dangerous! The pregnant mother had a fever and vomiting, and it turned out that the uterine fibroids were doing the work

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Vigilance against red degeneration of uterine fibroids during pregnancy

Details of the case

A 26-week pregnant second-born mother was admitted to the hospital with "lower abdominal pain with irregular contractions for 2 days", accompanied by nausea, vomiting, and fever.

Diagnosis and treatment: after admission, complete blood routine, liver and kidney function tests, fetal ultrasound and other related examinations, found that the blood picture is elevated, and there is a fibroid of about 4 cm in the right posterior wall of the pregnant mother's uterus, which is considered to be uterine fibroid degeneration; other tests have not seen obvious abnormalities.

Inform the patient of the effect of uterine fibroids on the pregnant fetus and pregnant mother, the patient expressed informed understanding; progesterone inhibition of contractions, antibiotics to prevent infection, rehydration and other symptomatic support treatment for one week, the patient improved and discharged; to 37 weeks of pregnancy through the vagina to give birth to a healthy baby boy.

In fact, it is not uncommon to encounter uterine fibroids during pregnancy, and some pregnant mothers are more anxious, worried about whether fibroids have an impact on children or whether fibroids can be removed during caesarean section, etc.

Why uterine fibroids

Easy to grow rapidly and degenerate during pregnancy?

It is well known that uterine fibroids are very common benign tumors in the female body. Some women with uterine fibroids are pregnant before they have time to deal with them, but during pregnancy due to the stimulation of rich estrogen and progesterone, fibroids grow rapidly.

In addition, during pregnancy, uterine fibroids are prone to red degeneration. Red degeneration is a special type of necrosis of uterine fibroids that may be associated with thrombosis and hemolysis caused by degeneration of small blood vessels within fibroids. When the fibroids are red degenerated, pregnant mothers are prone to severe abdominal pain with nausea, vomiting, fever, and elevated white blood cells, and the examination finds that the fibroids are enlarged and tender. The pregnant mother in this article is a typical case of red degeneration of fibroids.

Will fibroids affect pregnancy?

Uterine fibroids can be divided into uterine fibroids and cervical fibroids according to the place of growth, and are divided into submucosal fibroids, intermural fibroids, and subserous fibroids (including broad ligament fibroids) according to the relationship with the muscle layer. Do all fibroids affect pregnancy and childbirth? The answer is not necessarily, it needs to be determined according to the location of the fibroids.

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Fibroids at the site of the uterine horn: can compress the fallopian tubes leading to infertility;

Submucosal fibroids: can affect the implantation and embryonic development of a fertilized egg leading to miscarriage;

Inter-myomur fibroids: larger inter-myomural fibroids can lead to deformation of the uterine cavity or insufficient blood supply to the lining leading to miscarriage, intrauterine developmental delay or fetal malformation due to mechanical compression;

Cervical fibroids: cervical fibroids during childbirth can lead to obstruction of the birth canal; after delivery, fetal delivery is prone to postpartum hemorrhage due to placental adhesions, difficulty in excretion and poor uterine contractions.

concomitant uterine fibroids during pregnancy,

Can it be left untreated?

In principle, no special treatment is generally required, but close follow-up is required; if there are symptoms, most of them use symptomatic supportive treatment, and the pregnant mothers in this article take a conservative symptomatic supportive approach.

Further follow-up is required at the time of delivery, depending on the situation of the pregnant mother or whether to remove it depending on the size and location of the fibroids during caesarean section.

If there are small intermuscular fibroids or subserosal fibroids, it does not affect the progression of labor, and the pregnant mother has no other comorbidities, and can generally be delivered vaginally.

If the uterine fibroids in the uterine neck position affect the decline of the fetal head and make it difficult to give birth, caesarean section surgery is required.

If it is a pedunculated subserous fibroid, if the pedicle torsion occurs, secondary infection, etc., it is necessary to urgent surgery if conservative treatment is ineffective.

Therefore, for uterine fibroids under the mucosa, because it will affect the implantation of the embryo or affect the development of the fetus and the uterine fibroids that are completely located under the serous membrane and with a peduncle, because they are prone to torsion, it is recommended to remove the uterine fibroids before pregnancy; the remaining uterine fibroids generally do not affect conception, it is recommended to fully consider and fully communicate with the patient before treatment.

Shanghai Municipal Science and Technology Commission Science Popularization Project Grant (Project No.: 20DZ2311000)

Source of this article: Medical Community Obstetrics and Gynecology Channel