Submucosic myoma uterus. Submucosic myoma can give back to the lower back? Little pelvic zone also gets

Myoma uterus during pregnancy is a serious problem that pregnant women face. The development of pregnancy in the presence of this pathology is fraught with the risk of complications of complications, as a result of which a woman can lose not only the future child, but also a fully conducted organ.

Is pregnancy possible in the morning of the uterus? The probability of conception and successful toaling the fetus is influenced by the number and magnitude of myomatous nodes, as well as their localization. If the foci have small sizes, located in the wall of the uterus, the ability to conceive and endure the child is quite high.

With multiple myomatous nodes, large-size tumors, localized next to, uterine pipes, a chance for conception is minimal. If it happened, there is a big risk of developing complications and embryo pathologies.

Mioma uterus and pregnancy directly proportionately affect the development of each other. As a result of the growth and development of the fetus, there is a change in cells of myomatous tissue, and as a result of the progression of myoma, there is a violation of the normal functioning of the placenta.

In the development of pregnancy, as a rule, blood supply and nutrition of the tumor is disturbed. In the presence of a suburose-type woman in a woman, there is a fairly big risk of twisting the legs, especially if pregnant gestosis is accompanied by edema and increase pressure, or the hypertonus of the uterus.

If the placenta is located above a large myatous node, there is a violation of its blood supply. The structure of the vessels of the placenta changes, the formation of blood clots is possible. As a result, placental insufficiency develops.

The maximum severity of blood circulation disorders is observed when childbirth is approaching. For this reason, women make a cesarean section on the 38th or 39th week.

Diagnosis of tumor

When setting a woman in records of pregnancy, a survey is conducted, during which the state of the woman's health is determined.

If myoma has not been diagnosed before conception, the diagnosis can be delivered at the gynecological examination already developing pregnancy. Most often, this is due to the implementation of ultrasound examination.

During the ultrasound, the doctor determines the localization of myomatous nodes, their number and magnitude, structure, location relative to the placenta.

How does the Mioma of the uterus affect pregnancy, is it dangerous than it threatens the combination of the disease with the baby tooling - these and other questions are worried about women in position.

If a pregnant woman is diagnosed, the following factors can cause the development of a pathological process:

• the magnitude of the largest myomatous node is greater than 7-8 cm;
• multiple mioma ( total amount nodes - more than 5);
• the location of the placenta directly over the tumor;
• the direction of the node inside the uterine cavity, which leads to the deformation of the organ;
• necrotic or dystrophic changes Myomatous focus;
• the presence of scars on the uterus due to operations;
• diagnosis of infertility in the past ,;
• other diseases of the small pelvis organs;
• varicose veins of a small pelvis;
• the age of women is over 30 years old.

So, all the chances of a successful baby tooling have young women under 30, without others gynecological diseases and operations in the uterus in the past, if there are less than 5 myomatous nodes, the size of which is less than 8 cm. Tumor foci should be on the front or back wall And grow out regarding the uterus cavity, located away from the placenta. In this case, the development of the embryo passes, as a rule, without any complications.

Other options are considered to be a high risk, a woman can be interrupted in early or late time.

What complications may arise?

In patients who relate to the high risk group, the following complications are possible:

• fetoplacentar insufficiency;
• eastic-cervical insufficiency, as a consequence of the localization of the tumor on the neck or the ferrousness of the uterus;
• proliferating tumor (i.e. fast-growing);
• breasting information;
• breaking the uterus in the header (with scars in the presence of operations in history);
• gestosis;
• development of anemia;
• peeling the placenta;
• spontaneous interruption of pregnancy;
• premature childbirth.

On the video about the influence of moma uterus for pregnancy

Treatment

Does treatment required if there is a mioma of the uterus during pregnancy? Therapy is assigned at high risk of complications and the threat of interrupt.

In this case, the woman doctor prescribes the following:

• , vitamin complexes, spasmolitics;
• semi-noar or bed mode;
• full rejection of intimate life;
• ban on any physical exertion.

Other options for complications and appointed treatment:

• Rapid growth neoplasm. Antiggerants are prescribed (for example, Kuraltil Tablets), which allows you to improve the power of the tumor. It is possible to appoint antispasmodic drugs, hepatoprotectors.
• Eastic placental insufficiency. Recommended bed regime. Enter hynipral. The imposition of seams on the cervix is \u200b\u200bimpossible due to the high risk of damage to the nodes.
• Placental insufficiency. Therapy is carried out only in the hospital. Disposable by Kuraltil, Aktovegin, Magne B6 and other drugs.
• Node dysfunction. In this case, the well-being of a woman worsens, abdominal pain arise, the total body temperature rise, the threat of abortion is developing. Therapy implies appointment antibacterial drugs, spasmolitics, desensitizing drugs. If a medical therapy Does not give effect, but, an operation to remove a node is carried out.

Other indications for conducting an urgent operation with uterine and pregnancy:

• infringement of the uterus in the cavity of a small pelvis;
• breaking myomatous node;
• the development of peritonitis;
• necrosis neoplasm;
• moma transition to malignant shape.

Pregnancy tactics

Preservation of pregnancy in priority in such situations:

• woman desire to keep the child;
• term of more than 24 obstetric weeks;
• pregnancy after prolonged infertility.

Indications for interrupting pregnancy in the world are as follows:

• necrosis development Novo formation;
• the localization of the myomatous node in the cervix and the development due to this elderic-cervical insufficiency, miscarriage, bleeding, intrauterine infection of the embryo;
• multiple mioma with more than 15 cm;
• severe concomitant diseases of the small pelvis organs;
• the age of women is over 45 years old and the presence of high-risk factors.

How are childbirth?

Hospitalization of a pregnant woman with a diagnosed Moma of the uterus occurs on a period of 37-38 weeks. Surveys, determine the state of the fetus and placenta, the opening of the cervix. According to the results of the survey conducted, the doctor makes the choice of tactics of childbirth.

If there are low risk factors, natural labor is allowed, in difficult cases, a cesarean section is shown.

IN obligatory Cesarean is held in the following cases:

• the presence of a scar on the uterus;
• multiple mioma;
• large sizes of nodes;
• localization of the tumor in the lower departments, which will prevent the natural movement of the fetus;
• pelvic prevention of the fetus;
• suspicion of mischief tumor;
• suspicion of necrosis of myomatous node;
• the presence of concomitant diseases.

