Premise
Given the high frequency of fibroids in women of childbearing age, it is not uncommon for the fibromatous condition to arise during pregnancy. For the same reason, also considering the frequent asymptomaticity of the same, most uterine fibroids are diagnosed. for the first time, precisely in pregnant women.
Incidence
Fibroids and conception
In order not to alarm women on maternity leave, 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 low; consequently, in general, despite the presence of fibroids, the sperm does not find significant obstacles to proceed from the cervix to the fallopian tubes. Nonetheless, a particular subcategory of fibroids - submucosal fibroids - could hinder the implantation and development of the embryo more; Sometimes they could also cause abortion. Intramural fibroids, on the other hand, could cause both abnormal contractions during childbirth and premature birth of the baby, as uterine contractions are stimulated.
Growth of fibroid in pregnancy
The hypothesis that fibroids grow faster during pregnancy has been disproved by recent studies: only in some cases, fibroids can evolve during pregnancy. Medical statistics show that, approximately, in 30% of women presenting fibroids in pregnancy, myoma increases in size: complications during pregnancy are directly proportional to the development of the fibroid, also influenced by hormonal changes related to gestation. The exaggerated increase in the volume of the fibroid could cause possible bleeding (determined by vascular modulations) and pain.
The increase in the volume of fibroids during pregnancy is related not so much to an enhancement of cell proliferation, but to their hypertrophic status; in parallel, the volume decrease is linked to cellular atrophy.
Effects on the fetus
It seems that the variations in volume of uterine neoplasms in pregnancy, if not excessive, do not involve serious consequences, neither to the fetus nor to the mother; the major problem remains the localization of the fibroid, which greatly affects the success of the pregnancy.
In the event that the woman has a genetic predisposition to fibroids, has suffered from the same pathology in the past or has had numerous spontaneous abortions, the fibroids in pregnancy could involve serious problems, which should not be underestimated. Typically, 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 possible bleeding.
There are two factors that must be considered if a woman is affected by fibroids during pregnancy: first of all, the effects that the fibroid can cause on the fetus must be evaluated, but the consequences that pregnancy could lead to the fibroid must also be taken into account. same.
Diagnosis
Considering that the size of fibroids, as mentioned, change during the first trimester of pregnancy, diagnosis is absolutely essential, in order to keep any complications under control: ultrasound and gynecological inspection are the two most accredited diagnostic techniques for the recognition of fibroids during pregnancy. Through the ultrasound examination, the gynecologist is able to analyze the volume of the fibroid, the stage of development, the size, the location and the cellular composition; the ultrasound diagnostic technique is not only the simplest method, but also the best since reliability point of view. For pregnant women suffering from obesity, ultrasound diagnostic screening is more complicated.
Choice of therapy
The choice of therapy must be carefully evaluated by the gynecologist based on the age of the mother, the location of the fibroid and the period; surgical excision is performed only in cases of the most severe acute complication. The risk of negative repercussions on the successful outcome of pregnancy is in fact very high when the pregnant woman undergoes a similar surgery. Therefore, generally, to pregnant women suffering from fibroid, a conservative drug therapy is recommended, to promote correct uterine contractility during pregnancy. At the birth of the child, the gynecologist will evaluate for the mother, a possible further treatment to permanently eliminate the fibroid.
Summary
To fix the concepts ...
Illness
Fibroma
Incidence
Pregnant women
Age
Over 40 years old
Malignant evolution
Very rare
Submucosal fibroids
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 baby, as uterine contractions are stimulated
Symptoms
Pain, heaviness, bleeding
Diagnosis
Gynecological inspection
Ultrasound
Women at risk
Genetic predisposition, past history of fibroid, miscarriages
Pharmacological treatment
Surgery (rare, to be avoided during pregnancy)
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