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Questions and answers on: fibroids after cesarean section

2008-03-04 17:01:55

Vladimir asks:

My wife is pregnant. At 8 weeks, an ultrasound revealed three fibroids. different sizes. They didn’t say anything about the type of fibroids then. At the 11th week, when undergoing an ultrasound to check for Down syndrome, the doctor discovered that there were five fibroids, not three. The largest fibroid is 5x8cm, the smallest is 2x3cm. Two fibroids are subserous, three are interstitial. After the second ultrasound, the doctor said that at the 18th week (4.5 months), after the fetus starts to beat, surgery is needed to remove fibroids. Questions: could two more fibroids of size 2x3cm and 5x6cm have grown in three weeks or were they simply not noticed at the first ultrasound, how is the operation to remove fibroids performed, what kind of rehabilitation does the wife need after this operation, how dangerous is this operation for the fetus? Is it possible to carry a fetus to term for up to 9 months and remove fibroids by caesarean section? How dangerous general anesthesia for the fetus in case of cesarean section and subsequent surgery to remove fibroids. I would be grateful for any recommendations on maintaining my wife’s health.

Answers Pivovarova Tatyana Pavlovna:

Indeed, all myomatous nodes might not have been seen. If now the wife is not in danger premature birth, she is not in the hospital, then it will be possible to observe the nodes, but if not, then we need to operate. The anesthesia for a caesarean section is very short, just to quickly deliver the fetus, so you don't have to worry about it.

2015-05-29 09:03:54

Hope asks:

Hello!!! I have the following question: 5 months have passed since giving birth... and the menstrual cycle has not started... The birth was by cesarean section... the lochia lasted for 8 weeks... I breastfed for 2 months. I take a pregnancy test regularly, but it’s negative... I’m very worried... is this normal..
By the way, I still have uterine fibroids... before pregnancy it was 4 cm.

Answers Gerevich Yuri Iosifovich:

Good afternoon, yes it can be. If they do not start in 1-2 months, consult a doctor (blood prolactin, ultrasound) - all this provided that the birth took place without complications (bleeding, the uterus and/or ovaries were not removed during the operation).

2014-07-08 07:31:26

Alexandra asks:

Good afternoon We need your advice. After the second caesarean section in October 2013. (the first was in 2004), about five months later abdominal pain appeared and the uterus was enlarged. I did an ultrasound on the 11th day of the cycle and it turned out that I have grade 2 endometrioid engonies on both walls of the uterus, according to back wall On the left there is an 11mm intramural myomatous node. Diagnosis: uterine fibroids, adenomyosis. The doctor advised me to put on a Mirena coil, which supposedly would eliminate adenomyosis. But at the same time, apart from a smear + culture, there are no examinations. Please tell me what examination needs to be completed before installing this spiral? (is a mamogram necessary, etc.) And is the IUD effective in this case or are there any other methods of treating this problem?

Answers Wild Nadezhda Ivanovna:

The Mirena IUD or levonorgestrel system is, firstly, a contraceptive that can also be used for therapeutic purposes in case of endometriosis. To use a contraceptive, you need the result of a cytological smear. Ultrasound. The mammary gland is examined by palpation; an ultrasound of the mammary glands can be performed. It is advisable to know hemoglobin - Total blood an.an. It is necessary to take into account the presence of varicose veins on the lower extremities. The levonorgestrel system is characterized by its action in the uterine cavity on the uterine mucosa, ovaries, daily allocation small doses of progesterone, as a result of which endometrioid heterotopias do not spread. There is no heavy or irregular bleeding. During breastfeeding, Mirena is not contraindicated; there is no load on the liver and gastrointestinal tract.

2014-02-10 12:59:57

Anya asks:

Please tell me how the treatment will proceed. After the ultrasound they made a conclusion - ultrasound signs of uterine fibroids in initial stage development, adhesive process in the pelvis. And will I be able to give birth in the future. Before this, I gave birth by caesarean section. Please answer, I’m very worried and afraid..

Answers Gritsko Marta Igorevna:

Where is the fibroid located? Have you checked the patency fallopian tubes? If the fibroids do not deform the uterine cavity and the fallopian tubes are passable, then you will be able to get pregnant and carry a child to term.

2011-10-31 18:15:43

Nadezhda asks:

Hello, I am 45 years old. For 11 years I have been seeing a gynecologist for the presence of small uterine fibroids, and at first there was only one node on the surface of the uterus, now there are four of them. Over the past two years, I have had two hysteroscopies, the indication is suspicion of polyps, intermenstrual spotting, thickening of the endometrium up to 8 mm on days 6-8 of the cycle. During the first hysteroscopy, the conclusion was that there was a small uterine fibroid in its cavity. At the second, a polyp was removed. Next, treatment with the hormonal drug duphoston was prescribed from the 16th day of the cycle, 2 tablets per day, 10 days. I have been taking it for the 5th cycle already, and in the first three I was pleased with the result. Menstruation was not heavy, it began on the 4th day after the end of treatment, the tension in the breasts, which was observed already by the 15th day of the cycle, disappeared. The ultrasound picture showed normal thickness of the endometrium, the structure of the ovaries improved. On the 4th cycle, menstruation came 5 days earlier and went already on the 8th day of taking the drug. They passed without any problems. The gynecologist told me that Duphoston should be taken for no more than 6 months. She prescribed me to continue taking the drug for another 2 months, and then suggested the Mirena IUD. There was no alternative offer, despite my distrustful attitude towards this method of treatment. I had 2 caesarean sections, in addition there are cysts on the cervix, a scar from cauterization of cervical erosion, in my youth when installing a spiral as contraceptive I experienced discomfort and pain, after which it was removed after 6 months. I have heard a lot of negative reviews regarding the Mirena IUD. I would like to get an answer: how long can I take the drug Duphoston with my diagnosis, and what alternative treatment can I get, how effective a treatment can be the installation of the Mirena spiral. Thanks in advance.

Answers Wild Nadezhda Ivanovna:

Mirena is a levonorgestrel system. It just looks like an intrauterine device. She has healing effect due to the presence of gestogen or, in other words, progesterone, which acts in the uterine cavity for 5 years and does not allow the formation of new polyps and fibromatous nodes. Of course the choice is yours. Duphaston can be taken for a long time, there are no restrictions for it, just in the background long-term use Duphaston requires control of the blood coagulation system, control of a cytological smear from the cervix, control of the mammary glands, and ultrasound monitoring of the condition of the uterus. If there was endometrial polyposis, then it is necessary to repeat the histological examination of the endometrium after 6 months of treatment. What speaks in his favor is that while taking treatment there is a cycle disruption, i.e. Taking duphaston for 10 days in the menstrual cycle is not enough; you need to take it according to a different regimen, but after a diagnostic curettage followed by a histological examination of the scraping.

2011-04-23 15:11:05

Evgeniya asks:

Hello. I had uterine fibroid surgery in 2007, the node was located on the back wall, the operation was normal. went well without complications. Now I’m pregnant for 7-8 weeks, and I’ve already been in pregnancy (upon discharge, the uterus is still in good shape). How can my operation be successful during pregnancy and what is the percentage of cesarean sections after the operation?