Conducting hysterectomy during the cesarean section, that is, the removal of the uterus is possible with the following readings:

• the presence of multiple nodes in the woman in labor over the age of 40;
• repeated development of the tumor after the operation to remove - mioectomy;
• necrosis of the tumor located in the wall of the uterus.

After pregnancy and childbirth in most cases there is a tendency to stop the growth of myoma, which is the result hormonal perestroika In the body, lactation, the use of hormonal contraceptives.

Myoma uterus during pregnancy has different factors risk. Much depends on the type of tumor, its size and location, progression. In some cases, no treatment is required, in other situations, medication therapy and surgical intervention are carried out in the presence of indications. Natural childbirth is possible or conducting cesarean sections.

Submucose mioma uterus is a tumor of a benign character. It develops B. muscular fabric Uterine under the mucosa, the growth of formation is directed inside the cavity of the organ.

When submucosic Mioma of the uterus is diagnosed, what it is - a question that is disturbed by a woman. This tumor on the ICD 10 has a benign nature.

In contrast to other species, submucose is characterized by a rapid increase in sizes, pronounced symptomatics and a fairly frequent transition in a malignant form.

According to statistics, the submucous mioma is about 30 percent of the total number of uterine tumors. It develops more often in women in reproductive age.

The exact causes of the development of pathology cannot be called, but most often the culprit is a violation of the hormonal balance.

Submucose mioma uterus: symptoms and signs

Mioma with submucose node location often on initial stages Developed hidden. And only when purchasing large sizes The woman has the following:

• which lasts longer than usual;
• when menstruation;
• which gives to the lower back and the bottom of the abdomen;
• general weakness and ailments;
• the impossibility of conception when planning pregnancy;
• an increase in the circumference of the abdomen at large tumor sizes.

Mioma with submucosic growth of a node of small sizes practically does not give any symptoms.

Is this a terrible disease? A sharp increase in body temperature with acute pain at the bottom of the abdomen can point to the gap or twisting the myomatous node. In this case, emergency medical care is required.

Pregnancy

- Concepts, fully compatible with small education sizes. The answer to the question, in the presence of a swelling tumor, positive, again, with a small size of the latter. In this case, education does not interfere with the passage of male genital cells in the uterine cavity.

But if the submucose tumor increases rapidly in size, then it gradually fills the uterine cavity. With the conception, it will prevent the growth of the embryo. What is dangerous such pathology? First of all, miscarriage what happens most often in terms of more than 11 weeks.

The reasons

Submucose Mioma of the uterus, the treatment of which should be carried out immediately, is able to develop in women for the following reasons:

• diseases causing hormonal imbalances;
• inflammatory I. infectious diseases bodies of the reproductive system;
• long-term use of hormonal contraception;
• sharp decrease or increase in body weight;
• constant stressful situations;
• hereditary factor;
• lack of childbirth and lactation until 30 years of age.

Cause the development of the submembress tumor can one cause or a set of several. Reveal accurate cause Only the doctor is capable based on the survey data.

Diagnostics

Diagnosis of education in the uterus in most cases occurs when examining a gynecologist.

• Ultrasound. The study is carried out by a transabdominal or transvaginal route.
• Hysterosonography or intrauterine echography. It is carried out if a woman has abundant uterine bleeding.
• Three-dimensional echography. This technique makes it possible to get the most objective information.
• Dopplerography. Allows you to identify structural changes in the tissues of the uterus and predict the further growth of myomatous node.

After diagnosing and receiving data, the doctor will choose the necessary treatment tactics.

Treatment methods

Some time ago, the operation at submucosic uterine of large sizes was the only way to treat. In most cases, when removing the tumor was removed and the uterus.

Today, not only operational treatment is applied, but also conservative.

If the submucose uterine submucosic mioma is diagnosed, treatment without surgery is possible under the following conditions:

• small sizes sublizmoy Moma - not more than 12 weeks;
• lack of a rapid growth of the node;
• the presence of the patient of children and the desire to have them in the future.

The main goal of conservative therapy is to save reproductive function and suspension of the growth of myomatous nodes.

For this purpose, hormonal treatment is prescribed:

• Antigonadotropins. Apply with small tumor sizes. The goal is to stop the growth of Moma. It is also appointed at the stage of preparation for the operation. Effective drug - Gestrinon.
• Gnork agonists. Preparations suspend the growth of nodes, and also contribute to the decrease in their size. Similar therapy eliminates pain sensationsAnd also stops bleeding. Appointed drugs - Bususelin, Zoladex, Triptorelin, Gozerelin. Feedback after such therapy, as a rule, positive.

In parallel, the doctor prescribes symptomatic therapy:

• anesthetic drugs;
• sedative;
• means against anemia;
• vitamins complexes.

When passing conservative treatment, a woman should make a visit to your doctor at least twice a year.

Surgical intervention

Depending on the diagnostic data, the patient may be proposed operation as the only way of therapy. Need to understand that surgery Often is the most effective techniques In the presence of a submembrance of myoma.

Refusal of the operation at the initial stages of the tumor development can lead to the fact that hysterectomy will be required in later deadlines, that is, not only the removal of education, but also.

If there are submucosic uterus, the sizes for the operation are determined by the doctor. Indications for holding surgical intervention:

• large size of education - more than 12 weeks;
• rapid increase in nodes;
• severe pain;
• abundant bleeding from the uterus.

With operational removal of the swelling, the following techniques are applied:

• . The goal is to stop the nutrition of the tumor and its gradual resorption. For this, the administration of the catheter is injected with a medicinal substance.
• Laparoscopic Miomectomy. Tumor removal is carried out using laparoscope.
• Laparotomic Momectomy. A full-fledged operation at which the removal of the myomatous node is carried out by cutting the pure tissues.
• Hysterorezectoscopy. Removing a node using a hysteroscope.
• Hysterectomy. With this form of operation, not only a myomatous node is removed, but also the uterus.

ethnoscience

Question about the treatment of submucosic uterine folk remedies Interested in those women who are categorically against traditional treatment.

Opinion on greater effectiveness of herbal fees in contrast drug addicts Not always faithful.

When taking plant tools, a doctor consultation is required. It must be understood possible consequences refusal of therapy appointed by the doctor.

Each woman who collided with such pathology as the Mioma of the uterus should be understood that even after successfully conducted surgical intervention, there is always a risk of recurrence. Therefore, it is so important to periodically visit the gynecologist for inspection and do ultrasound. Such measures allow us to promptly learn about the re-development of education and minimize the risk of possible complications.

