Is a large left lateral uterine wall subserous fibroid an indication for Cesarean Section?

From the Guidelines

A large left lateral uterine wall subserous fibroid is generally considered an indication for Cesarean Section due to the potential risks of obstetric complications, including fetal malpresentation, placental abruption, and postpartum hemorrhage 1.

Key Considerations

• The size and location of the fibroid can impact the decision for CS, with larger fibroids posing a greater risk for complications 1.
• The patient's overall health, parity, and obstetric history should be taken into account when making the decision for CS.
• Preoperative management with medications such as misoprostol 25mcg orally 1 hour prior to surgery may be considered to reduce uterine tone and bleeding risk.

Uterine Fibroid Management

The management of uterine fibroids, including those that are large and subserous, involves a comprehensive approach that includes physical examination, imaging studies such as pelvic ultrasound or MRI, and additional workup as needed 1.

• Imaging studies are crucial in characterizing the location, size, and number of fibroids, which can inform the decision for CS.
• Patient evaluation should include an assessment of the patient's overall health, parity, and obstetric history to determine the best course of management.

From the Research

Uterine Fibroids and Pregnancy Complications

• A large left lateral uterine wall subserous fibroid may be associated with pregnancy complications, including preterm delivery, intrauterine growth restriction, and placental abruption 2, 3.
• However, there is no direct evidence to suggest that a large left lateral uterine wall subserous fibroid is an indication for Cesarean Section.
• Uterine fibroids can cause complications during pregnancy, including operational delivery, and may require medical intervention 2, 4.

Fibroid Treatment and Pregnancy Outcomes

• Treatment of uterine fibroids, such as laparoscopic radiofrequency volumetric thermal ablation, can improve symptom severity and quality-of-life scores 4.
• However, the relationship between fibroid treatment and pregnancy outcomes, including the need for Cesarean Section, is not well established.

Uterine Size and Fibroids

• Uterine size can be affected by the presence of fibroids, and large uterine fibroids can cause venous compression and thrombophlebitis 5.
• However, the normal uterine size in women of reproductive age can vary, and uterine size is not always a reliable indicator of fibroid presence or size 6.