Pregnancy is a physiological, normal state, characterized by the growth and formation of new tissues as a result of the action of growth factors with permanent activity or activated only during gestation.
The characteristics of a woman’s life today are: the first menstruation that appeared at a younger age than in the past, changes in diet, hormonal self-medication, hormonal contraceptive treatments started early in adolescence, delayed planning of the first pregnancy. All of these are possible explanations for lowering the diagnostic age of uterine fibroids below 35 years.
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Uterine fibroids may be known before pregnancy or discovered at the onset of pregnancy. Studies show an increase in the frequency of the association of uterine fibroids with pregnancy from 1% to 10%. At the same time, 11% of patients with infertility are diagnosed with uterine fibroids, and the chance of getting pregnant increases from 25% to 42% after surgical treatment of fibroids.
In the patient with uterine fibroids, the preconceptional gynecological balance is very important if the pregnancy is scheduled. The evolution of a pregnancy that is associated with a uterine fibroid (or more) depends on its location: submucosal, intramural, subserosal – the list is in the order of unfavorable influence it can have both on maintaining the pregnancy and on its occurrence.
Mutual influences in the pregnancy-fibroid association
Consequences for pregnancy are: difficulty in its appearance, imminent abortion, imminent premature birth, praevia location of the placenta, dystocic orientation of the fetus in the uterus, more bleeding at birth or in the period of immediate delivery, retention of sludge (uterine secretions after birth) .
Patients with uterine fibroids are more at risk of losing pregnancy in the first trimester (14%) than other patients. The higher the number and size of fibroids, the greater the risk.
The presence of uterine fibroids in pregnancy can associate hypertension with an incidence of 40% according to some studies. These situations involve the medical team monitoring the pregnancy and the cardiologist.
Consequences for fibroids are: increase in size, compression phenomena (constipation, frequent urination, low back pain, dyspnea), localization praevia that prevents vaginal birth. At the same time, a potential consequence for fibroids is the degeneration with aseptic necrobiosis (1.5% according to some studies) with the rupture of the fibroid due to ischemia by obstruction of the single terminal artery that irrigates the fibroid. It is clinically associated with subicteric facies, fever 38 – 38.5⁰C, excruciating pain on a permanent painful background, genital bleeding.
Most of the time pregnancy is a “treatment” for some pathologies, and establishing a fibroid pregnancy monitoring plan may be equivalent to a therapeutic plan. In patients with fibroids, the size of the formation may regress, according to studies, by 50% in 70% of cases at 3-6 months after birth.
In conclusion, pregnancy hygiene, drug treatment, quality prenatal consultations and good communication with the obstetrician can help a favorable evolution of pregnancy with uterine fibroids to term.
Dr. Camelia Cojocaruprimary doctor Obstetrics-Gynecology, Arcadia
The appointment of an Obstetrics-Gynecology consultation can be done at the telephone number 0232 920 – Call Center Arcadia.
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