Fetomaternal Outcome & Complications of Pregnancy with Fibroids
Abstract
Fibroid (myoma) is the most common benign tumors of the uterus. Chances of complications are approximately 10-40% in the presence of fibroids. This study was aimed to assess the maternal & fetal outcome and complications in pregnancy with fibroids. It was conducted on 20 pregnant women with fibroid. Routine basic investigations were done for all subjects included in the study. Ultrasonography was done at booking visit and during subsequent visits to assess changes in size of the fibroid and associated complications. It was found that Fibroids were more frequent in multigravidae (65%) than primigravidae (35%). Majoriy (70%) were diagnosed as having fibroid during routine antenatal visits and 30% were known case of fibroid prior to conception. Twenty five women had pain, 10% had threatened preterm labor, 15% had spontaneous miscarriage, 30% had anemia and placenta previa was diagnosed in 15% women. Majority (60%) had Lower segment cesarean section (LSCS) and only 40% had vaginal delivery. Though many fibroids are asymptomatic but fibroids during pregnancy can lead to complications during the antepartum, intrapartum, and postpartum period, so they need proper follow-ups and repeated assessment. Overall prognosis depends on their location and size.
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Introduction
Uterine leiomyomata are benign smooth muscle tumors. They are present in approximately 20-50 % of women of reproductive age.1 Presence of myoma during pregnancy may be a potential serious problem and of frequent clinical concern since fibroids are commonly detected in women of reproduction age, 2 and many times they have been implicated as a cause of bad pregnancy outcome. The incidence of fibroids in pregnancy ranges from 0.1-10.7% of all pregnancies.2
Effect of pregnancy on myoma may be stimulatory and it can lead to unpredictable and impressive growth during pregnancy. These tumors respond differently in different women. Fibroids may grow, regress or remain unchanged in size during pregnancy. Though in some cases it does not affect the outcome of pregnancy but they are associated with complications like preterm labor, IUGR, abortion, PROM, uterine dysfunction, placental abruption, and obstructed labor, increased risk of cesarean delivery, breech presentation, malposition.3
Fibroids are associated with menstrual disorders and pelvic pain, infertility and pregnancy outcome. Incidence of fibroids increases with maternal age. Women who are older than 35 years of age and in nulliparas are especially at risk.4 Fibroid <5 cm in diameter tend to remain stable or decrease in size and, larger fibroids (>5 cm) tend to grow during the pregnancy.5 The risk of adverse events in pregnancy increases with the size of the fibroid. Different complications with variable rates of incidence have been reported in pregnancy with fibroids.6 Above mentioned complications are more commonly seen with large submucosal and retroplacental fibroids.7
Conclusion
Pregnancies with fibroids are associated with complications during antepartum, intrapartum, and postpartum period. They need multiple follow-ups and assessment. Though many of the fibroids are asymptomatic, but may adversely affect the course of pregnancy and labor depending on their location and size.