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Fetal complications of fibroid

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uterine fibroids AND pregnancy

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SMFM fibroids pregnancy fetal complications fetal growth preterm birth placental abruption

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Fetal complications of uterine fibroids in pregnancy
Most pregnancies with fibroids have a good outcome. Risk rises with large, multiple, submucosal, lower-segment, or retroplacental fibroids, especially when the fibroid distorts the uterine cavity.
  • Early pregnancy loss / miscarriage
  • Fetal growth restriction or low birth weight: possible when a large fibroid compromises uteroplacental blood flow or mechanically reduces intrauterine space. Serial growth scans may be considered in high-risk cases.
  • Preterm labor and preterm birth
  • Malpresentation: breech, transverse lie, or unstable lie due to distortion of the uterine cavity.
  • Placental complications affecting the fetus:
    • Placenta previa
    • Placental abruption, which can cause acute fetal hypoxia, distress, or stillbirth in severe cases.
  • Fetal compression deformities: very rare, usually with a very large fibroid and prolonged space restriction. Reported abnormalities include limb deformity, torticollis, or head molding.
  • Intrapartum fetal distress: may result from abruption, malpresentation, or obstructed labor.
  • Rarely, fetal death, generally secondary to severe placental abruption or extreme growth compromise rather than fibroids directly.
Creasy and Resnik list increased risks of preterm delivery and malpresentation, and note higher associations with placenta previa and abruption. They also advise later ultrasound assessment when an anterior myoma may limit fetal growth or obstruct labor. Creasy & Resnik’s Maternal-Fetal Medicine: Principles and Practice, lines 3084-3113.
A recent review indicates that evidence for fetal growth restriction and fetal demise is inconsistent, so these should be described as possible in selected high-risk fibroid pregnancies, not inevitable outcomes. The recent clinical review similarly emphasizes that most women do not develop major adverse fetal complications.
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