Myoma of the uterus during pregnancy
Content:
- Symptoms of uterine fibroids during pregnancy
- Causes of uterine fibroids during pregnancy
- Why is uterine fibroids dangerous during pregnancy?
- Popular questions and answers
- How to treat uterine fibroids during pregnancy?
Myoma of the uterus during pregnancy is the presence of a benign tumor of the myometrium, combined with parallel bearing of the fetus.
This situation is a difficult test, both for the doctor and for the woman herself, since there is a risk of complications during pregnancy or during childbirth.
According to statistics, the percentage of pregnant women with fibroids varies from 0.5 to 6% of cases. While fibroids in non-pregnant women from the total mass of gynecological diseases account for up to 35% of cases.
In addition to the fact that the tumor affects the course of pregnancy, it can also serve as an obstacle to successful conception.
Symptoms of uterine fibroids during pregnancy
In the presence of a benign formation in a woman, while carrying a child, symptoms uncharacteristic for this period may be observed.
The clinical picture boils down to the following:
- The occurrence of menometrorrhagia, that is, pathological uterine bleeding;
- Painful sensations with predominant localization in the lower abdomen. Pain can be both mild and quite intense, with irradiation into the abdominal cavity, bladder, appendages and lower back. It depends on the location of the tumor and on its size;
- Violation of the functioning of nearby organs. Similar symptoms are expressed in the frequency of urination, the occurrence of constipation, which is caused by the pressure of the fibroids on the intestines and bladder;
- Increased body temperature, severe pain in the peritoneum, heartburn and flatulence are symptoms of an "acute abdomen". This may be due to impaired circulation in the fibroid node;
- An increase in the abdomen incomparable with the duration of pregnancy;
- Painful sensations during intercourse.
Also, the option of asymptomatic fibroids during the period of bearing a child is not excluded.
Causes of uterine fibroids during pregnancy
It should be understood that fibroids do not form in healthy women, therefore, in the body, in any case, pathological processes occur that caused its appearance.
Among the causes of fibroids during pregnancy, the following can be distinguished:
- Postponed earlier or occurring at a given time hormonal transformations, inflammatory diseases, damage to the uterus of a dystrophic and traumatic nature, disorders of neuroendocrine processes. All these factors lead to the fact that immature myocytes undergo tumor transformation, which leads to the formation of fibroids. Previous abortions and curettage have a special role in traumatizing the uterus;
- Inflammatory reactions in the ovaries or the presence of tumors in them;
- Diseases of the mammary glands;
- Insufficient function of the thyroid gland or adrenal cortex;
- Genetic predisposition. Moreover, in recent years, cases of "rejuvenation" of the disease have become more frequent. That is, if a mother suffered from fibroids over the age of 40, then her daughter may have it before the age of 30. This is the reason for the increased frequency of diagnosing fibroids during pregnancy;
- The first childbirth in a woman over the age of 35. The development of the tumor process is due to previous infections, the presence of chronic diseases, previous abortions, etc.;
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Complex malfunctions of the nervous, immune, endocrine and homeostatic systems are a positive premyoma background for any woman.
Why is uterine fibroids dangerous during pregnancy?
A tumor found at any time during the gestation of a child poses a certain danger.
The main risks are reduced to:
- High probability of termination of pregnancy at various periods;
- The risk of developing isthmic-cervical insufficiency, which threatens premature birth or late miscarriages, is most often observed with the cervical-isthmus arrangement of the neoplasm nodes;
- Placental insufficiency, which threatens with a delay in fetal development and its hypoxia, is most often observed with an intermuscular location of fibroids, as well as in the presence of a conglomerate of tumors;
- Delayed development of the fetus due to inadequate nutrition, the shortage is due to the fact that fibroids "rob" the child;
- Accelerated growth of neoplasms;
- Gestosis (toxicosis);
- Violation of the blood supply to the tumor and its necrosis;
- Thrombosis of the pelvic veins, resulting from their compression by large myomatous nodes;
- Fetal presentation;
- Too tight attachment of the placental membrane;
- Premature detachment of a normally located placenta;
- Myometrial ischemia caused by increased uterine tone, increased venous outflow and malnutrition of the node.