On video about treatment

Myomas of the uterus today is a fairly common phenomenon, the frequency of its diagnosis during pregnancy has increased. It is quite logical that the woman of childbearing age increasingly appear questions regarding the ability to become pregnant in the presence of the uterus, or after its removal, about its influence on the course of pregnancy and the methods of its treatment during the baby tool.

The influence of misa for pregnancy.
Immediately it must be said that myoma is a benign tumor, arises against the background of the growth of muscle fibers of the uterus walls. Immediately clarify that any tumor education in the uterine cavity sooner or later leads to its increase. Moma's growth can be very fast, but may not be observed at all, and for quite a long time. During the tooling of the fetus, the uterus is also increasing in size corresponding to one or another period. That is why the increase in the uterus is initially associated with pregnancy, and only according to the results of the ultrasound is made an accurate diagnosis.

Momoma really makes it difficult to conceive the process, since its size is pressed to the fallopian tubes, putting obstacles to the movement of spermatozoa, and also violate ovulation. As such, it is not the cause of infertility, but its removal significantly increases the chances to conceive the baby, unless, of course, its size does not exceed the twelve week of pregnancy. With more significant sizes, the tumor leads to deformation of the uterine cavity, as a result of which, after surgery, it is quite difficult to preserve the childbearing function as the removal large Moma It is often accompanied by strong bleeding, and in some cases the uterus specialists are forced to simply remove.

In the first months of pregnancy, complications may occur against the background of Moma, it occurs mainly with the close position of the tumor with the placenta. In this case, the sizes of the tumor are no less important. With small myomatous nodes, pregnancy proceeds without complications, and the tumor itself does not exhibit itself.

Mioma in the second and third trimester of pregnancy increases the risk of miscarriage, as well as premature birth. This happens as a result of the fact that myomatous nodes leave less freely for the fetus, moreover, stimulate the contractile activity of the uterus. In this situation, the location of Mioma and its distance from the placenta plays an important role (there is a contact).

Large tumors can affect the normal growth and development of the fetus. Often there are cases of low weight children on the light, with a changed form of skull, curvature neck, etc.

Most specialists converge that the uterus moma affects the generic process, significantly tightening it. Also, if it is presented, experts more often decide on cesarean sections. In this situation, the Mioma itself, as such, prevents childbirth, and a significant amount of myomatous nodes in combination with the pathologies of the position and prevention of the fetus (transverse, pelvic and facial preview). Sometimes, if the incision of the cesarean cross section coincides with the location of the Mioma, the doctor can delete it.

It should not be noted that pregnant women in the presence of Moma often there is a detachment of the placenta, especially with the retretsentar (behind the placenta) of the tumor location. During the generic process, doctors take into account this feature of the tumor.

In the postpartum period, Mioma can also give complications, both at once (bleeding against the background of the low tone of the uterus) and after a satisfied large period of time (infectious diseases, there is no achievement by the utensil sizes).

Pregnancy planning in the presence of uterine misa.
At the planning stage, it is necessary to take into account such facts as the location of the Mioma, its trends towards the growth, the size of the nodes. If the location of the nodes leads to the deformation of the uterine cavity, it is impossible to become pregnant in principle, since spermatozoa, without reaching the phallopy pipes, we are settled on their surface, and without having ever met with an egg. In this case, the nodes are subject to mandatory removal.

If the nodes are small and are in the thickness of the wall of the uterus or outside, there is no deformation of the cavity, then the probability of pregnancy is quite high. It should only be said that in the event of fertilization, a woman may have problems with tooling the fetus.

If a woman has a myomatous node on a thin leg, then there is a high risk of its twisting during pregnancy, and this, as a rule, leads to surgical intervention and often to miscarriage. In this situation, at the stage of pregnancy planning, these nodes are urgently recommended to remove.

It is also important to note that if, according to the ultrasound, a tumor predisposition was established to rapid growth (an increase of two times within six months), then pregnancy planning is prohibited. This is due to the high risk of an increase in myoma when having toed out, which provokes a nutritional disorder in the node, and this is already fraught with non-peculiar pregnancy. At the planning stage, this tumor must also be deleted in advance.

In the case of the uterine of large sizes (4 cm in diameter and above), it is also worth postponing, because, firstly, it is unlikely (on the background of endometrial pathology), and if it happens, it is fraught with miscarriage, since the probability of miscarriage and Fetal disorders, which will lead to surgical operation. Nodes are also subject to removal at the planning stage of the child.

Growth of Moma during pregnancy.
None of the Medic will be religious to answer how the tumor will behave during pregnancy (with its presence before conception). Here the genetic factor plays a big role. In most cases, the growth of MIOM is observed in the first two trimesters of pregnancy, and in the third, on the contrary, their decrease is noted. As a rule, when entering the fetus, the Moma is reduced in size on average by thirty-five percent, but there is still a small percentage of cases of increasing MIOM when having been heated twice, but it practically does not complicate and does not complicate pregnancy. However, the destruction or degeneration of myoma may contribute to various complications. This process is combined with necrosis of tissue of collapsed misa, bleeding, creating cyst, etc. Such a phenomenon may occur, directly, on any time of pregnancy and after the delivery. In this case, the location of the Mioma is important.

Why moma destruction occurs during pregnancy, to the end is unknown. This can be promoted hormonal (increase in the level of progesterone), vascular and mechanical changes (violation of the blood supply to the neoplasm due to thrombosis). This process is accompanied by pain in the node location zone, an increase in the tone of the uterus, an increase in body temperature, an increase in the level of leukocytes in the blood and the rate of erythrocyte sedimentation. Moma degeneration is diagnosed with ultrasonic research. Initially, the patient recommends a bed mode and analgesics are appointed, while maintaining pronounced symptoms is hospitalized for further inpatient treatment.

Operational treatment is appointed in exceptional cases in the presence of absolute indications (severe fever, leukocytosis, deterioration of the general condition, pain in the stomach of acute character, uterine bleeding). Often, during operational intervention, it is possible to preserve pregnancy.

I will note that Moma, which grew in the first months of pregnancy, after birth can not even declare themselves. After childbirth, as the uterus returns to its original state, the location of myomatous nodes may vary.

