Perinatal complications of pregnancies complicated by uterine fibroids

Abstract

Fibroids (myomas) are the most common tumors of the female reproductive organs, consisting of smooth muscle cells, fibroblasts, and extracellular matrix. They develop from menarche to menopause. They are diagnosed in 10-20% women of reproductive age. Their size varies from barely visible nodules to large tumors. Change in the size of fibroids during pregnancy and after childbirth is the subject of numerous studies. Most studies indicate a significant increase in the size of fibroids during the first trimester, unchanged size during the second and the third trimester, and a decrease in their size after the delivery. The effect of fibroids on pregnancy depends on their number, location, and size. Myomas are associated with numerous perinatal complications: bleeding in pregnancy, miscarriages, pain due to red degeneration, preterm birth, placental abruption, placenta previa, intrauterine growth restriction, fetal malpresentation, prolonged labor, increased cesarean section rate, uterine atony, and postpartum hemorrhage. Treatment of fibroids in pregnancy includes bed rest and follow-up with symp-tomatic therapy in case of pain, as well as intensive monitoring of the fetus. Very rarely, myomectomy may be necessary during pregnancy. Myomectomy during cesarean section has been considered contraindicated for years. Recent research demonstrates that this procedure may not be associated with an increased risk of perioperative complications. Its advantages include performing two operations within one surgical procedure while avoiding the risks of repeated laparotomy and anesthesia. The most common postpartum complications of fibroids are bleeding and infection.