Fibroids and pregnancy

What are uterine fibroids?

These are non-cancerous growths that come from the muscle layer of the uterus which are commonly found in women of reproductive age. Fibroids can be single or multiple. They have varying shapes and can be located inside the uterine cavity, within the walls of the uterus, or on the outer surface of the uterus. They are slow-growing (about 1-2cm a year) and will typically start to shrink once a woman reaches menopause. 

Can fibroids affect my pregnancy?

Many women get pregnant naturally even when they have fibroids. Most pregnant women with fibroids go on to deliver healthy babies. Fibroids will grow in size (together with the uterus!) as your pregnancy progresses, and shrink after delivery. Some complications that fibroids can cause when you are pregnant include:

• Miscarriage
• Red degeneration: this occurs when fibroid growth outstrips their blood supply and causes sudden severe pain during pregnancy
• Fetal growth restriction: large fibroids may decrease the available space for your baby to grow 
• Fetal malposition: large fibroids may alter the shape of your uterine cavity and force your baby to adopt a breech (head-up) or transverse (sideways) position; this may mean you are not able to have a vaginal delivery
• Increased risk of caesarean section
• Difficulty in getting to the baby at caesarean section: if your fibroids are at a location blocking access to the baby
• Increased risk of bleeding: this may occur during pregnancy if the placenta implants over the fibroid, or after delivery (postpartum haemorrhage) as fibroids prevent the uterus from contracting back to its normal size 

I am already pregnant and I have fibroids. What do I do?

You do not have to do anything. Your gynaecologist will monitor both your baby and fibroids throughout the pregnancy via ultrasound scans. Do see your gynaecologist if you develop sudden pain especially over your fibroid – this may be a sign of red degeneration. 

Can I remove my fibroids at the same time as my caesarean section?

This is not advisable as fibroids tend to be large with lots of blood supply at the time of delivery. Removing your fibroids at the time of your caesarean section will put you at risk of losing too much blood. It is recommended to leave the fibroids alone unless they are blocking access to your baby. Re-assess them after your uterus has shrunk back to its normal size – the fibroids would have most likely shrunk in size as well.