Some of the terms in used in this post might be difficult for non- medical personell to understand . If you do not understand or if you want more explanation please post your comments below. Alternatively you can ask any questions in my forums.

Some of the complications of fibroids in pregnancy:

i) Red Degeneration (Necrobiosis):

This is the classic complication of fibroids in pregnancy. It is due to acute disruption of blood supply during active growth. It usually occurs in large fibroids. Though it is commonly known to occur during pregnancy, it may occur during menopauce and among contraceptive pill users. In contraceptive pill users it is due to the high concentration of oestrogen.

The underlying mechanism of red degeneration is not fully understood. It is thought to be due to vascular changes resulting in venous thrombosis leading to accumulation of blood.

The clinical features are pain and tenderness around the uterus. There may also be mild pyrexia( Fever) and leucocytosis (Increased white blood cell count).

On cut section there are dark red areas , similar to the appearance of raw meat on cut section.

Management is conservative. It usually resolves spontaneously over a few days. There is a high risk of haemorrhage (Bleeding ) if surgery is attempted during pregnancy.

ii) Torsion of Pedunculated Fibroids:

This may occur either antepartum or postpartum. The rapid involution of the uterus postpartum is responsible for a higher incidence of torsion of pedunculated fibroids. 

This usually results in severe pain.

This could be confused with( Differential diagnosis) appendicitis, ureteric colic, intestinal volvulus, rectus muscle haematoma etc.

Laparatomy is required for the surgical removal of the pedunculated fibroid. Because of the high risk of haemorrhage if fibroids are operated on during pregnancy, only the symptomatic pedunculated fibroid should be removed.

iii) Obstructed Labour:

This can happen in the presence of a cervical fibroid (Fibroid at the cervix of the uterus) or a fibroid in the lower segment of the uterus.

If the patient has completed her family and desires to remove her uterus , a cesaean section can be done easily. Otherwise the ever prsent danger of haemorrhage should be considered before undertaking a cesarean section (Especially if the patient has multiple fibroids). The mother should be councelled about the risk involved in a cesarean section. Consent should also be taken from the mother for the removal of her uterus if haemorrhage cannot be controlled.

iv) Abnormal Lie /Abnormal Presentation:

This can be caused by a fibroid in the lower segment of the uterus. It will also be difficult for the head to engage if there is fibroid in the lower segment.

v) Infection :

Fibroids may become infected. This is more likely in sub mucous fibroids , postpartum or after abortion.

vi) Haemorrhage:

Post partum haemorrhage could be caused by fibroids. This is probably due to interference with the proper contraction of the uterus.

vii) Abortion:

Submucous fibroids could cause abortion in early pregnancy.

References:

Benign Diseases of the endometrium- By Kuman RJ and Mazur MT (1994). Pathology of the female genital tract 4th edition.

Deuhurst’s Textbook of Obstetrics and Gynaecology for Postgraduates – 6th Edition editer by D. Keith Edmonds.

Cramer S F and Patel .A- The frequency of uterine leiomyomas. American Journal of Clinical Pathology, 94- 1990.

Dr W. D. N De Alwis, Dr R Gunasekeram ,Dr N Gunawansa, edited by Professor C. Randeniya,Consultant National Hospital Sri Lanka- Clinical Gynaecology for Undergraduates.