Fibroids in Pregnancy: What Every Expectant Mother Should Know

Fibroids in Pregnancy: What Every Expectant Mother Should Know

By Dr. Anuradha Narayanan

Consultant Obstetrician & Gynaecologist | Anurag Women Health Care, Chembur, Mumbai

Pregnancy is a joyful journey, but it can also bring unexpected challenges. One such condition is uterine fibroids, which are common among women of reproductive age. While many women with fibroids have completely normal pregnancies, certain fibroids can increase the risk of complications for both the mother and the baby.

As an obstetrician with over 20 years of experience, I often reassure my patients that most fibroids do not prevent a healthy pregnancy, but careful monitoring and individualized care are essential.

What Are Fibroids?

Fibroids (also called uterine leiomyomas) are non-cancerous growths of the muscle layer of the uterus. They vary greatly in size—from tiny seed-like nodules to large masses occupying most of the abdomen.

Depending on their location, fibroids are classified as:

• Intramural (within the uterine wall)

• Submucosal (projecting into the uterine cavity)

• Subserosal (growing outward from the uterus)

• Pedunculated (attached by a stalk)

Their location often matters more than their size when it comes to pregnancy.

Can You Get Pregnant With Fibroids?

Yes.

Most women with fibroids conceive naturally and deliver healthy babies.

However, fibroids—especially large, multiple, or cavity-distorting fibroids—may reduce fertility or increase pregnancy-related complications.

How Pregnancy Affects Fibroids

Fibroids are hormone-sensitive.

During pregnancy, rising estrogen and progesterone levels may cause some fibroids to enlarge, particularly during the first trimester.

Interestingly:

• About one-third increase in size.

• Many remain unchanged.

• Some actually shrink later in pregnancy due to reduced blood supply.

Symptoms During Pregnancy

Many women experience no symptoms.

Others may develop:

• Persistent abdominal pain

• Pelvic pressure

• Backache

• Feeling of heaviness

• Frequent urination

• Constipation

• Vaginal bleeding in early pregnancy

One of the commonest reasons for hospitalization is red degeneration, where the fibroid outgrows its blood supply and becomes painful.

How Fibroids Can Complicate Pregnancy

1. Miscarriage

Fibroids that distort the uterine cavity, particularly submucosal fibroids, can interfere with implantation and increase miscarriage risk.

2. Pain Due to Red Degeneration

This usually occurs between 16–32 weeks.

Symptoms include:

• Sudden severe abdominal pain

• Localized tenderness

• Low-grade fever

• Nausea

Treatment usually includes:

• Rest

• Adequate hydration

• Pregnancy-safe pain medication

Surgery is rarely required.

3. Placental Problems

Fibroids may interfere with placental implantation leading to:

• Placenta previa

• Placental abruption

• Reduced placental blood flow

These conditions require close fetal monitoring.

4. Preterm Labour

Large fibroids reduce available space inside the uterus and may trigger:

• Premature uterine contractions

• Cervical shortening

• Preterm delivery

5. Malpresentation

Fibroids occupying the lower uterus may prevent the baby from turning head-down.

The baby may remain:

• Breech

• Transverse

• Oblique

Increasing the likelihood of Caesarean delivery.

6. Obstructed Labour

Fibroids near the cervix or lower uterine segment may physically block the birth canal, preventing normal vaginal delivery.

7. Caesarean Section

Women with fibroids have a higher chance of requiring a Caesarean section because of:

• Breech presentation

• Placenta previa

• Failure of labour to progress

• Obstruction by fibroids

• Fetal distress

8. Postpartum Haemorrhage

Fibroids may interfere with effective uterine contraction after delivery.

Poor uterine contraction increases the risk of:

• Heavy bleeding

• Blood transfusion

• Emergency interventions

9. Retained Placenta

Occasionally fibroids interfere with normal placental separation after birth.

Does Every Fibroid Need Treatment During Pregnancy?

No.

Most fibroids are managed conservatively.

Treatment focuses on:

• Pain relief

• Monitoring fetal growth

• Monitoring fibroid size

• Detecting complications early

Myomectomy (fibroid removal) is generally avoided during pregnancy because of the risk of severe bleeding. It is considered only in very selected cases.

Ultrasound Monitoring

Women with fibroids usually require more frequent ultrasound examinations to assess:

• Baby’s growth

• Placental location

• Cervical length

• Fibroid size

• Amniotic fluid volume

Regular antenatal visits become especially important.

Can Fibroids Affect the Baby?

Most babies are born healthy.

However, large fibroids may occasionally lead to:

• Growth restriction

• Preterm birth

• Abnormal fetal position

• Rarely, limb deformities due to pressure from very large fibroids

Fortunately, serious fetal complications are uncommon.

Delivery Planning

The mode of delivery depends on:

• Fibroid size

• Fibroid location

• Baby’s presentation

• Placental position

• Previous Caesarean section

• Maternal and fetal condition

Many women with fibroids still have successful vaginal births.

After Delivery

Following childbirth:

• Fibroids often shrink naturally.

• Symptoms may improve significantly.

• Definitive treatment, if needed, is usually planned several months after delivery.

When Should You Seek Immediate Medical Attention?

Contact your obstetrician immediately if you experience:

• Severe abdominal pain

• Heavy vaginal bleeding

• Leakage of fluid

• Fever

• Reduced fetal movements

• Regular painful contractions before 37 weeks

Prompt evaluation can help prevent complications.

Expert Advice

Having fibroids during pregnancy can understandably cause anxiety, but it is important to remember that the majority of women with fibroids go on to have healthy pregnancies and healthy babies. Early diagnosis, regular antenatal check-ups, and personalized obstetric care are the keys to achieving the best outcomes.

If you have been diagnosed with fibroids and are planning pregnancy—or are already expecting—consult an experienced obstetrician to develop a care plan tailored to your specific situation.

At Anurag Women Health Care, Chembur, Mumbai, we provide comprehensive antenatal care for women with fibroids and other high-risk pregnancy conditions, ensuring both mother and baby receive the safest possible care.

Call 8850911046 to know more