalence of fibroids in pregnancy varies between 1.6% and 10.7%, depending on factors like trimester and demographic characteristics. Prevalence increases with maternal age and varies by race.
Change in Volume During Pregnancy and Postpartum
Fibroid volume can change during pregnancy, influenced by factors like estrogen and progesterone levels. Most fibroids regress postpartum, but some may increase in volume.
Symptoms
Fibroids are usually asymptomatic during pregnancy, but can cause pain, pelvic pressure, and vaginal bleeding. Pain is the most common symptom, often occurring in the late first or early second trimester.
Complications
Most patients do not experience complications, but fibroids can lead to degeneration, early pregnancy loss, preterm labor, placental abruption, malpresentation, placenta previa, dysfunctional labor, cesarean birth, postpartum hemorrhage, and rare fetal deformities. Fibroids do not significantly increase the risk of preterm prelabor rupture of membranes, fetal growth restriction, fetal demise, or preeclampsia.
Treatment of Painful Fibroids
Pain is managed with analgesics like acetaminophen, opioids, or NSAIDs. Surgery is generally avoided during pregnancy due to the risk of significant morbidity.
Role of Myomectomy
Preconception myomectomy decisions are case-specific. Antepartum myomectomy is generally avoided unless necessary for severe symptoms. Cesarean myomectomy may be required in some cases.
Delivery
Most patients with fibroids can have a vaginal birth, but cesarean birth may be necessary for standard obstetric indications or if the fibroids obstruct the birth canal. Patients with prior myomectomy may require a scheduled cesarean birth.
Summary and Recommendations
Fibroid volume changes during pregnancy and postpartum. Most patients do not experience complications, but pain is the most common issue. Treatment of pain involves analgesics, and surgery is generally avoided. Delivery route is individualized based on fibroid characteristics and prior surgeries.
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