FIBROIDS ON PREGNANCY
FIBROIDS ON PREGNANCY

EFFECT OF FIBROIDS ON PREGNANCY
•Preterm labour
•malpresentation
•fibroids may cause infertility
•posterior wall fibroid may cause incarceration of a retroverted gravid uterus
•ectopic pregnancy due to obstruction of the tube
•nonengagment of the presenting part
•Placenta praevia
•Abortion
EFFECT OF FIBROID ON LABOUR
•Obstructed labour
•Atony
•Submucous fibroid predisposes to placenta accreta
EFFECT OF FIBROIDS ON PUERPERIUM
•subinvolution of uterus
•secondary postpartum haemorrhage
•inversion of uterus may be caused by a fundal submucous fibroid
•increased incidence of puerperal sepsis due to
•Infaction of a traumatized tumour and interference with drainage of the uterus
EFFECT OF PREGNANCY ON FIBROID
•increase in size due to increased vascularity and
•Oedema and hypertrophy of muscle fibers after delivery the tumour returns to its original size
•Apedunculated subserous fibroid may undergo torsion
•The tumour may become traumatized durin
•labour and this predisposes to infaction
•Asubmucous fibroid may become extruded during the puerperium leading to haemorrhage the tumour may become may be detached spontaneously
•Softening due to increased vascularity and Oedema and so it may be difficult to detect the tumour by palpation
MANAGEMENT
A: During preganancy
•Red degeneration which does not respond to medical treatment or when the diagnosis is doubted only the affected tumour is removed (known by badherent omentum)
•Torion of the pedicle of a subserous fibroud
• Haemorrhage from ruptured vein the surface of a subserous tumour
B: During labour
If a fibroid caused obstruction to labour the fetus is delivered by caesarean section Myomectomy is not some at the same time due to the danger of severe haemorrhage unless the fibroid is subserous with a stalk .caesarean hysterectomy is permissible in a patient with multipal fibroids over 40 years .fibroids detected during the puerperium need no treatment except after 3-6months
Dr/safwan abdo alsalam
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