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Fibroids Pregnancy

WombWisdom

In the context of uterine fibroids during pregnancy, I am interested in exploring the latest insights regarding the impact of fibroids on maternal and fetal health, particularly in relation to their size, number, and location. Existing literature suggests that fibroids can lead to complications such as pain, restricted fetal growth, and abnormal labor patterns. However, I am curious about recent advancements or ongoing research in non-surgical management options during pregnancy, considering the goal of minimizing risks to both the mother and fetus while avoiding unnecessary interventions.

Additionally, there is an emerging interest in understanding the role of fibroid growth dynamics during pregnancy. Are there any novel predictive models or biomarkers that have shown promise in forecasting fibroid behavior and associated outcomes effectively? Any information on innovative therapeutic approaches or trials that explore less invasive management strategies for fibroids during pregnancy would be appreciated.

Your insights or references to recent studies and clinical guidelines that address these concerns would be highly valuable.

FeminineFlowGuide

What’s actually shifted lately isn’t a magic drug, it’s better risk stratification and more pragmatic conservative care.

Risk signal: size and location beat “number.” Large (>5-7 cm), submucosal, lower‑segment, or retroplacental fibroids drive most issues (malpresentation, labor dystocia, PPH). Contemporary cohorts (e.g., nuMoM2b analyses in AJOG/AJOG MFM 2022-2023) reinforce that many small intramurals are bystanders.
Growth dynamics: most “action” is in 1st trimester; many stabilize or shrink later. Pain flares (red degeneration) tend to cluster around that transition. No validated serum biomarker. A few small studies are testing MRI radiomics/3D US volumetry to predict growth/degeneration, but nothing practice‑changing yet.
Non‑surgical in pregnancy: still conservative-acetaminophen first‑line, short NSAID course (<48-72 h) before 32 weeks if needed, hydration, rest; inpatient support if severe. GnRH analogs and SPRMs are out in pregnancy. UAE/HIFU/RFA are off the table.
Monitoring that actually helps: target scans if the fibroid is big or near the placenta/LUS-growth, placental position, fetal presentation, and plan delivery accordingly. Many MFMs do 4-6‑weekly growth + placental Dopplers selectively rather than blanket surveillance. Fibroids alone aren’t an indication for aspirin; use standard PE/FGR risk criteria.
At delivery: the shift is toward planned hemostasis rather than reflex avoidance. Cesarean myomectomy can be reasonable in experienced hands with vasopressin, uterotonics, TXA, meticulous multilayer closure/adjuncts; multiple recent meta‑analyses suggest it doesn’t universally increase hemorrhage or transfusion. Not a blanket policy-center experience matters.

Good summaries: SMFM Consult on fibroids in pregnancy (AJOG, latest update in the last few years) and ACOG PB 228 (2021). For the “what’s next,” keep an eye on small MRI/US radiomics cohorts and cesarean‑myomectomy hemostatic technique trials; the biomarker story is still speculative.