2010-08-27 18:29:57

Marina asks:

Good afternoon. I live in Severodonetsk, Lugansk region.
In the last year there has been a strong
hair loss all over the head. Especially severe in the summer, after washing your hair. More than 120 pieces, hair of different lengths falls out...both short and long. The scalp is already visible, hair loss is approximately 50%. I feel severe discomfort. My hair is about shoulder length, maybe a little shorter.
Did an ultrasound thyroid gland and gynecology, and also passed thyroid and gynecology hormones.
Conclusion Ultrasound of the THYROID GLAND: the volume of the thyroid gland is slightly less than the age norm. No structural changes in the parenchyma of the gland were detected.
Tests: T3- 0.75 ng/ml (normal 0.56-1.88)
T4 - 87.9 pmol/l (normal 60-150);
AtTG-58.5 U/ml (norm is not more than 100);
ST4-12.2 pmol/l (normal 9.0-22.2);
aTPO-11.7 IU/ml (norm is not more than 30),
TSH-1.05 µIU/ml (normal 0.4-4.0)
Conclusion of GYNECOLOGIST ultrasound: signs of uterine fibroids (1 node, 32x34 mm), multifollicular transformation of the ovaries.
Tests were taken on the 11th day of the menstrual cycle.
Blood tests: hemoglobin-145.5 g/l;
prolactin-108.89 µIU/l (normal 75-750);
FSH-6.38 IU/I (several values: normal - follic phase -3-12.... mid-cycle - 8-22...... luteal phase-2-12)
testosterone -0.45ng/ml (norm is not more than 0.6);
progesterone - 0.49ng/ml (normal several values: follicular phase - 0.2-1.4.......luteal phase - 4.0-25.0);
DHEA-S -7.82 umol/l (normal 1.65-9.15)
Childbirth - one caesarean section in 1995. abortion (last - 10 years ago) With a height of 1.63 - weight - 84 kg. Overweight. Stress also occurs.
Please tell me if it's related diffuse loss hair with thyroid function?? Or with gynecology? A competent consultation with a gynecologist-endocrinologist is needed. (we don’t have such a specialist in our city; there is either a gynecologist or an endocrinologist). And you need a consultation with a trichologist (which we don’t have either)
How to treat?? ((((
Thank you.

Answers Korop Zlata Anatolevna:

2010-08-12 18:13:44

rsaitbag asks:

Hello! I need your help, because I probably won’t get anything from my doctor...
I am 27 years old, 2007 caesarean section - large fetus. A year ago I had an ultrasound and was diagnosed with signs of uterine fibroids. In July 2010, during a repeat ultrasound:
date of last menstruation 07/08/10
Dimensions: length 54mm, thickness 43mm, width 57mm
the structure of the myometrium is heterogeneous due to diffuse changes, hypoechoic areas with a hypoechoic rim mainly along the posterior wall
myometrial thickness 10mm corresponds to phase 2 of the cycle
the endometrial contour is smooth and clear
the structure of the cervix is ​​changed due to echo-negative inclusions d=3-4mm
left ovary 24x23x35 mm volume 10.5 cm cubic.
structure corpus luteum 14x12mm
right ovary 31x21x27 mm volume 9.0 cm cubic.
structure of calcenates
free liquid is not detected
Conclusion:
Ultrasound signs of diffuse changes in the uterus such as endometriosis, chronic oophoritis, endocervical cysts.
Full diagnosis:
Chronic 2-sided adnexitis, beyond exacerbation. Adhesive disease abdominal cavity.Endometriosis.Cervicosis.
I contacted heavy menstruation(5 days of smearing, 2-3 days of clots, 3-5 days of smearing) on ​​top of everything else with pain in the lower abdomen and lower back and chronic anemia. The doctor prescribed me to donate blood for hormones and undergo a colposcopy, I can’t do this and I I don’t know how, since colposcopy is done 2-3 days before menstruation, but for me it starts a week earlier, then some black discharge appears after menstruation, more than once... after a day or two it can smear again. I just can’t get to a colposcopy, and I’m already tired of such periods. I want at least some kind of treatment to be prescribed. Have you heard about hysteroscopy, in what cases is it prescribed? Is my only method of treatment OK? What should I do and what should I do, because we are planning another child in a year...

Answers Samysko Alena Viktorovna:

Good afternoon. Let me start by saying that ultrasound is additional method examination and does not have the right to make a diagnosis, but only a conclusion. Regarding the fact that colposcopy is done 2-3 days before menstruation, this is complete nonsense. Colposcopy (this is an examination of the cervix under a microscope to look at the epithelium of the vaginal part of the cervix and take an analysis from there for atypical cells (cytology). Maybe colpocytology (this analysis says about hormonal saturation). On what day of the cycle was the ultrasound performed? And whether it was a vaginal sensor. I will ask you to repeat the ultrasound with a vaginal sensor on the 5-7th day of the cycle. And of course, go to see a qualified doctor. and endometriosis are two very different things.

2010-05-06 00:41:22

Anna asks:

If possible, then a question to Valery Dmitrievich Zukin. Hello!
I am 38 years old, height 1-65, weight 55 kg, cesarean section 13 years ago, intramural fibroids since 2004 (from 1.8 to 3.0) (2010) Periods are not heavy, 3-4 days, without disturbances. 2 pregnancies (August 2008, February 2010) occurred in the first month (I never took birth control) but unfortunately turned out to be ectopic. During the last one, both tubes and a small subserous node (1 cm) were removed. There was no treatment after the operation, ovulation in the first cycle was, in the second it was no longer there, and menstruation lasted for 2 days. Ultrasound data: uterus anteflexio-versio, contours of the uterus, size: 55-45-53, myometrium-uniform, endometrium-5.7 riven, (7th day of the cycle) cervix 33-23, the body of the uterus is not formed, the shape is original, at the rear wall there is an interglandular myoma d = 3mm (lmm is probably cm, just a typo, but I’m writing what’s in the papers), the structure of the endometrium is clear, the cervix is ​​one ., cervical canal: single puffs up to 4 mm, right ovaries 23-16-19, ob.-3.7, primary structure, follicle up to 10 mm-5, left-38-19-21, ob-7.9, fol. 10, ovule-uterine index - 1.3, endometriosis sign not found. I would really like to find out, at least in general terms: how tube removal affects a woman’s life (if we ignore IVF), in particular on fibroids and ovaries. Doesn’t menopause come faster, and did removal affect the cycle, two-day periods?? And do I have real chances for IVF in a natural cycle (I’m from Kiev), or instead of natural endless attempts - to be stimulated and not waste time? doctor, and forgive me my hopes!

Answers Petrik Natalia Dmitrievna:

Removal of the fallopian tubes does not affect the onset of menopause or hormonal imbalance. It could have been triggered by stress after undergoing surgery, and a repeat one at that. Taking into account your age, you are recommended to use the most effective methods of reproductive technologies (IVF using a long protocol, with ovulation stimulation). The drug Diferelin, used during long protocol stimulation, is also used for the treatment of uterine leiomyomas (fibroids). As practice shows, leiomyoma most often, if it increases during the stimulation protocol, is not so much as to be considered a complication. A tumor can grow without therapy under the influence of your own hormones.

