Our Summary

The research paper is about Uterine fibroids, a common benign disease affecting the female reproductive system, appearing in 20-40% of women and 10% of pregnancies. It aims to summarize the current knowledge on managing and treating this condition during pregnancy.

To do this, the researchers analyzed previous studies available on scientific databases, focusing on details like when the fibroids were diagnosed during pregnancy, their size, the type of surgery used, and the outcomes for mother and baby.

From the 66 articles they looked at, covering 199 patients, they found that in most cases, the fibroids were removed before the 20th week of pregnancy. The most common surgical approach was laparotomy, and in about 41% of the cases, the fibroids were between 7-20 cm in diameter.

In terms of delivery, a Cesarean section was the most common method, used in about 41% of the pregnancies. However, they also found that there were complications in about 8% of the cases. These included miscarriage, fetal demise, or neonatal death.

The paper concludes that while it is possible to remove fibroids during pregnancy (a procedure known as myomectomy), this does come with an increased risk of complications.

FAQs

  1. What is the most common surgical approach to remove uterine fibroids during pregnancy according to the study?
  2. What are the most common complications associated with removing fibroids during pregnancy as per the research?
  3. At what point in the pregnancy were fibroids most commonly removed according to the analyzed studies?

Doctor’s Tip

A helpful tip a doctor might give a patient about myomectomy is to discuss the potential risks and benefits of the procedure thoroughly before making a decision. It is important to weigh the benefits of removing the fibroids against the potential risks to both the mother and the baby during pregnancy. Additionally, it is important to follow up closely with your healthcare provider and monitor for any signs of complications after the surgery.

Suitable For

Patients who are typically recommended myomectomy for uterine fibroids include those who are experiencing symptoms such as heavy menstrual bleeding, pelvic pain, pressure on the bladder or bowels, infertility, or recurrent pregnancy loss. Additionally, patients who have large fibroids that are causing significant discomfort or impacting their quality of life may also be recommended for myomectomy. It is important for patients to discuss their individual symptoms and medical history with their healthcare provider to determine the best course of treatment for their specific situation.

Timeline

Timeline of a patient’s experience before and after myomectomy:

Before myomectomy:

  1. Patient experiences symptoms of uterine fibroids such as heavy menstrual bleeding, pelvic pain, and frequent urination.
  2. Patient undergoes diagnostic tests such as ultrasound or MRI to confirm the presence of fibroids.
  3. Patient discusses treatment options with their healthcare provider, including the possibility of myomectomy.
  4. Patient undergoes pre-operative evaluation and preparation for the surgery.

After myomectomy:

  1. Patient undergoes myomectomy surgery to remove the fibroids from the uterus.
  2. Patient stays in the hospital for a few days for recovery and monitoring.
  3. Patient may experience pain, cramping, and vaginal bleeding in the days following the surgery.
  4. Patient follows post-operative instructions provided by their healthcare provider, including taking pain medication, avoiding strenuous activities, and attending follow-up appointments.
  5. Patient experiences relief from symptoms such as heavy bleeding and pelvic pain.
  6. Patient may need to wait a period of time before trying to conceive if they desire to have children in the future.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy for uterine fibroids during pregnancy may include:

  1. What are the potential risks and benefits of having a myomectomy during pregnancy?
  2. How will the size and location of my fibroids impact the decision to have a myomectomy?
  3. What surgical approach will be used for the myomectomy and how will it affect my pregnancy?
  4. What are the potential complications that could arise from the myomectomy procedure?
  5. How will the myomectomy impact my ability to carry the pregnancy to full term?
  6. Will I need to undergo a Cesarean section for delivery if I have a myomectomy during pregnancy?
  7. What are the chances of miscarriage, fetal demise, or neonatal death following a myomectomy during pregnancy?
  8. Will I need to undergo additional monitoring or follow-up care after the myomectomy?
  9. Are there any alternative treatment options for managing uterine fibroids during pregnancy?
  10. How will the myomectomy procedure affect my future fertility and reproductive health?

Reference

Authors: Loverro G, Damiani GR, Malvasi A, Loverro M, Schonauer LM, Muzzupapa G, Dinaro E. Journal: Minerva Obstet Gynecol. 2021 Oct;73(5):646-653. doi: 10.23736/S2724-606X.21.04676-5. Epub 2021 May 14. PMID: 33988017