Leiomyomas and Pregnancy

ThThe a

Key Points

• 
  
• The prevalence of uterine leiomyomas in pregnancy varies between 1.6 and 10.7 percent.
•  
• Usually, the impact of leiomyomas on pregnancy is minimal, and complications during pregnancy and postpartum related to fibroids are rare. However, most complications occur with multiple leiomyomas, retroplacental leiomyomas, and with lesion diameters greater than 5 cm. 
•  
• Pain is the most common symptom, accompanied by pelvic pressure and vaginal bleeding. Painful fibroids are typically treated with analgesics. 
•  
• Complications include degeneration and torsion of leiomyomas, as well as an increased risk of obstetric complications such as early pregnancy loss, preterm labor and birth, placental abruption, malpresentation, placenta previa, cesarean delivery, and postpartum hemorrhage.
•  
• Most women with leiomyomas will have a successful vaginal delivery, and cesarean delivery is performed for standard obstetric indications, while cesarean myomectomy should generally be avoided.
•  
• In patients with prior myomectomy, the timing and route of delivery should be individualized based on prior uterine surgery details, favoring cesarean for extensive or complicated myomectomy and allowing trial of labor for uncomplicated cases.
  
  
• The choice to undergo preconception myomectomy should be personalized, considering factors such as age, symptom severity, reproductive history, and fibroid size and location.
  

Leio