Article outline

Many women who are planning their pregnancy often face various obstacles in the form of benign tumors of the uterine muscles. If fibroids are detected and pregnancy has already been going on for several months, then there is no need to panic. There are enough examples that a woman learned about the presence of a tumor during pregnancy, but her child was born healthy. For the normal course of this period, it is necessary to know the danger of fibroids for the uterine cavity.

Expectant mothers begin to worry when they hear the diagnosis of uterine fibroids during pregnancy. Is it dangerous to have uterine fibroids when they are discovered while carrying a baby? This question still remains open. But despite this, doctors know how to act when such a diagnosis is discovered.

What is uterine fibroid and why does it occur?

This formation is considered benign; it is a tumor that grows on the muscles of the uterus. Experts have not yet been able to give specific answers as to why this is happening. But there are suggestions that this may be increased hormonal stimulation and increased secretion of estrogen. In other words, the tumor forms due to low levels of progesterone in the body and grows due to an excess balance of estrogen.

But if no hormone imbalance is detected in the blood, this does not mean that a tumor cannot form. The level of estrogen in the uterus may increase slightly and not be reflected in a blood test. In almost all cases, the formation consists of several nodes in various sizes of seals. A tumor of this type is considered common, but it is extremely undesirable for an expectant mother.

Reasons

This disease occurs as a result of hormone imbalance. The amount of estrogen increases, which contributes to rapid cell division and the formation of unwanted nodes. Nodes can grow in different places on the uterus in multiple quantities. If a tumor is detected and treated in time, then it does not pose any danger.

Reasons for the rapid production of estrogen by the ovaries:

• genetics (if women had such a disease, then it is difficult for the next generation of women to avoid it);
• infections that inflame the genitals;
• intentional termination of pregnancy;
• cyst on the ovaries;
• birth control pills;
• excess weight;
• chemotherapy.

Uterine fibroids often cause infertility. But there are cases when pregnancy is still possible. Practice suggests that this disease affects each organism differently. Doctors cannot fully answer why some women give birth when fibroids form in the uterus, while others are unable to conceive a child with this benign multiple formation.

Symptoms

A formation on the uterus is accompanied by the following symptoms:

• the menstrual cycle is very painful;
• women very often feel slight pressure in the lower abdomen;
• abdominal pain intensifies and has a pulling character;
• sexual intercourse often becomes painful for a woman;
• bladder often makes you want to go to the toilet;
• the functioning of the gastrointestinal tract is disrupted;
• belly growth.

To be able to give birth to a baby, you need to contact a specialist for examination at the first sign of these symptoms. He will order an ultrasound to detect fibroids on the muscle layer of the uterus. Ultrasound examination will help to detect tumor formations in time. Also, using this procedure, the doctor will find out:

• the number of nodes that have formed on the uterus;
• condition of myomatous nodes;
• their place of growth;
• exact size of fibroids;
• exact location of lesions;
• structure of tumors.

These characteristics are necessary to determine the answer to the question - whether a woman has the opportunity to give birth to a child. Conception can occur if nothing blocks the entry of sperm into the uterus and does not disrupt the ovulation process. For successful pregnancy the cervix should not be blocked by this tumor formation. As you can see, there is a possibility of pregnancy with this diagnosis.

Diagnostics

At the very beginning of the diagnosis, doctors ask the woman a number of questions. They find out how many times the woman was pregnant and how many times she terminated the pregnancy. Also, specialists need to find out whether there have been uterine surgeries or miscarriages. One of the questions may be about the birth of a non-living child. After clarifying all the nuances, the woman is sent for research, which uses various diagnostic methods.

General clinical examinations and taking tests. Doctors find out the main aspects of this disease. Diabetics and hypertensive patients are examined very carefully, because these diseases have a great impact on the entire treatment process. In addition to general examinations, the woman is referred to a gynecologist.

The gynecologist must clarify through research all the sizes of the formed nodes and changes in the fibroids. Also, the exact location of fibroids. In addition, with the help of an ultrasound machine, a specialist monitors the development of the fetus if a pregnant woman is diagnosed. Ultrasound also determines where the tumors are located.

Treatment

At the very beginning of treatment for a woman who has been diagnosed with a tumor, doctors try to stop further growth of the tumor. All methods of stopping the development of a benign tumor depend on individual characteristics and fibroid structures. Also, the reason why the disease was diagnosed plays an important role. Pregnant women often experience iron deficiency in the body, and this can lead to tumor growth. Therefore, due to this factor, it is necessary to constantly take a blood test during pregnancy.

Prevention

Prevention involves taking iron, ascorbic acid and various vitamins. Proper nutrition, which includes food with a large number squirrel. Carbohydrates should be limited, and you should also stop eating animal fats. Fresh juices, vegetables and fruits have a beneficial effect on disease prevention. After giving birth by cesarean section, a woman may be prescribed a drug with progesterone. Thus, the process of cell division in the uterus is significantly reduced. The tumor does not grow under such conditions.

How fibroids affect pregnancy

It's no secret that such education has negative character during pregnancy. It can cause a miscarriage due to a lack of placenta, because the fetus must be surrounded by the placenta. Due to fibroids, the baby may receive little oxygen and all nutrients. The consequences may also cause heavy bleeding due to placental abruption. The worst thing is that all these processes can happen both in the early stages of pregnancy and in the last months. Therefore, uterine fibroids have a negative effect on pregnancy.

But if uterine fibroids are detected, you should not immediately terminate the pregnancy. After all, this disease and pregnancy are compatible. You just need to constantly be examined by a specialist. There are many examples where women carried healthy child, while the pregnancy period proceeded absolutely calmly. But it’s better not to take risks, because the child may be born with a small weight or a deformed body. Negative influence fibroids in pregnancy cannot be ruled out at all, even despite many successful cases.

After 40 years, pregnancy is more difficult, because at this age hormonal imbalance is very likely. Also, rapid growth fibroids can significantly outpace the capillaries, which causes bleeding. If no disturbances were observed over the course of 12 weeks, this does not mean that after 20 weeks the same result will occur. The first trimester can pass without any symptoms. But complications can appear at any time. There is a high probability that blood circulation will be impaired in the later stages because myomatous nodes grow. Therefore, it is recommended to perform a caesarean section when the pregnancy is 39 weeks.

Nowadays, most women give birth after 30. At this age, hormonal imbalances begin to progress. Therefore, before conception, it is necessary for doctors to discover the location and size of the formation. If they reach 4 cm or 5 cm, then pregnancy is possible. But if the fibroid is 7 cm or 8 cm, then this significantly complicates the process of treatment and pregnancy.

How does the disease manifest itself in pregnant women?

A pregnant woman can have many symptoms. When the baby is pregnant, the tumor can disrupt the placenta and its functions. A woman may have a stomach ache. These pains in the lower abdomen are caused by poor circulation in the nodes. Also, there is an increased blood pressure. Benign tumor can be easily recognized using echo signs of ultrasound examination.

Conception during illness

When a woman plans to conceive a baby, she needs to take into account all the characteristics of the tumor. It is important to know how it is located and where. Also, an important role is played by the size of the nodes and their predisposition to growth. If the uterus is deformed due to formation, then conception is impossible. In this case, it is necessary to remove the nodes. When planning pregnancy, fibroids should be carefully examined.