Treatment of misa during pregnancy.
Initially, Moma's therapy is conservative and aimed at suspending the growth of benign education. Methods in each case depend individual features Tumors and causes of its development. During the baby tool iron-deficiency anemia A pregnant woman can be provoking the growth of Moma factor. It is this fact that serves one of the arguments of a constant study of the blood of a woman in this period.

Therapeutic and prophylactic measures for the uterine Moma are the reception of iron, ascorbic and folic acid, vitamins of a group B, a diet with a predominance of protein food. Vitamins E and A are also recommended, which favorably affect the neuroendocrine system and reduce the sensitivity of the genital organs to estrogen.

With a violation of lipid metabolism in a pregnant woman with Moma, she corrected nutrition: strongly limit the consumption of carbohydrate food, they exclude any animal fats (they are replaced with vegetable), include more fresh juices from vegetables and fruits in the diet.

After the reception, the woman prescribed hormonal means with progesterone, which reduces the ability of cell division, preventing the tumor growth. If it is impossible or unsuccessful attempts to stop the growth of Mioma, a decision on operational treatment is made (conservative momectomy - removal of nodes with the conservation of the uterus).

Laparoscopy technique (operation performed using endoscope and tools under the control of the camcorder installed in abdominal cavity) Significantly reduces the risk of sauques in a small pelvis, which in the future helps to preserve the passability of phallopy pipes, and this is one of the main factors of the occurrence of pregnancy. Treatment technique with laparotomy ( extensive operation, everything makes the surgeon manually) is conjugate with the high risk of adhesion formation, and their formation may occur as in the small pelvis and in the abdominal cavity. In the future, this leads to infertility, and sometimes to complications from digestive system (for example, adhesive intestinal obstruction). However, the large sizes of the nodes in the method of laparoscopy do not allow to enter the uterus, as required, due to the peculiarities of the technique, the angle of the abdominal tools, some technical moments.

As a result, laparoscopy is carried out by women planning pregnancy if the size of the nodes does not exceed 5-6 cm. To sewing the uterus in this case, the skill and experience of the surgeon is required. To remove large-sized nodes, there are new technologies of strokes of the uterus, but at the same time the risk of rupture of the uterus in the log is significantly increasing.

If the nodes are exceeded in diameter 9-10 cm, the risk of rupture of the uterus on the header is significantly higher than the risk of adapted formation due to laparotomy. Therefore, it is recommended to abandon laparoscopy and open the abdominal cavity to excite the tumor.

After removing the uterine's mioma, regardless of the technique used, it is possible to plan a conception only eight or twelve months, it all depends on the size of the remote tumor.

It should be noted that after removing the Moma, the conduct of childbirth can be carried out natural wayIf remote nodes were no more than four centimeters in diameter, if there are no complications during pregnancy and after childbirth, if the scar in the uterus is satisfactory. Also, the age of women play a huge role. In other cases, the cesarean section is shown.

Multiple Mioma uterus.
It also happens that several myomatous nodes are formed in the uterus, and different in size. It is very difficult to plan a pregnancy in this situation, since the removal of such formations can lead to the fact that there will be no healthy tissue in the uterus. In such situations, doctors prescribe only those nodes that interfere with the attachment of the embryo, tend to grow, prevent the fetal tooling and may cause complications, etc. After the delivery can be used to excision of the rest of the nodes, or it can do doctors during the cesarean section.

One of the difficult problems of modern obstetrics is a combination of misa of uterus and pregnancy. In many patients, this state proceeds normally. However, there is always a risk of developing severe complications that can lead to a loss of not only pregnancy itself, but also the uterus. Causes of such complications:

• the tumor itself (large size of the node, violation of its power, unfavorable location, scars after transferred by momectomy);
• the factors that caused its (hormone imbalance, endometrial injuries, adnexitis and others).

Women are often interested in the question: is it possible to get pregnant with the Moma of the uterus? The probability of pregnancy depends on the location of the foci of the tumor, their quantity and size. With small clusters of cells located in the thickness of the uterine wall, the offensive and development of pregnancy can flow normally. With large nodes, especially located in the variant, in the mouth uterine pipes, rapidly growing, the ability to get pregnant low. If the embryo has formed, the risk of complications and the pathology of the fetus.

Changes in the uterus during pregnancy

The presence of uterine and the fact of pregnancy affect each other. During the tooling of the child, myomatous cells change, and the feature of the placenta is violated.

There is a breakdown of blood supply and nutrition of the tumor nodes. Especially often such changes occur at small single foci, located on the outside of the myometrium, that is, stiffitically. Subserosania mioma can be complicated by the twisted leg of the tumor. The risk of such a state increases with intensive physical activity, Hyperthonus of uterus, pregnancy pregnancy with eductions and an increase in blood pressure.

In case of hemorrhage into a myomatous node or its rapid growth, ahead of the growth of capillaries, the degeneration of moma tissue occurs.

The placenta is affected most often when it is arranged over a large myomatous hearth. At the same time, the structure of the placenta vessels is disturbed, they become short, defective, often thrombus. Chorion's vapors are underdeveloped and dystrophic. As a result, placental insufficiency is formed.

The most expressed circulatory disorders in the placenta in late dates before childbirth. Therefore, such women are recommended to perform a planned caesarean section on a period of 38-39 weeks of gestation.

Examination of pregnant women

Initially, there is a question of pregnant, specifying the number of pregnancies and childbirth, the presence of abortions, operations in the uterus and other manipulations. Find out the hereditary predisposition to this disease. Notes the presence of undeveloped and induced pregnancies, miscarriage, the birth of unviable children.

Generalization is evaluated general state Health. Special attention is paid to such states as diabetes, Pyelonephritis, hypertension.

Gynecological research is designed to identify the location and size of myomatous nodes. To clarify the obtained data is necessary with the help of ultrasound. The ultrasound helps to determine the quantity, location and nature of the growth of tumor foci, their size, structure and location relative to the placenta. In addition, the doctor follows the development of the fetus.

Risk factors for pregnancy pathology in the Mome

Factors increasing the likelihood of development of pathology:

• burdened obstetric anamnesis (birth in the past of a non-visual child, infertility);
• scars in the uterus after any transferred operations;
• concomitant diseases, in particular, varicose veins of a small pelvis;
• features of the location of the nodes are intertensive, cereal, striking, in the lower segment, with centripetal growth);
• the size of the largest focus is more than 8 cm;
• pronounced myomatous changes, that is, the presence of five or more nodes;
• centripetal (directed inward) tumor growth or submembraty node leading to deformation of the organ cavity;
• the location of the placenta above the node;
• swelling, necrosis, dystrophy of myomatous focus;
• age of 30-35 years old, when a decrease in the ability of the cells of myometrium stretch and shrink.

