Large fibroid & other things

[Hels]

Hi,
I am 32. I had a missed miscarriage last year detected at 11 weeks & a fibroid was picked up in a follow-up scan for the miscarriage - measuring about 7cm at the first scan, then 2 weeks later 9cm. Then my second pregnancy ended at 19 weeks when my waters broke and I delivered the baby (we later found out the baby was perfectly healthy). I had to have an emergency ERPoC as the placenta got stuck. The consultant discovered I have a vaginal septum (I didn't know & had never had problems). I've had many tests (all fine), a pelvic MRI, and I've since had a laparoscopy and hysteroscopy which has shown I have a 2 cervix as well as an abnormally shaped uterus - bicornuate, but one side is larger than the other - this side has the large fundal fibroid - which was measured at 10cm on the MRI on the outside of my uterus. My consultant has explained the risks of having it removed - i.e causing a weakness in the uterus wall that could lead to a rupture in a pregnancy or having to have a hysterectomy if there are complications. I feel at a loss with what to do. My consultant presumes I have an in competent cervix caused by having the 2 cervix, which led to the miscarriage at 19 weeks. If it is incompetent then presumably the large fibroid adds to the weight/pressure excerted on my cervix in a pregnancy. Emotionally it has taken more than 7 months to recover from the loss and the thought of being pregnant is terryfying but something we want so much. We know it can never be risk free, but if you are able to offer any thoughts on the fibroid or my circumstances we'd be very grateful. My periods have always been regular (around 26 days) but can be heavy. Thanks, Helen

[Mr. Hugh Byrne, MRCOG]

I think perhaps the risks of myomectomy have been focussed on, rather than the positives.

You are correct, such a fibroid will increase your risk of pregnancy loss.

However, the risk of loosing your womb due to bleeding during or after a myomectomy is still REALLY low. Infection afterwards if severe could cause you to need a hysterectomy but this is a really, really low risk as well.

Yes, myomectomy will leave a scar on the uterus but unless the scar crosses the full thickness of the womb wall then you could still have a trial of labour for your delivery. Even if the scar involves full thickness, you can simply have a planned caesarean when the time comes. The chance of the womb rupturing in pregnancy due to a myomectomy is very low indeed.

Consider a laparoscopic (keyhole) myomectomy - the fibroid may be small enough when you are not pregnant and it is solitary.

[Hels]

Thank you for your reply