fibroid complicating pregnancy
TRANSCRIPT
FIBROIDS COMPLICATING PREGNANCY
BYR.MADHAVA MANOJ
INCIDENCE AND PREVALENCE
Incidence : 1 in 1000.Prevalence : Highest in black women -18 percent
Lowest in whites - 8 percent
EFFECTS OF FIBROID ON PREGNANCY
May be none Abortion (submucous fibroid) Pressure symptoms due to impaction of
(a) Bladder - retention of urine (b) Rectum - constipation
Red degeneration Malpresentation (Four fold risk) Preterm labor and prematurity Non-engagement of the presenting part
EFFECTS ON LABOR
May be unaffected Uterine inertia Dystocia Obstructed labor Postpartum hemorrhage due to atonicity or adherent
placenta Difficult cesarean section (Eight fold risk)
EFFECTS ON PUERPERIUM
Subinvolution Inversion of uterus Secondary PPH Sepsis Lochiometra and pyometra.
EFFECTS OF PREGNANCY ON FIBROID
Changes in size – increases (?) Changes in position Changes in shape - becomes flattened Degenerative changes specially, red degeneration Torsion of pedunculated subserous fibroid Infection and polypoidal changes are more in
puerperium.
EFFECTS OF PREGNANCY ON FIBROID
Changes in size – increases (?) Fibroid is an estrogen dependant tumor. Pregnancy is a progesterone predominant state. So how does fibroid increases in size during pregnancy?
EFFECTS OF PREGNANCY ON FIBROID
Actually, most fibroids do not increase in size during pregnancy.
69% - had no increase in fibroid volume throughout pregnancy
31% - noted increase in fibroid volume, greatest increase before 10th week of gestation and a reduction to baseline value 4 weeks after delivery
EFFECTS OF PREGNANCY ON FIBROID
The main reason for the fibroid to increases in size during pregnancy is due to Increased vascularity Edema Hypertrophy and hyperplasia of the fibromuscular
tissues.
It is often difficult to diagnose a fibroid during pregnancy because of Marked softening Alteration in the shape (flattening)
In early months, fibroid is diagnosed but pregnancy is missed whereas in later months, pregnancy is diagnosed but the fibroid is missed.
DIAGNOSIS
Ultrasonography confirms the diagnosis with certainity.
DIAGNOSIS
USG showing uterine fibroid
If ultrasonographic findings are unclear, Magnetic Resonance
Imaging can be done
DIAGNOSIS
MRI showing degenerating fibroid
In uncomplicated tumor, fibroid is often confused with Ovarian tumor Retroverted gravid uterus Non gravid half of uterus didelphys
DIAGNOSIS
BASIC PRINCIPLE
Avoid treatment whenever possible.
TREATMENT
DURING PREGNANCYUncomplicated :
Usual antenatal care is followed. All cases to be assessed at 38
weeks to formulate the method of delivery. Acute pain following red degeneration
Conservative management
TREATMENT
DURING LABORFibroid situated above the presenting part:
Usually results in uneventful vaginal deliveryFibroid situated below the presenting part:
Spontaneous vaginal delivery may occur. If it fails, cesarean section is to be done.
TREATMENT
Fibroid in lower uterine segment Cervical fibroid, even if it is small Fibroid impacted in pelvis Malpresentation Obstetric complications
INDICATION FOR ELECTIVE CESAREAN SECTION
Cesarean delivery for a large leiomyoma in the lower uterine segment
TECHNICAL ASPECTS ON ELECTIVE CESAREAN SECTION
Myomectomy should be avoided during cesarean section
Be alert for postpartum hemorrhage and retained placenta.
Reverts to a smaller size during puerperium