So, the low probability of complications is available in young women without scars in the uterus and related diseases that have up to 5 nodes of up to 8 cm. These formations are located in the body and the bottom of the organ, do not cause unpleasant sensations In a woman and grow towards the peritoneum, that is, out. The placenta is located away from the node. Myoma uterus of small sizes during pregnancy does not usually progress. The development of the fetus usually proceeds without complications. Sometimes, as the embryo grow, myomatous nodes are shifted to the side, towards the peritoneum, or vice versa, closer to the uterus, deforming it.

In other cases, pregnant refers to a high risk group. She may be asked to interrupt pregnancy.

Complications of pregnancy on the background of Moma

In patients with high-risk groups, specific and non-specific complications may develop.

Specific:

• impairment of the blood supply to myomatous nodes;
• eastic-cervical insufficiency as a result of the cervical target of the tumor;
• the rapid growth of the neoplasm (proliferating mioma);
• fetoplacentar insufficiency;
• thrombosis of pelvic veins;
• gap on the header after Momectomy.

Nonspecific:

• miscarriage or premature childbirth;
• premature;
• rustling of chorion village;
• gestosis;
• anemia.

The frequency of miscarriages in women with high risk is up to 60%, premature labor arise from a quarter of such patients. In the threat of pregnancy interruption, generally accepted treatment regimens, including antispasmodic agents, antiagregants, vitamins, duphaston are used. A semi-respective or bed mode is assigned, it is recommended to refuse sexual activity and physical exertion.

In the exterminated cervical insufficiency of the seams on the neck, they are not imposed in order to avoid damage to myomatous nodes. The bed mode is used, the introduction of the Ginipral.

With the rapid growth of the tumor, antiagregants are prescribed (chief), which improve the nutrition of the node. In more severe cases, antispasmodics, cocolics, freshly frozen plasma, hepatoprotectors are shown.

For the prevention of placental insufficiency in a high-risk group, aspirin, chief, multivitamins and foliic acid. Treatment of placental insufficiency is carried out in the hospital. Reopolyglyukin, freshly frozen plasma, Trental, Actovegin, Eufillin, Magne B6, Kuraltil.

Mioma of the uterus during pregnancy can be complicated by the power disorders of the node. Pains appear at the bottom of the abdomen of different character, the body temperature increases, the general state of the woman is worse. There is a threat to interrupt pregnancy. Treatment includes antispasmodic, antibacterial, desensitizing agents. In the absence of the effect of therapy, the node (momectomy) is deleted within 3-5 days. This is possible only in the case of subserosny misa.

Cases when you have to resort to surgical intervention:

• necrosis (purulent melting) node;
• peritonitis;
• malignant transformation of myoma;
• infringement of the uterus in the cavity of a small pelvis;
• breaking a node capsule.

Pregnancy tactics

• persistent desire for the patient;
• appeal in terms of more than 24 weeks, when there is a viable fetus;
• long infertility when the child is long-awaited;
• the ability to interrupt pregnancy only by small cesarean sections.

Indications for the interruption of pregnancy at the Moma:

• suspected by malignant neoplasm in any organ;
• submucose mioma of the uterus;
• necrosis node;
• the location of the focus in the cervix with the development of eastic-cervical insufficiency, the intrauterine injecting the fetus, bleeding, miscarriage;
• the size of the neoplasms is more than 15 cm or their large number;
• age of women older than 45 years in combination with risk factors;
• severe concomitant diseases.

Childbirth and postpartum period

Pregnant women are hospitalized in 37-38 weeks. Explore blood coagulation indicators, the state of the placenta and the fetus, determine the maturity of the neck. Taking into account the risk factors choose the tactics of labor. Women with low risk are possible natural childbirth. In more complex cases, the cesarean section is preferable. If such patients try to behave naturally, you can call heavy complications - detachment of the placenta and the uterus break.

Caesarean section in scheduled order is performed in the following cases:

• nodes located in the lower departments preventing the promotion of the fetus;
• multiple or very large nodes;
• scar in the uterus;
• violation of nodes, which in childbirth may increase and lead to necrosis;
• pelvic prevention of the fetus;
• suspicion of necrosis or malignant rebirth;
• accompanying illnesses.

Cases when during the cesarean sections remove the uterus:

• multiple foci in women older than 40 years;
• necrosis of the node in the thickness of myometrium;
• recurrence of tumor after momectomy;
• sublifting or intercoupes, centripetal growth and other unfavorable location features.

After pregnancy in most women, the growth of Moma slows down or stops. This promotes breastfeeding and application hormonal means Contraception. Moma's growth prevention serves repeated pregnancy and childbirth two to three years.

IN last years In obstetric practice, women are increasingly found reproductive agesuffering from the uterus and planning the conception of the child. A doctor who observes such a patient has to solve a difficult question: is pregnant with this pathology acceptable if the baby is not fulfilling an impossible task? To unambiguously answer this question, it is necessary to evaluate the state of the health of the woman, to determine the severity of the course of the disease and find out other factors that can interfere with the implementation of the reproductive function.

We hurry to clarify: Myomas of the uterus and pregnancy are fully compatible, but only subject to certain conditions and fulfill all the recommendations of the doctor. After all, if one women manage without medical intervention to take and give birth healthy child, I can not avoid other preliminary treatment. How does mioma affect the course of pregnancy, and what should every woman know about this problem?

Overview of the disease

Before talking about possible risks For a woman and her baby, it should be understood. This diagnosis is made when identifying muscular layer Matties benign tumor. Pathology is found during the gynecological inspection or with an ultrasound, the diagnosis is confirmed during hysteroscopy or laparoscopy. Other diseases of the disease - Leiomiomioma, Fibromyoma (Fibrom).

This is what the mioma of the uterus on the foot with dimensions of 6.8 x 5.3 cm with ultrasound examination looks.

On a note

Myoma uterus is more often found at the age of 35-45 years. In young patients, in menopause - with an endometrial hyperplasia.

On localization, three versions of nodes are distinguished:

• Subserosny - grow in the direction of the outer shell of the uterus;
• Submucous - deform the uterine cavity;
• Interstitial - do not go beyond the muscular layer.