If the nodes are small and do not affect the uterus, then the likelihood of pregnancy becomes high. But during pregnancy, problems can arise. A woman may not be able to bear a child. Miscarriage or termination of pregnancy is more likely.

Can a doctor remove fibroids during a caesarean section?

Removal of fibroids by a doctor during a cesarean section is possible:

• in case of single education;
• abdominal tumor, which has a stalk;
• if there is structural changes tumors;
• large intermuscular formation.

But it happens that after a cesarean section, it is necessary to completely remove the uterus. This is necessary for women over forty years of age. Also, with necrosis of fibroids and recurrence of tumors. If during a cesarean section it was possible to remove the formation, then the woman can safely plan another conception of a child.

Natural birth or caesarean section

For each woman with a tumor, the choice of childbirth is individual. Natural childbirth can take place in the absence of contraindications. For example, the formation does not grow and will not interfere with the birth process. For such births, only pain medication is used. But often the doctor recommends a cesarean section to his patient. During a caesarean section, the fibroids can be removed by a doctor.

Caesarean section is necessary:

• if the tumor is located low;
• many nodes;
• if there is a scar on the uterus after surgery;
• the blood circulation of the tumor is impaired.

Contraindications

The growth of fibroids while carrying a child can lead to many complications. Development all kinds of pathologies and diseases sometimes have to be stopped through emergency childbirth or termination of pregnancy. Therefore, pregnancy must be taken very seriously. Constant examination by specialists is necessary to avoid unpleasant unexpected situations.

For this disease, gynecological massage is contraindicated. Also, the lower abdomen should not be allowed to warm up in any way. That is, a bathhouse, solarium, sauna, etc. are contraindicated. Do not lift weights over 3 kg and drink a lot of water before bed. The latter can lead to swelling of the uterus.

Postpartum period

It is worth noting that tumors after childbirth may stop growing and developing. The uterus returns to starting position, and accordingly, fibroids and nodes also change. Uterine leiomyoma is found in almost every fifth woman, so the process of bearing a child and the postpartum period can be complicated by various processes.

Multiple uterine fibroids and pregnancy

In the uterus, fibroids often form with many nodes. After removing all the nodes, there may be no healthy tissue left on the uterus, so planning conception and pregnancy may be accompanied by difficulties. But doctors can remove precisely the nodes that interfere with the development of the fetus, which will lead to various complications. Pregnancy with fibroids can proceed smoothly after removal of such nodes. And after the birth, the doctor will remove the remaining nodes that have formed.

Forecast

Pregnancy with a tumor can proceed calmly. But a tumor can reveal itself even on later. This will lead to premature labor or the need for a caesarean section. Also, a miscarriage may occur. Therefore, when planning a pregnancy with this disease, you need to think about all the consequences.

Complications

Why fibroids are dangerous:

• insufficient power supply to nodes;
• neoplasms begin to grow rapidly;
• placental insufficiency;
• vein thrombosis;
• miscarriage;
• anemia.

Myoma during pregnancy threatens miscarriage. The risk is quite high. The percentage reaches the sixty mark. 25% of women give birth prematurely. To prevent the threat, patients take vitamins and special means. Doctors recommend staying in bed and limiting yourself to physical activity to prevent the occurrence of various complications.

Surgery to remove uterine fibroids during pregnancy

The surgical method is used to treat fibroids. Laparoscopy is an operation that is performed necessary tool and a camera for recording video in the abdominal cavity. This operation prevents the formation of adhesions and increases the patency of the tubes, so that a woman can become pregnant. This technique is safer than, for example, laparotomy.

The surgery to remove fibroids, called laparotomy, involves a manual process that may carry the risk of adhesions. This can lead to consequences such as infertility and even intestinal obstruction. But with the first type of operation, if the fibroid nodes are large, it will not be possible to stitch the uterus. This is solely due to the use of specific technology.

Therefore, women undergo laparoscopy and remove fibroids if the nodes are small - no more than six centimeters. An experienced surgeon is able to suture the uterus under such conditions. To sutured the uterus, which had large nodes, there is latest technology, but it also has some nuances. There is a risk that the uterine scar will simply rupture. Removing fibroids during pregnancy is not advisable because there is a risk of miscarriage. Often, fibroids are removed during childbirth during a cesarean section.

But is it necessary to remove fibroids before pregnancy? Yes, because then the pregnancy can proceed in the most normal way, without any intervention. But this is provided that the nodes were small. Also, before planning to conceive, it is necessary to undergo gynecological examination to make sure the scar is in good condition. The age of the pregnant woman also plays an important role in this matter.

Treatment of infertility with fibroids

To cure infertility when a tumor is detected, surgery is necessary. If the size of the fibroids is large, then it can interfere with the process of conception. After its removal, there is a chance to conceive a child. But if the size was large, which led to deformation of the uterus, then perhaps the fibroids will be removed along with the uterus itself. It is necessary to detect the tumor in time so as not to lead to such consequences.

How pregnancy affects fibroids

Doctors cannot guarantee exactly how the formation on the uterus will change during pregnancy. We have not yet found out exactly why the formation decreases during pregnancy, which happens in most cases. But there is a small percentage that the tumor can almost double in size. However, it does not always interfere with pregnancy and childbirth. Perhaps progesterone increases and fibroid development decreases. But scientists cannot fully answer this question.

Uterine fibroids are often found in women of reproductive age. It happens that for the first time you can find out about it only with an ultrasound during pregnancy or after childbirth. This can affect the growth and development of the baby, and also put the woman’s life at risk. How does fibroid behave during pregnancy and after childbirth, does it grow or shrink? What to do and when can you get pregnant if you have fibromatous nodes?

Read in this article

Why do uterine fibroids appear after childbirth?

Uterine fibroids are a multifactorial disease. And hormonal disorders play a significant role in the formation of nodes. It is reliably known that, once fibroids appear, they begin to respond inadequately to changes in the concentration of sex hormones. This causes changes in the size of the nodes, including during pregnancy and after childbirth. Thus, the concentration of the following hormones in a woman’s blood is important:

• Estrogens. During pregnancy, their number increases, especially in the first and third trimesters. Estrogens are responsible for hyperplasia muscle fibers And connective tissue, which leads to the growth of fibromatous nodes. During lactation their levels drop.
• Concentrations of LH and FSH (luteinizing and follicle-stimulating hormones). During pregnancy and after childbirth, their formation decreases. Similar effect give oral contraceptives. This leads to some reduction in nodes.
• The balance between estrogens and gestagens is important, the violation of which also leads to the growth of nodes.
• Gestagens. Their high concentrations during pregnancy (and this is necessary for pregnancy) contribute to the degeneration of nodes (reduction in size).

During pregnancy and then during lactation, constant changes concentrations of certain hormones, which are necessary for the normal growth and development of the baby, changes in the size of the uterus itself. This cannot but affect the growth of fibromatous nodes.

