From the Guidelines
Uterine fibroids can indeed cause issues with pregnancy, particularly those that are submucosal or intramural, as they can lead to lower pregnancy and implantation rates. These noncancerous growths in the uterus affect a significant number of women and can impact fertility and pregnancy outcomes depending on their size, number, and location 1. According to a study published in Environmental Health Perspectives, the pregnancy rates per transfer were significantly lower in patients with intramural and submucosal fibroids compared to those with subserosal fibroids or no fibroids 1.
Some of the potential issues that can arise during pregnancy due to uterine fibroids include:
- Preventing embryo implantation
- Increasing the risk of miscarriage
- Causing placental abruption
- Leading to preterm labor
- Restricting fetal growth
- Causing abnormal fetal positioning
- Necessitating cesarean delivery
It is essential for women with fibroids who are pregnant or trying to conceive to receive regular monitoring from their healthcare provider. Treatment before pregnancy may be recommended for certain fibroids, including myomectomy (surgical removal) for submucosal fibroids that distort the uterine cavity 1. However, many women with fibroids have completely normal pregnancies without complications, especially when the fibroids are small and located in areas that don't interfere with the pregnancy.
In terms of treatment, a review of studies found that myomectomy can improve fertility outcomes, with pregnancy rates ranging from 54% to 58.2% after the procedure 1. Additionally, laparoscopic myomectomy or hysteroscopic resection of submucosal fibroids can also improve fertility outcomes, with clinical outcomes similar to those seen after myomectomy at laparotomy 1.
From the Research
Uterine Fibroids and Pregnancy Complications
Uterine fibroids can cause issues with pregnancy, including:
- Abdominal pain
- Miscarriage
- Malpresentation
- Difficult delivery 2
- Preterm labor
- Placental abruption
- Fetal growth restriction
- Fetal malpresentation 3
Factors Affecting Pregnancy Outcomes
The size, location, and number of fibroids, as well as their relation to the placenta, are critical factors in determining the impact of fibroids on pregnancy outcomes 2, 4.
- Fibroids can affect pregnancy and delivery in several ways, with the most frequent complications being abdominal pain, miscarriage, and difficult delivery
- Ultrasound scanning plays a central role in diagnosing and monitoring fibroids during pregnancy and in determining the relative position of the fibroids to the placenta 2
Management of Fibroids During Pregnancy
Few treatment options are available during pregnancy, but in carefully selected patients, myomectomy has been performed successfully without jeopardizing pregnancy outcome 2, 4.
- Laparotomic myomectomy during pregnancy can be considered in selected cases for uterine fibroids with severe symptoms when other treatment options have failed and there is high risk of adverse maternal-fetal outcomes 5
- A successful pregnancy and delivery is common with appropriate surveillance and supportive management 2