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ObGyn/Pregnancy issues/Do I need to have a surgery?

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My Sonography Results
My Sonography Results  
Hello

Dr. Kandeel I live in Iran and there are not a lot of good ObGyn specialists in my town, so I think a second opinion can help me in my conditions.

I am 35, and I am pregnant (with my second child) and it is 7 and a half month that I am pregnant. When I became pregnant some fibroids started to grow in my uterus and the growth was stopped in the third month (I have attached my sonography results). As seen in results, the size of the fibroids are small but my Doctor now tells me she might have to do a surgery to take these fibroids out during my delivery which has worried me a lot. I wanted to know if the surgery during the delivery is an obligation in my conditions? and whether there are any risks of doing the surgery (I have heard there may be problems after the surgery of myoms)?

[one more thing to add: my doctor says since my first child has been born in a vaginal delivery, this delivery can be a vaginal delivery and there is no need to c-section]

(my cousin had tried to contact you and ask you but she didn't get successful so I resent this and hope you will answer this)

My sincere thanks Dr. Kandeel

R Mirtel

Answer
Rana

Pregnancy is well known to increase blood flow to all pelvic organs and fibroids. This complicates the situation to remove a fibroid at delivery as there could be a risk of uncontrollable bleeding during surgery and may necessitate removal of the uterus in a surgery called hysterectomy. We usually prefer to postpone surgery if fibroids do not obstruct the birth canal and vaginal delivery is expected. It is importnat to be aware that fibroids cannot be removed if vaginal delivery is expected as well. Fibroids can only be removed abdominally.

Having a previous vaginal delivery does not mean you will have another. Simply, you might not have fibroidsin your previous pregnancy. Still vaginal delivery remains a possibility if they are small, not in the uterine cavity but on the outer uterine surface, does not interefere with the capacity of the birth canal. If any of these 3 conditions is absent, Cesarean section is a must.

If your doctor have made a decision to remove these fibroids at delivery, then they probably interfere with the birth canal capacity. However, if they are small, he should try to deliver the baby without manipulating the fibroids. Surgery can then be performed after 6 months when the effects of pregnancy ends and bloood supply to the fibroid decreases.

Good luck

ObGyn/Pregnancy issues

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Mohamed Kandeel

Expertise

I can answer questions about antenatal care, medical problems associated with pregnancy, labor and delivery and postpartum care.

Experience

Currently I am working as a Professor of Obstetrics gynecology, Menofyia University, Egypt. Since 1987, I worked in many university and private hospitals with a high load of pregnant population averaging 7-9,000 deliveries/year. This exposed me to all problems associated with pregnancy, labor and delivery. I had my doctorate degree in Obstetrics and Gynecology in 1996 in the use of Doppler ultrasound in high risk pregnancies.

Organizations
Menofyia University, Egypt

Publications
-British Journal of Obstetrics and Gynecology (Kandil M) -Egyptian Journal of Obstetrics and Gynecology (Kandil M) -Ain Shams Journal of Medicine (Kandil M)

Education/Credentials
-Master's degree in obstetrics and Gynecology 1989 -Doctorate degree in Obstetrics and Gynecology 1996

Awards and Honors
Editorial advisor: Fetal monitoring section of the international website www.obgyn.net

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