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.