Uterine fibroids can be diagnosed for the first time in a woman during pregnancy and childbirth for the following reasons:

• If formerly a woman I have never had a pelvic examination. Perhaps she had knots for a long time. And during pregnancy and after childbirth, they grow, and when examining the baby, a tumor is detected.
• Sometimes a woman learns that she has fibroids only during a cesarean section and a visual examination of the uterine body. As a rule, small (up to 2 - 3 cm) nodes with subserous growth are detected.

How does fibroid behave?

It is extremely difficult to predict what will happen to the node during pregnancy and after childbirth. Often fibroids either decrease or increase in different trimesters. This depends on many factors, namely:

• From where the node is located - on the surface of the uterus or in the thickness of the myometrium, at the fundus, isthmus, on the side wall, between ligaments, etc. This determines the blood supply, which affects growth.
• What is the initial size of fibroids? Small nodes are less susceptible to change than large ones. The latter can increase two or more times.
• From hormonal levels women.
• Was the pregnancy natural or IVF? In the latter case, serious hormonal support occurs, which does not go unnoticed for the nodes.

During pregnancy

Under the influence of all factors, in 2/3 of cases, the size of fibromatous nodes decreases by approximately 20 - 30% during pregnancy. In the remaining third of women, fibroids increase in size, often doubling or even more.

But this is the general picture that can be obtained if you measure the nodes at the beginning and then at the end of pregnancy. In fact, there are fluctuations in the diameter of formations by trimester.

The general trends are as follows:

• In the first trimester, fibroids grow due to the action of estrogen.
• In the second, the pace decreases and even regression of formations occurs.
• In the third, the estrogen content increases again, and the fibroid grows.

Watch the video about uterine fibroids and the reasons for their development:

In the early postpartum period

In the early postpartum period You can observe a slight increase in the size of the fibroids. This may be a consequence of swelling of the nodes during myometrial contraction. Sometimes these processes are so pronounced that necrosis of the fibroid is observed - a condition requiring immediate surgical treatment.

As the uterus contracts, the nodes also become smaller, but more often they remain somewhat larger than before pregnancy.

Uterine fibroids in the early postpartum period can cause another dangerous condition - bleeding. It occurs when myometrial contraction is impaired. Sometimes you even have to resort to removing the uterus in order to save a woman’s life.

In the late postpartum period

The size of fibroids in the late postpartum period largely depends on whether the woman is breastfeeding. The fact is that during lactation the production of LH and FSH is inhibited, which directly affects the nodes.

As a result, women who have fibroids of any size are advised to continue breast-feeding. This is beneficial for both her and the baby.

In women with fibroids, late postpartum period often complicated by the following conditions:

• slowing down the involution of the uterus;
• risk increases inflammatory processes genitals.

Can fibroids go away or resolve after childbirth?

Many women wonder whether uterine fibroids can go away on their own after childbirth. It is impossible to answer unequivocally. It all depends on the size of the nodes, their location, how old the woman is and some other parameters. Small nodes, up to 2-3 cm, may disappear completely. Large formations either remain the same size or increase slightly.

Is fibroid dangerous if discovered after childbirth?

Myoma – benign disease. And only in the case of rapid growth of nodes, a malignant process - sarcoma - cannot be excluded. But such a tumor is extremely rare. Therefore, if fibroids are detected after childbirth, you should not worry too much. The recommendations in this case will be as follows:

• If the tumor size is up to 3 cm, prolonged breastfeeding and observation are indicated. ultrasound examination once a year.
• In cases where the fibroid is more than 3 cm, dynamic observation (ultrasound after 6 months and then annually), lactation and hormonal contraception in the future.
• If the fibroid is large (compared to the size of the uterus during pregnancy), more than 12 weeks, you should consider removing the node. But in each case the approach will be individual.

Treatment of fibroids after childbirth with drugs and OK

Treatment of uterine fibroids after childbirth can be either conservative or surgical. The following parameters are taken into account when choosing a method:

• woman's age;
• number of births;
• sizes of nodes and their location;
• availability concomitant diseases and some others.

There is no effective conservative treatment for uterine fibroids. The most effective are hormonal contraceptives, which can reduce the rate of growth of nodes and also prevent the appearance of new ones.

Used as regular oral contraceptives, vaginal rings, dermal patches, hormonal IUDs, injectable forms, etc. The choice depends on the goals pursued and the clinical situation.

Purpose shown hormonal drugs in the following cases:

• For small fibroids to reduce the rate of their growth.
• With a combination of fibroids and other gynecological pathology(for example, endometriosis, mastopathy, etc.).
• If the goal of contraception is also pursued.
• In order to slightly reduce the size of large nodes for subsequent surgical removal. This way you can reduce the volume of the operation and reduce the likelihood of complications.

Removal of fibroids after childbirth

In the case of fibroids, we can talk about either removing the nodes or the entire uterus. IN lately Organ-preserving techniques are increasingly being used. This issue is especially relevant for women who have not given birth or are planning a second pregnancy.

Removal of the uterus

Removal of the uterus (amputation or extirpation) is carried out if there is a concomitant pathology of the cavity - endometrial hyperplasia, etc. Especially conditions that are difficult to treat conservatively. The issue of removing appendages is resolved intraoperatively. If they are not visually changed, they are left.

Removing individual nodes

Individual nodes are removed in the following situations:

• upon detection subserous fibroids different sizes;
• in women planning pregnancy at some point;
• Recently, it is increasingly possible to encounter the fact that myomectomy is performed as a stage of preparation for spontaneous or artificial conception;
• with single large nodes without concomitant gynecological pathology.

But on an individual basis, organ-preserving surgery can be performed even in the most seemingly hopeless case.

Types of surgical interventions

Removal of uterine fibroids can be done in the following ways:

• Using hysteroscopic techniques. Used for small submucous tumors.
• Laparoscopic technologies are the choice today in many situations. Such operations are less traumatic, are not accompanied by massive blood loss, and have less rehabilitation period subsequently. But not always and not all nodes can be deleted using this method. For example, it is technically impossible to perform such an operation for large fibroids, more than 16 - 20 weeks.
• Classic laparotomy interventions, which are carried out according to all the principles of surgery. The most commonly used Pfannenstiel incision is a horizontal one along the pubic hairline. Less often - lower middle, from the navel down along the white line of the abdomen. These operations should be preferred if a woman is preparing for pregnancy or planning one in the future.

The fact is that only in this way can the most durable and deep seams be applied. This is important, since during pregnancy the uterus grows and a rupture along the scar may occur with intra-abdominal bleeding. It is reliably known that after laparotomy operations this practically does not occur, in contrast to laparoscopic ones.

Can it be removed during pregnancy?

There are various tactics for managing pregnant women with uterine fibroids. Indeed, sometimes nodes can lead to impaired growth and development of the fetus, the threat of premature birth, miscarriage, etc.

Removing fibroids during pregnancy is a risky procedure that can cause miscarriage, developmental arrest and other pathologies. Optimal timing carrying out such operations - 16 - 18 weeks. At this time, the formation of the baby’s main structures has already occurred, so all the methods used will cause minimal damage possible harm to him.

Removal of fibroids during pregnancy is carried out in the following situations:

• If the node is located intraligamentally - between the broad ligaments of the uterus. This anatomy will lead, with increasing pregnancy, to compression of all nearby structures (vessels, nerve endings, ureters, etc.). Also, the large size of the tumor will not allow the uterus to fully grow in this direction. All this is dangerous for both the life of the woman and the baby.
• For large nodes, especially with subserous growth.