Due to the fact that the number of possible complications is quite high, a woman is recommended to maintain a pregnancy only if the degree of risk is low. Among the indications for the preservation of pregnancy: the young age of the woman in labor (up to 35 years), the absence of extragenital pathologies, the subperitoneal arrangement of the nodes, their small size and the short duration of the disease (up to 5 years). In addition, pregnancy is preserved with a late visit to the doctor and a viable fetus, with prolonged infertility and with the impossibility of interruption.
Popular questions and answers
Women of reproductive age who have fibroids are often asked the following questions:
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Does uterine fibroids resolve during pregnancy? The likelihood that the tumor can dissolve during pregnancy on its own is quite high. It can disappear both during gestation and after childbirth. Doctors associate myoma degeneration with the fact that hormonal changes occur in the woman's body, which, against the background of circulatory disorders in the tumor, lead to the fact that it dies.
The process of tumor resorption can be suspected by several signs:
- Firstly, this is an increase in uterine tone and an increase in body temperature.
- Secondly, it is painful sensations in the area of the nodule.
- Thirdly, changes in blood parameters (growth of ESR and leukocytes).
Most often, these symptoms are observed for 14 days. Determine whether the formation has degenerated or not, you can undergo an ultrasound scan.
- Is it possible to get pregnant after removal of uterine fibroids? After the operation, the chances of conceiving a child are significantly increased. This is due to the fact that in some cases it is the fibroid that prevents the fertilization of the egg or the attachment of the embryo, especially if its size is high enough. In addition, the tumor greatly complicates the process of carrying a child. As for the time period that should be observed before starting to plan pregnancy, it is 1 year. Although it all depends on the individual characteristics of the woman, the complexity of the operation and the nature of the tumor.
How to treat uterine fibroids during pregnancy?
It is important to understand that the period of bearing a child, accompanied by the presence of a disease such as fibroids, may be accompanied by a certain therapeutic effect. Doctors have several treatment goals. This is a decrease in the muscle tone of the uterus, prolongation of pregnancy to normal and the possibility of having a healthy baby.
For this purpose, the following medications may be prescribed:
- Antispasmodics, namely drotaverine, administered intramuscularly and then orally;
- Antiplatelet agents such as pentoxifylline, aspirin, and dipyridamole;
- Tocolytics, namely hexoprenaline;
- Antibiotics, however, they are prescribed only if there are signs of malnutrition of the myomatous node;
- With insufficient production of progesterone, it is advisable to take duphaston and tocopherol acetate.
On the subject: List of drugs used for uterine fibroids
In addition, preventive measures aimed at preserving the life and health of both the mother and the fetus are important. For this purpose, a woman is prescribed antioxidants and antiplatelet agents, which help to prevent the formation of placental insufficiency. A similar preventive measure is advisable to be administered from 16 weeks.
It is important to regularly observe a woman by a doctor to find out not only the condition of the fetus and the placental system, but also changes in the myomatous nodes.
To provide an antispasmodic, metabolic and antiplatelet effect with a preventive purpose, a woman can be recommended to take Magne B6, Curantila, Actovegin.
If preventive and therapeutic measures do not bring the desired effect and serious complications arise, then it is advisable to carry out a surgical intervention. Indications for myomectomy when carrying a child may be threatening abortion, severe pain syndrome with compression of the pelvic organs, malnutrition in the nodes and their gigantic size.
In addition, a woman must be hospitalized if fetal hypoxia is observed, the course of pregnancy is complicated by placental insufficiency and perverse risks.
Often, the threat of miscarriage with fibroids is observed in the early stages of pregnancy, in percentage terms it can reach 58%. With regard to the threat of premature birth, the risk ranges from 12 to 25%. In this case, the treatment does not differ from similar therapy for pregnant women who do not have a neoplasm on the uterus.
In order to assess the degree of risk and decide on the need for treatment, ultrasound and Doppler ultrasound are shown.
A therapeutic measure for pregnancy with fibroids is also adherence to bed rest, a decrease in physical activity. In addition, doctors recommend abstaining from sexual activity, caution will ensure normal uteroplacental and renal blood flow.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