• Violation menstrual cycle;
• Acyclic uterine bleeding;
• Chronic pelvic pain.

The treatment of the neoplasm is engaged in a gynecologist. When the first symptoms appear to make an appointment and receive detailed advice. The sooner the diagnosis is made and the treatment has begun, the greater the chances of a woman for a favorable outcome of pregnancy.

Under influence hormonal changes Myomatous nodes may increase in size, so the earlier myoma is revealed and the smaller its size, the greater the chance to cure the tumor conservatively.

Pregnancy with moma: what you need to know

Some statistics designed to shed light on some aspects of pathology:

• Mioma of the uterus sooner or later arises almost all women (up to 85%);
• Clinical manifestations of the disease are found only in 30% of patients;
• During pregnancy, the tumor is observed in 0.5-4% of cases;
• In 60% of patients, there is a slight change in the tumor in size (in any direction), 40% the diameter of the node does not change;
• In 20-25% of cases, an increase in education is noted (characteristic of - from 5 cm);
• The maximum growth of myoma goes in the II trimester, minimal - after 24 weeks;
• The total diameter of the tumor increases by no more than 25% (an average of 10-12% compared to the initial size);
• In 8-27% of cases, regress or decreases are noted;
• In 60% of future mothers, medium-sized nodes (2.5-5 cm) are not determined on the ultrasound at the end of the pregnancy period;
• The tumors of small sizes (up to 2.5 cm) are more often stabilized (do not grow and do not decrease);
• Complications during pregnancy in the presence of Moma are found in 15-40% of cases.

So, to enter and give birth to a child with a momer of the uterus, it is possible, that's just this period will not be the easiest in the life of a woman. Of course, against the background of complete health, pregnancy passes much easier, but this does not mean that in the presence of a tumor you need to put a cross and refuse to become a mother. Modern medicine It allows you to give birth to patients with rather heavy diagnoses, and the uterus myoma is not the most difficult case in obstetric practice. In compliance with the recommendations of the doctor, a woman has every chance to pass this difficult stage without significant problems and complications.

Myoma uterus is not a contraindication to pregnancy, but its presence can complicate the enhancement of the fetus.

How does the new formation behave when to wear a child

The state of the tumor directly depends on the period of gestation and the level of hormones during this period.

On the early timing Pregnancy marked a gradual increase in myomatous nodes in size. Such a phenomenon is associated with the rapid growth of progesterone - the main hormone responsible for the possibility of tooling the fetus. Maximum growth is up to 8 weeks due to proliferation and tissue hypertrophy. It is at this time that the spontaneous miscarriage is most often happening as a result of growing mioma.

After 8 weeks of pregnancy, the cell hyperplasia is blocked, and the further increase in myoma is explained by the edema of tissues and hemodynamic disorders. The next jump growth jump is observed in the II trimester (12-24 weeks), when the placenta is formed and the blood supply to the tumor changes. At the same time, it is not excluded with the advent of the corresponding symptoms of acute abdomen.

In the third trimester of pregnancy, myomatous nodes stabilize in size. This is due to a decrease in the level of progesterone and its stabilization until the end of the gestational period. Part of women on the period of 36-38 weeks, the tumor is not determined on the ultrasound. This does not mean that the knot is completely left - it only decreased to the size of invisible in ultrasound examination.

After the birth of a child, for some time myoma remains the same, then again begins to grow and for 1-2 years it returns to its former sizes. It is observed that prolonged breastfeeding and lactation amenorrhea slow down the proliferation of tissues and the activity of the tumor. From part of women, the nodes are not defined and several years after the birth of a child. Predict in advance how the tumor behaves in a particular patient, it is almost impossible. The question of, we disassembled in another article.

Each case of pregnancy with the Moma is individual and requires a special approach and control of the growth of myomatous nodes.

On a note

The mioma of the uterus is unlikely to completely resolve during pregnancy, but it is capable of decreasing to clinically insignificant sizes.

Understand which complications of pregnancy can create momas in the uterus will help interesting videodevoted to this problem:

Conception during pathology: Is there chances?

Fibromyoma as the only pathology quite rarely gives such a complication as infertility. Tumor does not affect hormonal background And usually does not prevent conception. Problems arise later: at the stage of implantation fruit eggWhen you wear from the earliest time. Many women are repeated repeatedly, only not always to convey such pregnancy to the latter period.

What situations are infertility on the background of Moma?

• A benign tumor is located at the mouth of the uterine pipes. Mioma overlaps the clearance and mechanically prevents the sephematozogeon meeting with the egg. Natural way The conception is impossible, shown Eco. In the article "" we considered the main aspects of this procedure for pathology;
• The tumor is combined with other diseases of the female reproductive sphere: endometriosis, cure ovary. In this case, the tumor goes like a concomitant pathology. It affects the possibility of conceiving a child, but does not act as a key factor;
• Mioma arises against the background of significant hormonal disorders. We are talking about endocrine infertility, while the tumor itself is only one of the factors that prevent pregnancy.

Myomatous knot can overlap clearance fallopeye tubethat becomes the cause of infertility.

It also happens that during the examination for infertility, nothing except Mioma is detected. In such a situation, the doctor, of course, will suggest to get rid of the tumor, because it does not see any obvious causes of the problem. After receiving hormones or operation, many women manage to conceive and endure a child. Even after removing myoma, the question remains not solved, you should look for a different reason for infertility.

Diagnosis of tumor during pregnancy

Detect Mioma in a pregnant woman helps ultrasound. This is the easiest, secure and affordable method used to detect the tumor and its complications. Ultrasound can be carried out on any pregnancy rate without harm to the child. Quite often, the neoplasm is first detected during the gestation.

Echo angkingons of the disease do not differ from those outside of pregnancy. located in the bottom or body of the uterus. Special attention deserve such options for the localization of Mioma:

• Submucosic node - is able to deform the uterine cavity and lead to spontaneous miscarriage;
• A tumor located near the field of attachment of a fetal egg can also cause abortion. After 16 weeks of fibromyoma, localizing near the placenta, interferes with the flow of nutrients to the fetus, may cause delays in its development and hypoxia;
• Or close to the outer zev - a reason for the planned caesarean section.

Myoma uterus on ultrasound during pregnancy

Important aspects that are worried about many women:

Is it possible to confuse Mioma and developing fruit?