In order to continue pregnancy during all such operations the day before and long time Afterwards, maintenance therapy is carried out.

How will childbirth go after removal?

Most often, after removal of myomatous nodes, a woman’s subsequent birth is carried out by cesarean section with the following purposes:

• This way you can protect expectant mother and the baby from during labor.
• Also often during a cesarean section, additional removal of newly formed nodes is performed. After all, fibroids are a complex disease; removing one or several tumors does not solve the problem - others gradually begin to grow. From this position, caesarean section - best option delivery.

But if small nodes (up to 3 cm) were removed without opening the uterine cavity, the postoperative period proceeded without complications, natural childbirth can be performed. Risk adverse consequences in these situations is minimal.

Uterine fibroids are common among women. But this is not a death sentence of infertility or a malignant tumor. Modern medicine allows you to control the growth of such nodes and, if necessary, remove them, preserving the uterus. This gives the woman the opportunity to have children in the future and also protects her from other complications. In each case, the treatment and choice of surgical technique is individual.

Catad_tema Pathology of pregnancy - articles

Obstetric tactics in the management of pregnant women with uterine fibroids

The article is devoted to obstetric tactics in the management of pregnant women with uterine fibroids. 153 pregnant women with uterine tumors were examined. At 16-18 weeks of gestation, 25 pregnant women underwent myomectomy. After the operation, the pregnancy in 15 women was prolonged to full term and a caesarean section was performed. In 48 pregnant women, abdominal delivery was performed when uterine fibroids were combined with obstetric or extragenital pathology. 80 patients were delivered vaginally birth canal also if they have a uterine tumor. Outcomes from both operative and spontaneous births were favorable for both mothers and their newborns. L.S. Logutova, S.N. Buyanova, I.I. Levashova, T.N. Senchakova, S.V. Novikova, T.N. Gorbunova, K.N. Akhvlediani
Moscow regional research institute Obstetrics and Gynecology of the Ministry of Health of Russia (Director of the Institute - Corresponding Member of the Russian Academy of Medical Sciences, Prof. V.I. Krasnopolsky).

In recent years, obstetricians have increasingly had to decide on the possibility of prolonging pregnancy when it is combined with uterine fibroids. This is due to the fact that the number of women of fertile age suffering from uterine tumors is increasing from year to year. The course of pregnancy, obstetric tactics, as well as methods of delivery have their own characteristics. Features of the course of pregnancy when combined with uterine fibroids include the threat of miscarriage different terms gestation, fetoplacental insufficiency (FPI) and fetal growth restriction syndrome (FGR), rapid tumor growth, malnutrition and necrosis of the myomatous node, placental abruption, especially in cases where it is partially located in the area of ​​the myomatous node, incorrect positions and fetal presentation. Childbirth in pregnant women with uterine fibroids also occurs with complications (untimely rupture of water, abnormalities of uterine contractility, fetal distress, tight attachment of the placenta, hypotonic bleeding, subinvolution of the uterus in the postpartum period, etc.).

Complicated course of pregnancy and childbirth determines high frequency surgical interventions and obstetric care in pregnant women with uterine tumors. C-section in the presence of uterine fibroids, as a rule, ends with an expansion of volume surgical intervention(myomectomy, hysterectomy). Complicated course of pregnancy and childbirth requires strict differentiated approach for the management of pregnant women with uterine fibroids and determines individual obstetric tactics in each specific case. First of all, this concerns resolving questions about the need, possibility and conditions of myomectomy during gestation. Indications for this operation may arise in situations where prolongation of pregnancy is practically impossible (cervical-isthmus or intraligamentary location of the myomatous node, centripetal growth of interstitial fibroids, large sizes of subserous-interstitial tumors). Pregnancy in these women, as a rule, proceeds with a pronounced threat of miscarriage, but when a miscarriage begins, curettage of the walls of the uterine cavity is sometimes technically impossible (cervical-isthmus location of the node). Gynecologists have to resort to radical operations(removal of the uterus along with the fertilized egg), which is a great tragedy for women who do not have children. At the same time, in many women, with a small tumor size and no signs of malnutrition of the nodes, pregnancy proceeds favorably and, as a rule, ends in spontaneous birth.

We observed 153 pregnant women with uterine fibroids. In 80 women, pregnancy ended with spontaneous birth, 63 had a cesarean section, 10 women continue to be monitored for pregnancy (they underwent myomectomy at 15-18 weeks of pregnancy). Another 15 patients underwent surgical treatment during gestation; their pregnancies had already ended with surgical birth. Thus, 25 women underwent myomectomy during pregnancy.

All pregnant women at various stages of gestation were observed in the scientific advisory department and the department of pathology of pregnant women of MONIIAG, 143 pregnant women gave birth at the institute. There were 33 (23.1%) women aged from 20 to 29 years, 89 (62.2%) from 30 to 39 years old, and 21 (14.7%) pregnant women were over 40 years old. Thus, the age of 76.9% of women exceeded 30 years, 80 (55.9%) pregnant women were about to give birth for the first time. In 128 patients, uterine fibroids were detected before pregnancy and only in 25 - in early dates gestation. In addition to uterine fibroids, 15 (10.4%) patients suffered from adenomyosis, 23 (16.0%) had infertility, and 19 (13.3%) had ovarian dysfunction. Of the extragenital diseases, 13 (9.1%) pregnant women had myopia, 17 (11.9%) had hypertension, 11 (7.7%) had an enlarged thyroid gland, and two had mitral valve prolapse.

When examining pregnant women with uterine fibroids, attention was paid to the following features: localization of myomatous nodes, their structure, location of the placenta, tone and excitability of the myometrium. In 6 pregnant women, at the first examination, isthmus uterine fibroids were discovered, but the size of the tumor was small and did not interfere with the development of pregnancy. In 12 women, the nodes were subserous-interstitial (from 8 to 15 cm in diameter), located in the fundus or in the body of the uterus, nutritional disturbances in the nodes were not noted, and the pregnancy was also prolonged to full term. In 106 patients, uterine fibroids were multiple, myomatous nodes were small in size, predominantly subserous-intrastial. In 4 pregnant women, centripetal growth of fibroids was detected, but the fertilized egg was implanted on the opposite wall of the uterus, and the pregnancy was also able to be prolonged until the period at which the fetus became viable.

And finally, in 25 patients at 7-14 weeks of gestation, giant tumors were found, located intraligamentously, preventing the development of pregnancy, with symptoms of compression of the pelvic organs. These pregnant women underwent conservative myomectomy at 16-18 weeks. 3-5 days before the operation, “conservation therapy” was carried out, including tocolytic drugs, which were prescribed to all pregnant women with symptoms of threatened miscarriage and with preventive purpose. Tocolytics - partusisten, bricanil, ginipral - were used either per os, 1/2 tablet 4-6 times a day together with verapamil, or intravenously at a dose of 0.5 mg of a tocolytic drug with 40 mg of verapamil in 400 ml of isotonic sodium chloride solution. The most favorable results were obtained when alternating intravenous administration partusistene with a solution of magnesium sulfate (30.0 g of magnesium sulfate diluted in 200 ml of isotonic sodium chloride solution). At the end infusion therapy used drugs such as baralgin or spazgan in a dose of 5 ml intravenously. They are anti-prostaglandin agents and normalize the tone of the uterus. In addition, the complex of therapy aimed at prolonging pregnancy included drugs such as Magne-B6; vitamin E, spazgan 1 tablet per day.

