Why fibroid may not hurt your pregnancy —Experts

For women who are considering becoming pregnant and with growing fibroids in their womb, it does not negatively interfere during a pregnancy. However, experts in this report by Sade Oguntola, say this is dependent on the size, number and location of the fibroids within the womb.

Often, the first time many women learn they have a fibroid in their womb during routine pelvic examination when pregnant or having a problem conceiving, there is always a panic. That is because fibroids usually don’t have symptoms. But they are quite common—more than 70 per cent of women have them.

Fortunately, in most instances, fibroids do not negatively interfere during a pregnancy, depending on the size of a fibroid and its location within the womb.

In most cases, fibroids won’t cause a problem with the pregnancy, said Professor Adetokunbo Fabamwo, a Consultant Obstetrician and Gynaecologist at the Lagos State University Teaching Hospital (LASUTH).

According to Fabanwo, “we know that women can safely carry a pregnancy and have deliveries even if they have a fibroid.”

The presence of fibroids commonly begin during a woman’s childbearing years. They are usually found in or around the body of the womb but sometimes are in the cervix (lower part of the uterus). It can be as small as a pea or as large as a grapefruit.

Estimating the overall incidence of fibroids in the population depends on the community under investigation and the sensitivity and specificity of the methods used to detect fibroid.

The exact cause of fibroid is unclear, but there is evidence that it may be a combination of genetic, hormonal, and environmental factors.

There are three main types of fibroid depending on their location- fibroid that are inside the womb (submucosal), within the wall of the womb (intramural) or in the outer wall of the womb (subserosal).

He declared: “We know that those that are really inside the womb are those competing for the space with the growing foetus. So, if a woman is with this type of fibroid, it is better she removes them before attempting to get pregnant.

“If she does not remove them before attempting to get pregnant, she may have a miscarriage or a premature delivery. Even if she has a normal delivery, she is likely to bleed heavily and uncontrollably,” he said.

However, women whose fibroids are outside the womb or within the body of the womb can safely carry their pregnancy and have deliveries without first having them removed.

“Aside from the pain that they are likely to have constantly during pregnancy, usually they carry on with their babies normally, and their babies are delivered safely,” said Fabamwo.

During pregnancy, hormones in the body cause the womb to grow and accommodate the developing baby, and in some cases, this massive influx of pregnancy hormones may also cause fibroids to enlarge creating issues both during pregnancy and delivery.

Some fibroids will grow large enough to take much-needed blood supply from the foetus or take up too much room in the womb, which can result in a miscarriage.

Other consequences that fibroids inflict on pregnancy include acute abdominal pain and in some instances, bleeding if the placenta is near the fibroid.

Studies have shown a greater risk of bleeding (60%) in early pregnancy if the placenta is implanted close to the fibroid, compared to when there is no contact between the two (9%).

If the pregnancy goes smoothly despite the presence of fibroids, there can also be challenges during delivery. Fibroids may cause the baby to lie in breech, transverse position, or block the progress of labour and expulsion of the placenta.

Fabanwo, however, stated the need for counselling for a woman who has fibroid and who got pregnant because complications may arise on the way in some cases, depending on the fibroid location, size and number.

When the fibroid is located right by the placenta, it can affect the blood supply to the foetus. And so, sometimes the baby may be born a little on the small side.

Baby born a little on the small side stand a higher risk of complications, including difficulty in breathing, problems maintaining weight and body temperature.

Moreover, depending on the location and orientation of the fibroid, the baby can end up in an abnormal position for delivery. And if the fibroid is located in or near the cervical opening, it may block the baby’s passage. All may necessitate a cesarean delivery.

In 2018, expert’s assessment of the fibroid’s adverse effect on the mother and her unborn baby in Egypt, for instance, indicated that Cesarean sections were done in 85 per cent. It was in the journal, BioMed Research International.

The study had recruited 64 pregnant patients with fibroids larger than two centimetres over a period spanning May 2015 to August 2017 at Obstetrics and Gynecology Department in Zagazig University Hospitals, Egypt.

Miscarriage occurred in 2 per cent, premature delivery in 27.7 per cent, and delivery at 37 to 41 weeks of pregnancy in 70.2 per cent.  The mode of delivery was vaginal delivery in 15 per cent and cesarean sections in 85 per cent.

Also, 34 per cent had threatened miscarriage, 21 per cent had preterm labour, 2 per cent had antepartum bleeding in the form of placenta previa, 4 per cent had abdominal pain needing admission, 2 (4 per cent) experienced heavy bleeding after childbirth and only one needed blood transfusion.

But researcher in a 2010 review suggests that the most common complication of fibroids during pregnancy is pain. It’s seen most often in women with fibroids larger than 5 centimetres who are in their last two trimesters.

It’s other symptoms, however, include the urge to frequently urinate, pain during sex, constipation, painful bowel movements, lower back pain and feeling of fullness in the pelvic area (lower stomach area).

Most women with fibroids will not be infertile. Women with fibroids and their partners should be thoroughly evaluated to find other problems with fertility before fibroids are treated. A fertility specialist can help assess if fibroids might be hampering conception.

Dr Abayomi Ajayi, a fertility specialist, Nodical Fertility centre, treatment of fibroids is decided on a case-by-case basis. It is based on the symptoms of fibroids and may improve overall fertility. How and whether treatment of fibroids will be necessary depends on the severity of the symptoms and the doctor’s recommendations.

He, however, warned that it is not every woman with fibroids that needs surgery; it has to be that the fibroid is causing problem, although its delay in those who need treatment, especially surgery because of myths and misconceptions can worsen the problem.

Ajayi added: “A common myth is that the womb would be removed through hysterectomy (surgical removal of wombs). However, there are several options that help preserve the womb.

“Successful fibroid removal surgery is possible through a procedure called myomectomy that allows the womb to be left in place without losing function, and for some women make pregnancy more likely than before.

“Fibroids are widely misunderstood and a number of misconceptions that create confusion for women with fibroids have been cleared up over time, yet they persist. Perhaps one of the commonest misconceptions are that every woman with fibroids will experience heavy menstrual bleeding and pain.”

An obstetrician and gynaecologist, Dr Tunde Olayemi also advised women to avoid undergoing unnecessary surgery to remove the fibroid to avoid complications from the process.

Olayemi, a Consultant Gynaecologist at the Medicrest Hospital, Bwari, Abuja, declared, “There are possible complications following fibroid surgery that can cause infertility such as fibrous adhesion which can obstruct the fallopian tube.”

Moreover, Dr Benjamin Olowojebutu, Executive Director of the Benjamin Olowojebutu Foundation, BOF, debunked the claim that drugs can shrink fibroid.

He declared: “There is no medicine that will shrink fibroids and there is no way you will pass it out through the anus. That is a lie and that is what is killing a lot of our women. These people are deceiving them and making money from them. They keep taking these drugs for years and instead of the fibroids shrinking, they keep getting bigger.”