Yes, for gynecological inspection. The increase in the uterus goes and during pregnancy, and with the growth of myomatous node. If the tumor does not germinate to the serous shell, the surface of the uterus remains smooth, and in this case you can confuse one state with another.

On a note

During pregnancy, certain changes in the cervix and the mucous membrane are noted, which does not occur during the formation of a tumor. Attentive doctor, most likely, will notice the difference and will suspect Mioma.

When conducting ultrasound, distinguished Mioma and pregnancy will not be much difficult. The fetal egg has distinctive echo-discs, and already in 6 weeks the heartbeat of the embryo is determined. You can only confuse these states on very early time when the tumor and the pregnancy is visible as some kind of formation in the uterine cavity (as well as with poor resolution of ultrasonic equipment).

So the ultrasound looks like mioma (25 x 13 mm) and pregnancy for a period of 6 weeks.

What if the neoplasm first revealed during pregnancy?

It happens that the diagnosis is made only when conducting the first ultrasound screening for a period of 12-14 weeks or even later. After the examination, the doctor will give its recommendations for further tactics.

When I detecting myoma in a pregnant woman, attention is paid to such moments:

• The number of nodes and their localization. It is very important to find out where the fibromyoma grows: in the uterus cavity or outward to the organs of a small pelvis. This is a key aspect that determines the further course of pregnancy and childbirth;
• The location of the neoplasm relative to the fruit egg (placenta);
• Blood flow around the node;
• The state of the fetus: the correspondence of the term of gestation, heartbeat, the presence of vices.

If myoma appeared already during pregnancy, it is also not a reason for panic. In this case, the node is still too small to seriously harm the fetus. According to gynecologists, small-sized tumors usually does not interfere with the safe tooling of the fetus and does not interfere with independent birth.

Can not see the pregnancy because of Moma?

Yes, if the tumor is large enough, and the embryo is too small. In this case, it is recommended to repeat the ultrasound after 1-2 weeks.

Can a pregnancy test show a tumor?

The pharmacy test strips react to the content in the urine of the hCG - hormone standing out after the child's conception. It is noticed that in rare cases, chorionic gonadotropin is detected with the Moma, but more often - when malignant tumors uterus. If the test showed a positive result, you need to pass the blood to the definition of HCG, make an ultrasound and get to the gynecologist.

Moma's symptoms in pregnant women: how does the disease manifest

If a woman has found Mioma during gestation, she needs to know how this pathology takes place and pay attention to the following signs:

• Lower abdominal pain. The tumor in the muscular layer can give an unpleasant pulling sensations over the Lone, giving in the back, crotch, on the thigh. Such pain is often taken for signs of threatening miscarriage, which leads to unreasonable hospitalization in the hospital;
• . Alla or brown discharge It can be both a manifestation of Mioma and a sign of the miscarriage. Requires a gynecologist. It is worth noting that the tumor is extremely rarely manifested by bleeding during pregnancy;
• Signs of comprehensive pelvis organs: rapid and difficult urination, constipation. Such symptoms are found almost in all pregnant women and without mioma, so these signs are quite difficult to differentiate.

On a note

In 50% of all future mothers, pathology proceeds as impatient.

If there are moma during pregnancy, you need alertness to some symptoms (pools at the bottom of the abdomen, bleeding), as they can testify not only about the manifestation of the tumor and its potential growth, but also about the threat of pregnancy interruption.

Anxiety symptoms during pregnancy:

• Catching strong pain At the bottom of the abdomen;
• Bleeding of any intensity;
• Acute urine delay;
• The leakage of spindle water;

The emergence of such symptoms indicates the development of complications and requires urgent appeal to the doctor.

Is it worth planning a pregnancy in the presence of Moma?

Should I give birth to the Moma or risks too high? Before answering this question, all existing factors should be assessed:

1. Localization of nodes (in the bottom, body or neck, on the front or rear wall). Interstitial tumors with centrifugal growth and subseasonous misers usually do not interfere with the conception and drying of the child. Problems arise mainly at the collapse of the uterus and interstitial miomes with centripetal growth;
2. Sizes of nodes. The greater the tumor, the higher the probability of complications;
3. The number of formations in the uterus. With multiple nodes, the forecast is worse;
4. State of blood flow in the uterus. If there are signs of necrosis of myoma, the tumor needs to get rid of pregnancy;
5. The presence of concomitant pathology. The simultaneous development of endometriosis or endometrial hyperplasia takes the course of pregnancy;
6. Age: The older woman, the higher the probability of complications. After 35 years (when myomas is usually detected), the number of other gynecological pathologySomatic diseases are superimposed, which increases the risk of complications. It is important to understand that reproductive period Women are limited. It happens that after long-term treatment, the patient can no longer have children due to the onset of Klimaks;
7. Reproductive history. Intelligence in history - another reason for preliminary treatment of myoma.

Moma's pregnancy planning should begin with a comprehensive survey to identify the risk factors for non-banking and developing complications

How to be? First treat the tumor, and then pregnant, or still on the contrary? An unambiguous answer to this question is impossible, and tactics are determined individually for each woman after full examination. Great importance Have a reproductive patient plans. If a woman does not want to become a mother in the coming years, there is no point in prescribing hormones or carry out an operation to stabilize the nodes. After 3-5 years, when the patient decides to conceive the child, the nodes can grow again, and the next course of therapy will be required.

It's important to know

It is only a stable and asymptomatic miomer. If the tumor grows or worries a woman, treatment is carried out soon.

In the therapy of the Moma uterus to pregnancy, such methods are practiced:

• Before conceiving a child. Stabilize the nodes help Kok and agonists gonadotropin-rillation hormones;
• Embolization of the uterine arteries - the method of choice for women planning pregnancy during the Moma;
• Conservative Miomectomy. After surgery, the scar remains in the uterus, which will be indicated to Cesarean section.

On a note

According to the reviews of women and gynecologists, AM is the best option For the treatment of myoma. If there is such a technical opportunity, doctors direct their patients on embolism. The procedure is well tolerated, does not violate fertility, and pregnancy occurs over the coming months. After an EMA, the tumor does not grow, the baby tooling is passed without complications. The most important thing is that the scars on the uterus remains, and the woman who suffered an AM, can give birth to a child through natural labor paths.

The procedure of the EMA does not require cuts and is a minimally invasive operation.

You can plan a pregnancy immediately after the abolition of hormones and the restoration of the menstrual cycle. After the operation, it is recommended to wait at least 3 months.