Considering the adverse effect of uterine fibroids on the state of fetoplacental blood flow, especially when the placenta is localized in the area of ​​the myomatous node, therapy was carried out aimed at its improvement (chirantil 25 mg or trental 300 mg 3 times a day), as well as the prevention of intrauterine fetal hypoxia (sigetin, cocarboxylase , ascorbic acid).

We considered the optimal time for conservative myomectomy to be 16-19 weeks of pregnancy, when the concentration of progesterone produced by the placenta increases approximately 2 times. The latter is considered a “protector” of pregnancy. Under the influence of progesterone, the contractile activity of the uterus decreases, the tone and excitability of the myometrium decreases, the extensibility of muscle structures increases, and the obturator function of the internal pharynx increases. Deadline possible holding operations during pregnancy - 22 weeks, since in the event of premature labor a very premature newborn is born.

The surgical tactics of conservative myomectomy during pregnancy differ significantly from those performed outside of pregnancy. This is due to the need to carry out the operation in compliance following conditions: 1) minimal trauma to the fetus and blood loss; 2) selection of a rational incision on the uterus, taking into account subsequent abdominal delivery: 3) suture material with sufficient strength, minimal allergenicity, and capable of forming a full-fledged scar on the uterus. Features of surgical interventions during pregnancy were as follows.

1. The operation was performed under endotracheal anesthesia or epidural anesthesia. This type of anesthesia, from our point of view, is the most preferable, as it allows for maximum relaxation and minimal impact on the fetus.

2. To create the most gentle conditions for the pregnant uterus and fetus, as well as optimal access to atypically located fibroid nodes, lower median laparotomy was used. In this case, the body of the uterus with the fetus located in it was not fixed, but was freely located in the abdominal cavity. Given the pronounced vascular network with well-developed collaterals, in order to avoid additional blood loss, fibroid nodes were captured with gauze swabs moistened with warm isotonic sodium chloride solution, without the use of clamps such as Museau and “corkscrew”.

3. If the myomatous node is located cervically on the anterior wall of the uterus, the peritoneum was opened in the transverse direction between the round ligaments, and the bladder was bluntly relegated to the womb. Then, the capsule of the node was dissected with a longitudinal incision along the midline. The myomatous node was isolated by sharp and blunt methods with simultaneous ligation of all vessels located in the myometrium. Careful hemostasis was performed, taking into account the severity of the blood supply to the nodes during pregnancy.

4. If the node is located intraligamentously, the round ligament of the uterus was transected above the node. In a number of cases, with large tumor sizes and its intraligamentary location, there was a need to intersect own ligament ovary and tube, vascular bundle (in those cases when the listed formations are located on top of the node). Partly stupid, partly sharp way the node was peeled out. The bed of the latter was sutured with interrupted vicryl sutures in two rows. Careful hemostasis and peritonization of the parametrium were performed.

5. If the node is located subserosally-interstitially, the incision was made longitudinally, bypassing the vessels dilated during pregnancy, reducing trauma to the uterus.

6. An important point surgical tactics during pregnancy, which we want to address special attention, it is advisable to remove only large nodes (from 5 cm in diameter or more) that prevent the bearing of a real pregnancy. Removal of all nodes (smaller ones) creates unfavorable conditions for the blood supply to the myometrium, wound healing on the uterus and fetal development.

7. We assigned an important place in the outcome of the operation and pregnancy to the suture material and the technique of suturing the uterus. The main suture material used for surgical interventions during pregnancy was vicryl N 0 and 1. Sutures were applied to the uterus in one or two rows. Only interrupted sutures were applied, since in this case the closure of the wounds was considered more reliable. The distance between the sutures and each other was 1-1.5 cm. Thus, the tissues were kept in a state of reposition, and ischemia of the sutured and adjacent areas did not occur.

Postoperative management of pregnant women who underwent conservative myomectomy had its own specific features, due to the need to create favorable conditions tissue repair, prevention of purulent-septic complications, adequate intestinal functioning. At the same time, a complex of therapeutic measures aimed at developing pregnancy and improving uteroplacental blood flow was continued. After surgical intervention intensive infusion therapy was carried out for 2-3 days, including protein, crystalloid drugs and agents that improve microcirculation and tissue regeneration (reopolyglucin in combination with trental and chimes, native plasma, 5-20% glucose solutions, actovegin or solcoseryl). The question of the duration of infusion therapy was decided individually in each specific case and depended on the volume of surgery and blood loss. In order to prevent purulent-septic complications, a course of antibiotic prophylaxis was prescribed (preferably synthetic penicillins or cephalosporins). Bowel stimulants (cerucal, oral magnesium sulfate) were used with caution.

Depending on the severity clinical signs threats of termination of pregnancy continued from the first hours after surgery therapy aimed at maintaining pregnancy (tocolytics, antispasmodics, magnesium sulfate according to generally accepted regimens). Oral medication was prescribed until 36 weeks of gestation with a gradual dose reduction. Taking into account hyperestrogenism in pregnant women with uterine fibroids, progestin drugs (turinal) were used together with minimal doses of glucocorticoids or duphaston until 24-25 weeks of pregnancy. On days 12-14 after surgery, pregnant women with progressive pregnancy were discharged for outpatient treatment.

At 36-37 weeks of gestation, 15 pregnant women were hospitalized at the institute for delivery. In case of full-term pregnancy, a caesarean section was performed. Newborns with a high score on the Algar scale (8 and 9 points) weighing 2800-3750 g were extracted. Anterior incision abdominal wall was lower-median with excision of the skin scar. When opening the abdominal cavity, only three women had minor adhesive process in the abdominal cavity. Scars on the uterus after myomectomy were practically not visualized. The duration of cesarean section was 65-90 minutes; blood loss during surgery is 650-900 ml. Pregnancies combined with uterine fibroids in another 48 patients were completed by caesarean section. The localization of the tumor was different: small subserous-interstitial nodes (less than 10 cm in diameter) were located in the body of the uterus or the lower segment: large subserous-interstitial nodes were located mainly in the fundus of the uterus, as well as in its body, but at a considerable distance from lower segment. In neither case did the presence of a tumor prevent the prolongation of pregnancy and the need for surgical treatment there was no birth before the due date. The gestational age before delivery was 37-39 weeks. In only one case, in an elderly primigravida with a history of long-term infertility, with FPN due to the localization of the placenta in the area of ​​a large interstitial myomatous node (15 cm in diameter), a cesarean section was performed at 34-35 weeks of pregnancy. A newborn weighing 1750 g was extracted with an Algar score of 5 and 7 points at 1 and 5 minutes, respectively.

