Fibroids and Pregnancy

  • 28 Aug 2020
  • 4 mins read

Fibroids are tumors that grow from muscle tissue in the uterus. Women with fibroids do go on to have normal pregnancies, though in some cases, it can cause challenges. We learn more from our Obstetrician and Gynecologist, Prof. Fong Yoke Fai, how fibroids can affect pregnancy and how it can be treated with high intensity focused ultrasound (HIFU).

Fibroids, also known as myoma or leiomyoma, is the growth of muscle tissue within the uterus.

“These non-cancerous growths may be present in up to 30 percent of women, and one in three women experience symptoms such as heavy, or painful periods, abdominal or lower back pain, frequent urination, or a mass in the abdomen,” said Prof. Fong.

Subserosal, submucosal, and intramural are the three main types of fibroids. They can be outside the uterus wall, in the womb cavity or within the uterus wall. Fibroids also vary in number and size, and they tend to enlarge rapidly during pregnancy. In pregnancy, fibroids can be associated with various complications. These include:

  • Miscarriage
  • Preterm labour
  • Pain in pregnancy due to red degeneration
  • Placenta problems
  • Breech presentation
  • Obstructed labour

No effect on Fertility and Pregnancy 

It is a misconception that all fibroids lead to infertility.  There are multiple pregnancies where fibroids may not cause a problem at all. In that case, fibroids may be left as it is. Whether any complication may arise can be screened with the use of imaging tests such as ultrasound scans or MRIs. If a problem is anticipated, then the removal of fibroid is advised. 

However, it is essential to note that fibroids may reoccur as their reoccurrence rate is 30 to 40 percent. “Predisposing factors include age, race, the number of times the woman has given birth, and the number of fibroids removed. Generally, fibroids are hormonal dependent and there should not be any further growth after a woman reaches menopause,” Prof. Fong added.

Treating Fibroids

In Singapore, up till last year, fibroids were mainly treated with a surgical approach; however, with the introduction of HIFU, a non-invasive treatment option is made available. HIFU is a gentle, non-surgical approach that uses ultrasound waves to treat fibroids. A benefit of HIFU is that it does not require any incision and hence does not leave a scar. 

It is a day surgery procedure and typically takes around one to two hours. Mild sedation is provided. The patient will lie on the ultrasound probe of the HIFU machine; ultrasound waves are focused on the fibroid to be treated. The doctor is seated at the control panel visualizing the MRI scans of the patient's womb.  This allows the doctor to maneuver the focal point of the ultrasound probe in response to how the targeted area of fibroid or adenomyosis responds to the HIFU treatment.

Considerations for Treatment

HIFU is particularly recommended for younger women, especially those who are planning for pregnancy in the future. This procedure might be selected depending upon the size, number and location of fibroids. 

Instead of normal delivery, is it advisable to elect for Caesarean delivery so that the fibroid can be removed at the same time? “The standard answer is no because the risk for bleeding is greatly increased due to the increase in blood supply and engorged blood vessels in the pregnant uterus,” Prof. Fong explained. 

However, there is an exception. “If the fibroid is pedunculated, which means it is attached to the uterus by a thin stalk of tissue, or causing obstruction, exceptions might be made,” he added. 

Treating symptomatic or problematic uterine fibroids before pregnancy has its benefits. Do talk to a Gynecologist to understand the options available for you.

To learn more, send us an enquiry here.

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Contributed by

Prof. Fong Yoke Fai
Obstetrician and Gynecologist
Farrer Park Hospital