Discussion
The diagnosis of uterine fibroid is made prenatally on physical exam or
ultrasound; however, detection rates are limited. The prevalence of
uterine fibroids during pregnancy is 1% to 10% and are associated with
a 10-40% complications rate during pregnancy2.
Fibroids that are larger than 5cm in diameter are more likely to grow
during pregnancy and can lead to increased risk of miscarriage, preterm
labor, placenta abruption, malpresentation, labor dystocia, cesarean
delivery, and postpartum hemorrhage1,2.
Most women with uterine fibroids will deliver vaginally, however uterine
fibroids are a well-known risk factor for cesarean delivery. Women with
fibroids are 3.7 times more likely to need cesarean delivery due to
fetal malpresentation and labor dystocia. Women with uterine fibroids
during pregnancy are 2.5 times more likely to have fetal malpresentation
and 2 times more likely to have labor dystocia. In most cases, uterine
fibroids during pregnancy should not be considered a contraindication to
trial of labor1.
Most authors agree that myomectomy at the time of cesarean section
should be avoided given the increased risk of severe hemorrhage, uterine
ligation, and peripartum hysterectomy. New literature suggests that
myomectomy at the time of cesarean delivery could be considered in
selected patients with careful consideration of several
factors1-3.