In 32 (66.7%) pregnant women, cesarean section was planned. Indications for surgery in 6 women were the isthmus location of the myomatous node, which prevented the advancement of the fetal head along the birth canal; in 2 - rapid tumor growth at the end of pregnancy with signs of malnutrition; In 24 pregnant women, indications for cesarean section were combined: breech presentation fetus, advanced age of the first-time mother, a history of long-term infertility, unpreparedness of the body for childbirth, FPN, high myopia, etc. In 16 (33.3%) women in labor, a cesarean section was performed during childbirth, mainly due to anomalies labor activity(13 women) and fetal hypoxia (3 women in labor). In 30 women giving birth, the scope of the operation was expanded: 24 women underwent myomectomy, 5 had supravaginal amputation, and one had hysterectomy. Extracted to satisfactory condition 34 (70.8%) children (state assessment on the Algar scale - 8 and 9 points at the 1st and 5th minutes, respectively), 13 (27.1%) - in a state of hypoxia mild degree and only one child with hypoxia medium degree gravity. The weight of the newborns was 2670-4090 g. Current postoperative period In 45 women it was uncomplicated, in two with myomectomy during cesarean section uterine subinvolution was noted and in one there was a wound infection.

Pregnancy in combination with uterine fibroids in 80 women ended in spontaneous birth. Myomatous nodes, as a rule, were small in size and located in the body of the uterus, without interfering with the spontaneous birth of the fetus. In this group, 28 (35%) pregnant women were elderly primiparas: 13 suffered hypertension, 10 were found to have an enlarged thyroid gland, and 9 had myopia. In all pregnant women, at 37-38 weeks of gestation, preparation for childbirth began with antispasmodic, sedatives; 6 women were prepared with intravenous drip administration of enza-prost. Childbirth in 34 (42.5%) women was complicated by premature rupture of water, in 4 (5%) - bleeding in the placenta and early postpartum periods. The average duration of labor was 10,425 minutes +/- 1 hour 7 minutes, the anhydrous interval was 15 hours 12 minutes +/- 1 hour 34 minutes. 56 (70%) children were born in satisfactory condition, 22 (27.5%) in mild condition hypoxia and two newborns with moderate hypoxia. The weight of newborns ranged from 2050 to 4040 g. In four, the weight exceeded 4000 g. In all postpartum women, the course of the postpartum period was uncomplicated. 78 (97.5%) newborns were discharged home on days 5-7 in satisfactory condition, two children were transferred to staged nursing and then also discharged.

Thus, the increasing incidence of uterine fibroids in women of fertile age increasingly raises the question of obstetricians and gynecologists about the possibility of prolonging pregnancy with this pathology. Conservative myomectomy, especially for women with the last and often only opportunity to have a child, is a method that makes it possible to realize this opportunity.

LITERATURE

1, Ivanova N.V., Bugerenko A.E., Aziev O.V., Shtyrov S.V. // Vestn. Ross. accots, obstetrics-gin. 1996. N 4. P. 58-59.
2. Smitsky GA. // News. Ross. assoc. obstetrics-gin. 1997. N3. pp. 84-86.

Childbirth with uterine fibroids poses a threat to the life of the expectant mother and her unborn child. Therefore, doctors carefully study all possible indications. The decision that a cesarean section will be performed for uterine fibroids is made collectively or individually by a gynecologist, depending on the current circumstances. In most cases, fibroids and cesarean sections are inextricably linked, since a woman with a tumor gives birth naturally can't. Natural childbirth with fibroids is allowed only if complete absence any contraindications. You can read about how decisions are made and what parameters of the health of the mother and unborn child doctors pay attention to on this page. Describes all the indications for the use of cesarean section for fibroids as the main or the only way woman's permission from pregnancy.

Is natural childbirth possible with large fibroids?

Pregnant women with uterine fibroids should be hospitalized at 37-38 weeks for examination, preparation for childbirth and selection of a rational method of delivery. But whether safe natural childbirth is possible with fibroids, we will consider further in the article.

Due to the fact that the presence of myomatous nodes on the posterior wall of the uterus and their centripetal growth may not be recognized in a timely manner, surgical delivery is not excluded in every patient with this pathology.

Features of managing labor with large fibroids through the natural birth canal in patients with uterine fibroids who have low risk, are the following provisions:

1. Use of drugs antispasmodic action during the active phase of the first stage of labor (opening of the uterine pharynx by 5-8 cm).
2. Limit the use of labor stimulation with oxytocin. If it is necessary to enhance labor, it is advisable to prescribe prostaglandin drugs, which have an optimal effect on the myomatous uterus and do not disrupt the microcirculation of the myometrium and the hemostatic system.
3. Prophylaxis of fetal hypoxia during childbirth.
4. Prevention of bleeding during labor and the early postpartum period using a strongly contracting agent for the uterus. It is administered simultaneously intravenously immediately after the birth of the fetal head.

Indications for caesarean section for uterine fibroids

Caesarean section for uterine fibroids to prevent pregnancy is used in most cases with a preliminary diagnosis of the tumor. Indications for cesarean section for fibroids in a planned manner are:

• Low-lying myomatous nodes (cervix, isthmus, lower segment of the uterus), which can be an obstacle to the dilation of the cervix and the advancement of the fetal head.
• The presence of multiple intermuscular nodes or large fibroids (diameter 10 cm or more).
• A scar on the uterus after myomectomy, the consistency of which is difficult to assess. This is due to the fact that, firstly, a whole conglomerate of nodes is often removed, and secondly, diathermocoagulation is used for hemostasis. This is especially true for myomectomy using laparoscopic access. All these features are rarely reflected in the discharge summary after myomectomy.
• Malnutrition leading to secondary changes in tumor nodes, which after vaginal delivery can undergo necrotic changes. At the same time, necrotic inflammatory and dystrophic changes spread to unchanged areas of the uterus (metritis).
• Breech presentation of the fetus, which may be a consequence of a myomatous node with centripetal growth.
• Suspicion of malignancy or necrosis of fibroids (rapid growth, large size, soft consistency, local pain, anemia).
• The combination of uterine fibroids with other diseases and complications of pregnancy that worsen the prognosis for the mother and fetus (ovarian tumor, endometriosis, late age women, data indicating a proliferating variant of the fibroid morphotype, placental insufficiency).
• Multiple uterine fibroids with different locations of myomatous nodes in women of late reproductive age (39-40 years or more).
• Necrosis of the interstitial (intermuscular) node.
• Relapse (further growth of myomatous nodes) after a previously performed myomectomy (most often this is a variant of the active growth of this muscular fibrous tumor).
• The location of myomatous nodes in the area of ​​vascular bundles, the lower segment of the uterus, interligamentous localization, centripetal growth and submucosal nodes.

These are the main indications for cesarean section for fibroids and the need for a planned abortion of a woman from a full-term pregnancy. With low location of fibroids emanating from the lower segment, isthmus, cervix, with malignancy (established during urgent histological examination) hysterectomy is necessary.

In the postpartum period, patients with uterine fibroids should be prescribed antispasmodic drugs. If there are signs of decreased contractility of the uterus, uterine contracting agents are injected into the muscle.

After myomectomy and complicated cesarean section, antibiotics are used wide range actions. Combinations of drugs that have an effect on aerobic and anaerobic microorganisms are used.

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