Complications: What threatens the pathology of the future mother and baby

Fibromomomomomoma uterus leads to the development of such undesirable consequences:

• The threat of interrupting pregnancy capable of miscarriage in the early stages or premature Rodam (after 22 weeks);
• Eastic and cervical insufficiency. It occurs at the pressure of the tumor on the cervix. Material Zev does not cope with the load, reveals ahead of time, and miscarriages;
• Placental insufficiency at the location of the Mioma near the fruit location or with multiple nodes. Threatens chronic fetal hypoxia and the delay in his physical development;
• Premature delaying placenta with massive bleeding. The state threatening the life of a woman and a child;
• Low attachment placenta. When implantation due to the tumor, the embryo cannot find a comfortable place for itself and is attached too close to the inner zev. Threatens bleeding and miscarriage;
• The preview of the placenta is a state at which the fruit location covers the output from the uterus. Causes and consequences are similar to the previous item. Is an indication to Cesarean section;
• Squeezing the child with a tumor and development of deformations (for large submucosic nodes);
• Improper position of the fetus (oblique or transverse), pelvic preview as a result of deformation of the uterine cavity by myomatous node;
• Compression of pelvic veins and their thrombosis (relevant for large subserosic nodes).

On a note

Fibromyoma is not the cause of underdeveloped (regressive) pregnancy, although it may increase the risk of its occurrence (with a violation of the nutrition of the uterine tissues).

This is how pregnancy looks like in the presence of a fibromatous node of large sizes.

Not only myoma does not affect pregnancy, there is also feedback. The period of navigation of the fetus negatively affects the state of the tumor, which threatens the development of complications of the disease:

• Node necrosis. It is more often noted and arises as a result of a circulation of blood flow in myiometry;
• Twisted the tumor leg with the subserosic location of the node;
• The rapid growth of Moma under the influence of progesterone.

• First childbirth after 35 years;
• Duration of the disease for more than 5 years;
• Submucosic nodes deforming the uterine cavity;
• Interstitial tumors of large sizes (the initial value of the uterus - from 10 weeks);
• Mioma location in the cervix;
• The development of secondary changes, signs of necrosis;
• The location of the placenta on the Myomatous node;
• Concomitant pathology (gynecological and extragenital);
• Induced pregnancy.

For your information

Extremely high chances of a favorable outcome of pregnancy in women under the age of 35 without heavy chronic diseases, P. subserosan Momea and sizes of nodes up to 5 cm.

Pregnancy Tactics for Mother Miser

Pregnancy against the background of Mioma proceeds with complications, but this does not mean that all women with this pathology are sent to the abortion. You can make a child (if there are no obvious contraindications), but for this you need to follow all the recommendations of the doctor:

• Mappared as soon as possible (better immediately after the test will show two strips);
• On time to undergo all screening ultrasound and other surveys;
• Monitor your condition and contact a doctor when any complaints appear.

Pregnancy is contraindicated in such situations:

• Suspected malignant tumor;
• Moma rapid growth;
• The development of complications (necrosis, twisted legs);
• Thrombophlebitis pelvic veins.

At the age of 40 and in the presence of Moma, pregnancy is also not recommended to save.

During gestation, special attention is paid to the size of the nodes and their possible growth. Control over the neoplasm is carried out with the help of an ultrasound within the regulated timelines:

• 6-10 weeks;
• 12-14 weeks;
• 18-24 weeks;
• 32-34 weeks;
• 38-40 weeks.

From the 32nd week, the weekly CTG (cardiotokography) is shown to evaluate the fetal heartbeat and the timely detection of hypoxia.

Under the Moma, the weekly cardiographic procedure is required, starting with 32 weeks of pregnancy.

In the development of complications, the woman is hospitalized in the hospital, where it turns out all the necessary assistance, taking into account the period of gestation.

On a note

For the prevention of placental failure and hypoxia of the fetus can be assigned tools that improve uterine blood flow. According to the testimony, tocologists and antispasmodics are used. Hormonal drugs In early terms (duphaston, uremines) are prescribed with caution, since there is a risk of rapid growth of the node.

Conservative treatment of uterine misa during pregnancy is not carried out. A woman is observed, but no hormones are prescribed. Operational intervention (momectomy) is possible on strict testimony:

• Necrosis of the node and the appearance of appropriate symptoms;
• Compression of pelvic organs and severe pain;
• Threatening or the beginning of the miscarriage when it is impossible to spend the scraping of the uterine cavity (with the cervous location of the node);
• Giant Mioma and the absence of a prospect for tooling the fetus.

The planned procedure is carried out in 16-19 weeks. Under development acute states The operation is possible on any time.

How best to give birth?

Birth through natural labor pathways are possible subject to the following conditions:

• Fresh pregnancy (from 37 weeks);
• Normal pelvis sizes;
• Sizes of myomatous node up to 5 cm;
• A good location of the tumor (does not overlap the output from the uterus).

On a note

According to the reviews of women who have undergone pregnancy with the Mioma, you can say: small nodes usually do not interfere with the fetal tooling and do not interfere natural Rodam. The easiest passes the pregnancy in the subseroic tumor: childbirth go on time without complications, postpartum period - without features.

Gifts in women with uterine are complicated by premature expulsion of water, delaying placenta and bleeding. Quite often the weakness arises generic activity As a result of the change in the structure of myometrium. When developing complications, an emergency caesarean section is shown. During the operation after the extraction of the fetus, momectomy is often carried out. In special cases, the extirpation of the uterus is shown.

Indications for planned cesarean section:

• Fibromyoma is more than 5 cm in diameter;
• A large number of interstitial nodes;
• Scar on the uterus after conservative Momectomy;
• Localization of a node preventing the normal promotion of the fetus generic ways (in the cervix, during the deformation of the cavity);
• Suspicion of malignation;
• Complications from the fetus and states threatening his life.

The final choice of the method of the root separation is carried out after a complete examination of a woman and evaluating the state of the fetus.

Many women in the presence of Moma try to choose a competent physician who will help to endure and give birth to a healthy child. Increasingly, the patients are addressed to private clinics. It is worth noting that the price of making pregnancy in the Moma will be increased by additional examinations. The average cost of observation of the gynecologist in the world from registration to childbirth is from 80 thousand rubles in Moscow and from 60 thousand rubles in the regions.

Myoma uterus and infertility