What should I do if I find uterine fibroids during pregnancy?

1. Unless absolutely necessary, surgery is generally not performed

In principle, unless there are some unavoidable circumstances, surgery is generally not performed on uterine fibroids during pregnancy, and treatment should be delayed until delivery or after delivery.

Myomectomy during pregnancy may cause excessive blood loss;

Surgery may cause miscarriage and premature birth;

The wound caused by surgery may cause uterine rupture in late pregnancy or during delivery.

2. Caesarean section or natural birth?

If the fibroids "linger" and grow with the fetus until delivery, should it be done by "caesarean section" or "natural delivery"? This mainly depends on the size and location of the fibroids.

(1) Natural childbirth

When the following three points are met at the same time, you can try natural childbirth, and then treat the fibroids according to the situation after delivery:

Fibroids are located at the top (fundus) of the uterus or on the front or back wall of the uterus;

Less than 8 cm in diameter;

Examination determined that the fibroids did not affect the fetus's entry into the pelvic cavity and vaginal delivery.

However, it should be noted that the contraction, traction and squeezing of the uterus during delivery may damage the fibroids, leading to fibroid degeneration and infection. Therefore, it is necessary to pay attention to the recovery of the uterus after delivery and use drugs and antibiotics that promote uterine contraction as appropriate.

(2) Cesarean section and simultaneous removal of fibroids

If any of the following situations occurs, a cesarean section should be chosen to remove the fetus and then the fibroids to prevent the fibroids from causing poor postpartum uterine recovery, prolonged lochia, or even infection.

Fibroids are located at the lower end of the uterus;

Affect the fetus's entry into the pelvic cavity or vaginal delivery;

Fibroids may cause the uterus to contract weakly.

Rarely, a hysterectomy may be necessary if there is excessive bleeding during or after a myomectomy.

In addition, some scholars believe that there is a risk of residual fibroids when removing fibroids during cesarean section. Because the uterus is large and has not yet returned to its normal size after the baby is delivered, some small fibroids appear even smaller and may be ignored and left behind, resulting in recurrence in the future.

But in fact, the same problem also exists when removing uterine fibroids during non-pregnancy. Doctors can avoid this situation to a large extent by carefully palpating and searching with their hands.

3. Those unavoidable situations

For uterine fibroids during pregnancy, myomectomy is generally not performed, but if the following conditions occur, surgery for uterine fibroids will be required during pregnancy.

Large uterine fibroids: Fibroids that are too large are prone to degeneration and affect pregnancy

Symptoms are obvious: frequent abdominal pain, frequent uterine contractions or vaginal bleeding.

The fibroids are located close to the placenta: This situation may cause poor uterine contraction after delivery, leading to postpartum hemorrhage or retained placenta.

Others: The degenerative changes of the fibroids are more serious, irritating the peritoneum, causing symptoms of localized peritonitis such as acute abdominal pain, low fever, and increased white blood cell count.

4.How is the surgery performed?

Usually the surgery is done in the second trimester (around 14 to 16 weeks of pregnancy), when the uterus is not significantly enlarged and the fetus is relatively stable. Even so, it is difficult to perform myomectomy during pregnancy.

Whether to go through laparoscopy or laparotomy depends on the doctor's judgment based on the condition of the fibroids. Unless it is a subserosal fibroid with a pedicle, laparotomy is usually safer. Postoperative treatment is also required to strengthen pregnancy preservation.