While patients with myoma may get pregnant and have natural deliveries, several studies have suggested that the size and location of the myoma within the uterus may weaken fertility and cause pregnancy complications that may arise due to fibroid growth in the uterus (ref. 2, 3).
Uterine fibroids may lead to some complications during pregnancy including:• Bleeding during the first trimester (ref. 2).
• Placenta Displacement (ref. 2) - Increased estrogen may cause accelerated fibroid growth. If the fibroid grows during pregnancy then there is a risk that it will move or tear the placenta.
• Caesarian Section (ref. 4) - Multiple fibroids located in the lower part of the uterus may block the birth canal. In this case a caesarian birth is necessary.
• Premature Labor (ref. 4) - A pregnant woman with uterine fibroids is at greater risk of premature delivery, depending on the location and shape of the fibroid(s).
• Miscarriages (ref. 2) - Fibroids may act as an obstruction in the uterus which prevents the embryo from developing and ultimately causes a miscarriage.
Treatment for myoma during pregnancy
Generally, myomas are not removed during pregnancy due to the increased risk of hemorrhage. It is possible that between weeks 12-22 the blood supply to the fibroid may stop causing it to turn red and die, this is called “Red Degeneration” (ref. 4).
When this occurs it causes intense abdominal pains and contractions which may lead to premature labor or even miscarriage.
In spite of the various complications, many patients with myoma, who do get pregnant, have normal pregnancies and successful deliveries (ref. 4).
Pregnancy and myoma treatment – ExAblate*
The Royal Women's Hospital in Australia reported that that their staff had successfully treated about 110 women with Exablate, including several who have gone on to fall pregnant and deliver healthy babies (ref. 5).
To date, there have been over 80 pregnancies with 45 deliveries with no treatment related adverse effects.*.
* Following European CE mark change, women planning future pregnancies should consult with their physicians before seeking treatment with the magnetic resonance-guided focused ultrasound surgery (MRgFUS) system.
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Studies: Pregnancy following focused ultrasound surgery
1. Morita Y, Ito N, Ohashi H.Pregnancy following MR-guided focused ultrasound surgery for a uterine fibroid. Int J Gynaecol Obstet. 2007
2. Hanstede MF, Tempany MC, Stewart EA. Focused Ultrasound Surgery of Intramural Leiomyomas May Facilitate Fertility: A Case Report, Fertility & Sterility, 2007.
3. Gavrilova-Jordan LP, Rose CH, Traynor KD, Brost BC, Gostout BS. Successful Term Pregnancy Following MR-guided Focused Ultrasound Treatment of Uterine Leiomyoma, Journal of Perinatology, 2007, 27:59-61.
4. Rabinovici J, Inbar Y, Eylon-Cohen S, Schiff E, Hananel A, Freundlich D Pregnancy and live Birth after Focused Ultrasound Surgery for Symptomatic Focal Adenomyosis: A Case Report, Human Reproduction, 2006, pp. 1-5.
1. Walker CL, Stewart EA. Uterine fibroids: the elephant in the room, Science, 2005, 308:1589-92.
2. Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor and delivery with uterine leiomyomas: a population based study, Obstet Gynecol., 2000, 95:764-9.
3. Yoon SW, Kim KH, Kim SH, Ha DH, Lee C, Lee SY, Jung SG, Kim SJ. Pregnancy and natural delivery following magnetic resonance imaging-guided focused ultrasound surgery of uterine myomas, Yonsei Med J, 2010, 51(3):451-453.
4. Hasan F, Arumugam K, Sivanesaratnam V. Uterine Leiomyomata in pregnancy, Int. J Gynecol Obstet, 1990, 34:45-48.
5. Revolutionary uterine fibroid treatment breeds new life