Most pregnant women with fibroids do great and have no problems related to their fibroids. Most commonly your doctor will tell you that your fibroids are not a significant problem and not to worry about them. That said, depending on the number, size and location of your fibroids, your obstetrician may talk to you about the following potential implications of your fibroids in your pregnancy.
Pregnancy demands a large blood supply and may result in depriving larger fibroids of their blood supply leading to auto-infarction, or degeneration, within the fibroid. This can be very painful and even lead to fever and an elevate white blood cell count mimicking an infection. Your doctor will confirm this is the case by ruling out other more serious things like appendicitis, a kidney infection or infection around the pregnancy. Fibroid degeneration is usually managed with pain medications and followed expectantly, meaning controlling your symptoms until they pass is all that is needed.
If fibroids are very large they may cause bulk symptoms with increased abdominal distension and pelvic pain and pressure. Massage, support belts, optimized sleep positioning and dietary adjustments usually are the mainstay for such symptoms. We do not remove fibroids during pregnancy due to the risk hemorrhage when operating on a highly vascular pregnant uterus.
Growth Problems and Premature Delivery
Rarely with multiple very large fibroids the uterus fails to distend ideally and is thought to contribute to poor fetal growth and/or early breaking of the water bag and premature labor. If the placenta implants on a fibroid, the pregnancy may not get ideal blood supply and nutrition leading to poor growth of the baby. We measure the belly in pregnancy to make sure the baby is growing adequately, large fibroids may make these measurements less accurate so your doctor may recommend more frequent ultrasounds if your fibroids are very large. Most women with fibroids have babies that grow normally and deliver at term. Discuss the details of your fibroids with your obstetrician to see if there is any reason for additional testing in your pregnancy.
Occasionally, fibroids distort the uterine contour in such a way that a baby is unable to get head down for a vaginal delivery. We usually do not recommend an external cephalic version (turning the baby) in these situations and recommend a cesarean delivery. Sometimes the baby may be head down, but there are large fibroids blocking the lower uterine segment or cervix so the head cannot properly dilate the cervix; this is rare, but requires a cesarean delivery.
Women with fibroids are at increased risk for excessive bleeding after both vaginal and cesarean birth. This is most common when the placenta is abnormally attached to the uterus (placenta acreta or increta). Abnormal placentation is more common if a woman has had prior cesarean births or myomectomies. Depending on the details of your fibroids, your doctor may request that you have a specific IV in place and make sure there is blood available specifically for you in the hospital where you are birthing. Large obstetric units, like that at Barnes Jewish Hospital, are well-equipped with massive hemorrhage protocols to make sure these rare emergencies are handled swiftly and that both mom and baby get the best care possible.
Will I Need a Hysterectomy if I Get a Cesarean with Fibroids?
Most women with fibroids who require a cesarean delivery do just fine! Fibroids can make the surgery more complicated with a higher blood loss if the fibroids are in the front of the lower uterus where the uterine incision is commonly made or if there is abnormal placental attachment. Your doctor should be aware if your specific fibroids pose increased risk for a cesarean birth and will talk to you about it and make sure the hospital has appropriate medications and blood products available if there is excessive bleeding. Requiring a hysterectomy following a cesarean because of fibroids is exceedingly rare.
Will My Recovery Be Harder Because I have Fibroids?
There is no reason to anticipate a significantly harder post-partum course following a vaginal or cesarean delivery just because you have fibroids. Although fibroids may grow during pregnancy, they generally shrink after pregnancy as the estrogen and progesterone levels fall. There is no reason to fear that fibroids will inhibit your ability to breastfeed, hold, bond, or engage with your new baby.
Can I have a Home Birth with Fibroids?
This would be a question for the midwife or doctor who would attend your homebirth. I do not attend home births myself, and I encourage anyone considering a homebirth to hire a well-trained midwife or physician to attend the birth to manage any unexpected complications. If you have fibroids you should be sure your birth attendant is aware of them and the ultrasound report’s specific detail describing them. Many women who plan a homebirth come to a physician for at least a consultation, and I think fibroids would be an appropriate indication for such a consultation. In my opinion, almost all women who have had myomectomies are not ideal candidates for a homebirth. A woman who wants a homebirth, but finds herself with a pregnancy that demands a hospital-based birth should seek a physician or midwife with experience caring for women in this situation to optimize her birth experience. I tend to care for a lot of women in this very situation, and I find it particularly rewarding. We CAN have fabulous birth experiences in a hospital even when you really wanted to be at home! I promise--we can.
Fibroids and Dr. Gray-Swain’s Scoop:
I really enjoy caring for women with fibroids in pregnancy. Most of the time I get to reassure them and help them stop worrying about something they have been fretting over. Reducing a woman’s anxiety in pregnancy is one of my favorite things. In my experience, most pregnant women with fibroids still get to share the joys of a healthy pregnancy and wonderful birth. When fibroids do pose potential risk during a pregnancy I enjoy working with my patient to develop a plan to minimize and manage risk, while still helping her optimize her personal pregnancy and birth experience.
Rosanna Gray-Swain, MD, is a board-certified physician who specializes in obstetrics and gynecology. She is a member of BJC Medical Group and affiliated with Barnes-Jewish Hospital. To learn more call her practice at 314-286-2620 or schedule your appointment .