I’m pregnant AND have fibroids. Is this bad?

Q: I’m about two months pregnant, and my doctor just told me I have fibroids. Will this complicate the pregnancy? Should I be worried?

A: Probably not. However, you — and your doctor — should be cautious, as I’ll explain below.

First, a little background. Fibroids are very common. Recent estimates suggest that as many as 35 percent of women over the age of 35 develop these benign uterine growths. But 35 is an arbitrary “start-off” age used by medical statisticians; and it is common for a younger woman to be given a fibroid diagnosis during routine pregnancy ultrasound, especially if she has a family history of fibroids or if she is African-American (in which case the incidence of fibroids is much higher). 

Yes, a fibroid can affect a woman’s pregnancy, but, surprisingly, the numerous studies that have been performed often disagree on the extent. (This is most likely because fibroids come in varying sizes and locations, and the studies often vary in what they are addressing.) What we do know is that pregnancy hormones cause the uterus to grow in order to accommodate the enlarging fetus, and a co-existing fibroid may grow simultaneously. The majority of fibroid growth seems to occur during the first few months of pregnancy.

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Although most fibroids will not cause harm during pregnancy or delivery, it is important to be aware of the following potential complications:

Pain
If the fibroid outgrows its blood supply, it may undergo “red degeneration” (it bleeds into itself) or “white degeneration” (portions of the fibroid undergo cell death and liquefy or become cystic). Both of these conditions can cause pelvic and/or abdominal pain. Usually the pain (which is temporary) can be controlled with oral pain medications. In rare cases, the pain becomes severe enough to necessitate hospitalization for epidural pain management and in the worse case scenario, necessitate fibroid removal surgery (myomectomy).

Complications during early pregnancy
Fibroids may cause bleeding and increase the risk of early miscarriage, but even here studies are not very conclusive. The type of fibroid most likely to cause problems is one that grows into the uterine cavity (submucosal). Because it disrupts the lining of the uterus it can prevent normal implantation of the pregnancy or the ongoing growth of the placenta. Some data show that uterine fibroids may also increase the risk of second-trimester miscarriage, but that risk seems to be fairly small. Procedures such as amniocentesis or chorion villus sampling (CVS) may be more difficult in women with fibroids and result in complications such as ruptured membranes, contractions and miscarriage.

Complications during late pregnancy
The major concerns regarding fibroids are preterm labor, abnormal separation of placenta — placental abruption — or fetal growth restriction. If a fibroid is large or there are multiple fibroids, the risk of preterm labor may be higher. Placental abruption is more likely to occur if the fibroid is large or has grown into the area where the placenta has attached. It’s not clear whether fibroids restrict fetal growth. One recent study of more than 12,000 pregnant women did not demonstrate that fetal growth restriction was more common among the women with fibroids.

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Complications during delivery
A strategically “misplaced” fibroid can cause the baby to lie in breech or transverse position and an elective C-section may be in order. Even if the baby is positioned head-down (vertex) the fibroid can block its descent and the progress of labor, again necessitating a C-section. Sizable fibroids also increase the risk of heavy bleeding after delivery (postpartum hemorrhage). In addition, they can block the expulsion of the placenta, and may also prevent proper contraction of the uterus after delivery.

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