Fibroids in pregnancy: Management & outcomes 2018 TOG

Question 1

What proportion of women in 1st trimester have a fibroid?

Answer 1

10%

Question 2

Most common complication relating to fibroids in pregnancy

Answer 2

Pain

Question 3

Increase risk of obstetric outcomes with women with fibroids

Answer 3

Maternal
FTP
Abruption
Praevia
CS
PPH
Retained placenta

Fetal
Miscarriage
PTL
PPROM
FGR
Malpresentation

Question 4

How common is sub fertility in women with fibroids?

Answer 4

5-10%

Question 5

Women who have undergone UAE vs controls, which increased risk?

Answer 5

Miscarriage
CS
PPH
?placenta accreta

Question 6

AN management of fibroids

Answer 6

> 3cm or near Cx - cons led care
Treat & prevent anaemia
Consider serial ISS

Question 7

If AN myomectomy performed, when should this occur? Most likely pregnancy complication?

Answer 7

1st or 2nd trimester
Increased risk CS

Question 8

Why AN myomectomy performed?

Answer 8

Severe pain
Large/rapidly enlarging fibroids
Fibroids >5cm within lower segment
Torsion of pedunculate fibroids

Question 9

Mode of delivery after myomectomy?

Answer 9

Consider CS if
- Breached cavity
- Laparoscopic (high rates rupture)
- Large defect

Question 10

At CS how far away from fibroid should uterine incision be made

Answer 10

2cm

Question 11

What % of fibroids regress after 3-6 months post pregnancy?

Answer 11

70%
Less likely to regress in black women, POP pill, miscarriage

Question 12

Rare life threatening complication of fibroids seen postnatally?

Answer 12

Pyomyoma - septic/abdo pain
Imaging non specific - seen at laparotomy

Question 13

Spont pregnancy rates following CS myomectomy

Answer 13

79%