Premise
Given the high frequency of fibroids in women of childbearing age, it is not uncommon for the fibromatous condition to arise precisely during pregnancy. For the same reason, also considering the frequent asymptomatic nature of the same, the majority of uterine fibroids are diagnosed, for the first time, in pregnant women.
Incidence
Fibroids and conception
In order not to alarm women on maternity, other factors must be taken into account: "dangerous" fibroids hardly prevent the successful outcome of pregnancy and rarely hinder conception, since the probability that the fallopian tubes are damaged is very poor; consequently, generally, despite the presence of fibroids, the sperm does not find significant obstacles to proceed from the cervix to the tubes. Nevertheless, a particular sub-category of fibroids - the submucosal fibroids - could hinder the implantation and development of the embryo; sometimes they could also cause abortion. Intramural fibroids, on the other hand, could cause both abnormal contractions during childbirth and premature birth of the child, as uterine contractions are stressed.
Growth of the fibroid in pregnancy
The hypothesis that fibroids grow faster in pregnancy has been denied by recent studies: only in some cases, fibroids may evolve during the expected wait. Medical statistics show that, in approximately 30% of women with fibroids in pregnancy, the myoma increases in size: complications during pregnancy are directly proportional to the development of the fibroid, also influenced by the hormonal changes linked to gestation. The exaggerated increase in fibroma volume could cause a possible bleeding (determined by vascular modulations) and pain.
The increase in the volume of fibroids during pregnancy is related not so much to an increase in cell proliferation, but to their hypertrophic status; in parallel, the volume decrease is related to a cellular atrophy.
Effects on the fetus
It seems that the volume changes of uterine neoplasms in pregnancy, if not excessive, do not lead to serious consequences, neither to the fetus nor to the mother; the main problem remains the localization of the fibroid, which greatly affects the success of the pregnancy.
In the case in which the woman presents a genetic predisposition to the fibroids, has suffered from the same pathology in the past or has had numerous spontaneous abortions, the fibroids in pregnancy could lead to high-level problems, which must not be underestimated. In general, if the mother has suffered from fibromatosis in the past, the gynecologist recommends removing them, so that the chances of a successful future pregnancy may increase. The removal of the neoplasm is almost never carried out during the caesarean section, in order to prevent a possible bleeding.
There are two factors that must be considered in the case of a woman suffering from fibroids during pregnancy: first of all, the effects that the fibroma can cause on the fetus must be evaluated, but it is also necessary to take into account the consequences that pregnancy could lead to the fibroid same.
Diagnosis
Considering that the size of the fibroids, as mentioned, change during the first trimester of pregnancy, the diagnosis is absolutely essential, in order to keep any complications under control: ultrasound and gynecological inspection represent the two most accredited diagnostic techniques for recognition of fibroids during pregnancy. Through the ultrasound examination, the gynecologist is able to analyze the fibroma volume, the stage of development, the size, the location and the cellular composition; the ultrasonographic diagnostic technique is not only the simplest method, but also the best from the point of view of reliability. For pregnant women suffering from obesity, ultrasound diagnostic screening is more complicated.
Choice of therapy
The choice of therapy should be carefully evaluated by the gynecologist based on the mother's age, the location of the fibroid and the period; surgical excision is performed only in cases of more severe acute complication. The risk of negative repercussions on the successful outcome of pregnancy is in fact very high when the pregnant woman is subjected to a similar surgical intervention. Therefore, generally, for pregnant women with fibroma, a conservative drug therapy is recommended, to favor the correct uterine contractility during pregnancy. At the birth of the child, the gynecologist will assess for the mother, any further treatment to permanently eliminate the fibroid.
Summary
To fix the concepts ...
Disease | fibroma |
Incidence | Pregnant women |
Age | Over 40 years |
Malignant evolution | Very rare |
Submucous fibromas | They could interfere more easily with implantation and embryonic development; sometimes they could cause abortion |
intramural fibroids | They could cause both abnormal contractions during childbirth and premature birth of the child, as uterine contractions are stressed |
Symptoms | Pain, heaviness, bleeding |
Diagnosis | Gynecological inspection Ultrasound |
Women at risk | Genetic predisposition, past history of fibroma, spontaneous abortions |
| Treatments to eliminate uterine fibroids | Pharmacological treatment Surgery (rare, to be avoided in pregnancy) |
