Myoma of the uterus and childbirth - the concepts are quite compatible. It is recommended only to undergo additional ultrasound before the very birth - this will help to clarify the location and dimensions of the tumor nodes.
How does pregnancy and childbirth affect myoma? During pregnancy, certain changes occur in the woman's body:
- hormonal rearrangement, which increases the level of estrogen and even more progesterone, and this affects the state of myoma;
- Mechanical restructuring of the uterus - its increase and extension.
To supply the enlarged organ with blood, new vessels grow to the muscles. All these changes can affect the already existing myoma, but the degree of its changes will depend on where and how the tumor is located, and how much it "captures" the uterus.
During pregnancy, the uterine fibroids practically do not grow. Her slight growth can be observed in 1 and 2 trimesters, but in the 3rd trimester, fibroids become smaller. In general, the growth of fibroids practically does not affect the development of pregnancy.
In the postpartum period, fibroids may undergo changes, but they are unpredictable. So, for example, the tumors that brought trouble during the gestation period after birth may not manifest themselves as a single symptom. However, as a result of the reverse development of the uterus in the first months after birth, the myoma often changes its location.
Delivery with uterine fibroids
Pregnancy that has arisen against the background of uterine fibroids may be accompanied by a number of complications, and at the same time the risk of its interruption remains. However, if this happens, then a miscarriage occurs due to a malnutrition of the endometrium and in the early stages. Sometimes the fault of the miscarriage becomes an uncomfortable place of attachment of the embryo (for example, the so-called cervical - in the region of the cervix, which makes it impossible to bear fruit). With myoma increases the risk of tubal pregnancy.
If the tumor is localized in the cervix, its painless opening occurs before the onset of labor, and in early terms, it can provoke miscarriage, and after 22 weeks there is a threat of premature birth.
With a large size of the nodes and pathology of the endometrium, the increased tone of the uterus persists throughout the period, which often leads to premature birth. This is explained by the fact that the large size of the tumor prevents the baby from taking the correct position in the uterus, and most often it is located either obliquely or across, which is an indication for cesarean section operation. Moreover, the tumor located in the muscular layer of the uterus interferes with the normal functioning of the placenta: the supply of nutrients and oxygen to the fetus is disturbed, hypoxia (oxygen deficiency) develops, which leads to a delay in the development of the fetus (it lags behind in growth and weight). In the future - after birth - it will affect the health of the baby, on his physical and mental development.
Another danger, arising from the growth of fibroids, is a change in the endometrium and a tight attachment of the placenta. This makes it difficult to self-release afterbirth after delivery and provokes heavy bleeding. In this case, the doctor conducts a manual examination of the uterus and removes the latter under general anesthesia.
Can myoma affect natural childbirth?
Often, in pregnant women with uterine myoma, labor occurs on time and passes without any complications, but the hospitalization of the expectant mother is performed at 37-39 weeks.
With a satisfactory condition of the fetus and small size of the myoma, independent births are allowed. In some cases, delivery in the presence of a tumor has some peculiarities:
1. Premature water leakage.
2. There is a possibility of premature birth (up to 37 weeks).
3. Approximately half of pregnant women with myomas have protracted births and in the presence of large sizes or numerous nodes in the tumor, there is often a need for a cesarean section. This is mainly due to the presentation of the fetus - transverse, pelvic, Facial, in which natural childbirth is not possible. In this case, if the area of ??the incision is involved in myoma surgery, the doctor can immediately remove the tumor.
4. Cesarean section is recommended also in the following cases:
- the pregnant woman had previous operations to remove the fibroids, and the scars formed on the uterus;
- The previous pregnancy ended with Caesarean section;
- necrosis of myoma occurs;
- a myoma degenerates into a malignant tumor;
- In addition to fibroids, there are other complications of pregnancy;
- the severe condition of the fetus is diagnosed.
5. Another feature that arises when the tumor is located in the place of attachment of the placenta is its detachment.
Can I remove myoma during Caesarean section?
Most specialists oppose the removal of myoma in Caesarean section, since this is associated with a high risk of dangerous bleeding. However, in an exceptional case, the tumor can be removed, for example, if:
- myoma on the stem (subserosal);
- a tumor prevents suturing of the uterus,
- if the cross section of the section is in the myoma.
Myoma in the postpartum period
The presence of fibroids often in the early postpartum period because of a decreased tone of the uterus provokes a delay in the removal of the placenta due to its tight attachment or increment, and postpartum haemorrhages . However, these conditions are successfully treated.
In the late postpartum period incomplete involution of the uterus (when it can not return to its original dimensions) and infection of its cavity may occur.
Quite often after birth, myoma significantly decreases in size.