Although myomas are a very common problem in women, they can usually be detected during a gynecological examination performed for different reasons. Myomas are benign masses that contain smooth muscle and connective tissue. The uterine wall consists of three layers. The innermost layer, the endometrium, undergoes changes during the menstrual cycle and is shed and expelled with menstrual bleeding if there is no pregnancy. The muscle layer in the middle, called the myometrium, contains the thickest and involuntary smooth muscles of the uterus. The muscles contract to expel the blood accumulated inside during menstrual bleeding and the baby and placenta from the uterus during birth. It can be said that myomas are benign tumors that originate from the muscles in the myometrium layer. However, their content does not consist solely of muscle tissue. They consist of smooth muscle cells held together with connective tissue. Myomas, which come in different sizes, are the most common tumors in the female pelvis. The best feature of these formations is that they are benign and have a very low probability of turning into cancer.
Up to 75% of women are unaware that they have fibroids. However, since they are commonly seen in women, they should be investigated during regular gynecological examinations. In some women, fibroids manifest themselves by causing pain, increased menstrual bleeding, constipation, and increased urination, and can have different effects depending on their location, size, and number.
Although the exact cause of myoma development is not known, it is known that the estrogen hormone has an effect on it. Therefore, due to the estrogen hormone that increases especially during pregnancy, existing myomas may experience effects such as growth and development of myomas. In order to avoid any negativity related to myoma during pregnancy, it is beneficial for women to undergo a gynecological examination before pregnancy and be evaluated for myomas. Myomas, which can prevent women from getting pregnant even slightly, can cause more serious problems especially during pregnancy. They can cause the mother-to-be to miscarry, the threat of premature birth, early separation of the placenta, and even affect the baby's position in the womb. They can also carry risks related to birth. They can cause the mother-to-be to give birth by cesarean section. Therefore, myomas should be taken seriously and monitored during pregnancy. In order to protect against complications of myomas, they should be treated in the most definitive and guaranteed way known and removed surgically.
What are the risks of fibroids during pregnancy?
The risks that arise from myomas during pregnancy vary depending on the location of the myomas in the uterus, the size and number of myomas. Submucous and intramural myomas can cause recurrent miscarriages in pregnant women, as well as pose a threat of premature birth during pregnancy. In addition, the normal placement of the fetus during pregnancy can cause it to take an abnormal position, such as head down, and can cause premature separation of the placenta and prevent the uterus from contracting, causing bleeding in the woman after birth. Since these risks are likely to occur, the expectant mother may have to have a cesarean section.
Since the effect of the estrogen hormone on the development of myomas is known, and since this hormone increases during pregnancy, myomas tend to grow. This risk is higher if the diagnosed myomas are larger than 6 cm.
Because of the rapid growth of myomas during pregnancy, when there is a disruption in their nutrition, degeneration of the myoma may occur. Pregnant women with this may experience severe pain in the abdominal area. This pain is especially effective in the area where the myoma is located. Since expectant mothers can often confuse this type of pain with conditions such as premature birth, appendicitis, and premature separation of the placenta, they should be a little more careful. They should be especially sensitive in the 20th and 22nd weeks, when myoma degeneration is more common. These pains can even cause labor to begin.
What Should Be Done If Myoma Is Diagnosed Before Pregnancy?
The myomas that will cause the most problems for expectant mothers during pregnancy are those located in the submucosa. Therefore, if myomas with this location are detected before pregnancy, they should be removed with appropriate treatment. For this, open surgery can be preferred, or hysteroscopy can be performed vaginally. Operations performed to remove myomas can sometimes cause adhesions and blockage in the tubes after surgery. In this respect, when myomas are diagnosed before pregnancy, care should be taken in choosing the preferred method for their removal. It is recommended that subserous and intramural myomas, those that cause bleeding or other symptoms, and those that are large in size, be removed.
Women should have their existing fibroids removed before their new pregnancy, especially if they have had a problem that is thought to be related to fibroids in their previous pregnancies. Women who have had problems such as premature birth or miscarriage should be monitored during their pregnancies.
What Should Be Done When Myoma Is Diagnosed During Pregnancy?
If myomas are not detected in expectant mothers before pregnancy, they should be monitored during pregnancy. Because the estrogen hormone increases during this period, there may be growth in myomas. If a mother is diagnosed with myoma during pregnancy, she should be closely monitored during pregnancy. Any abdominal pain that the woman feels should definitely be reported to her doctor. During this period, more sensitivity should be exercised in order to prevent harm to the mother and the baby in case of problems that may arise due to myoma.
The most common problem that may occur due to myoma during pregnancy is myoma degeneration. This occurs in approximately 10% of expectant mothers with myoma during pregnancy. The most important indicator of this is pain in the abdomen. In particular, more pronounced pain occurs in the area where the myoma is located. In this case, other causes of the expectant mother's pain are investigated and appropriate treatment is applied. If the pain is not caused by a threat of premature birth, premature separation of the placenta, appendicitis, and is thought to be due to a myoma, treatment with painkillers can be applied. In this case, hot and cold applications to the expectant mother may be useful in relieving the pain.
Is Myoma Removal Surgery Performed During Ongoing Pregnancies?
In the ongoing pregnancy of expectant mothers, myoma removal is very rarely performed. If the myoma is located in a location that blocks the birth canal or prevents the uterus from contracting and causes labor to slow down, the pregnant woman will need to give birth by cesarean section. If it is seen during the cesarean section that the myoma in the uterus is covering the lower part of the uterus, the cesarean section is not performed routinely with a horizontal incision, but with a vertical incision in the uterus to remove the baby.
In every expectant mother who has had myoma removal surgery before pregnancy, especially if there is severe pain and other serious symptoms, uterine rupture should be evaluated, although the possibility is quite low.
Is Myoma Removal Performed During Cesarean Birth?
If the myoma is detected during pregnancy and the myoma is removed during the birth by cesarean section, it is not preferred because it can cause excessive bleeding in the mother. However, myomas that are close to the incision where the baby was removed during the cesarean section can be removed during the cesarean section.
How Should Expectant Mothers Who Have Previously Had Myomectomy Surgery Deliver Their Babies?
Since the inner layer of the uterus may have been damaged during the previous myomectomy surgery performed on the expectant mother and therefore there is a risk of uterine rupture during normal birth, it would be more appropriate for the birth to be by cesarean section. For other expectant mothers, normal birth may be preferred. However, it should not be forgotten that in case of any complications during birth and if there is a risk of uterine rupture, the birth can be converted to cesarean section at any time.
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