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Radiology
Fibroids in Pregnancy
Built from Obstetric Imaging
What’s inside
8 sections · 64 slides
Overview
- What this covers
What a fibroid is
The commonest tumour of the uterus, and where it sits
- The commonest growth in the womb
- Who gets them
- Usually more than one
- What they cause outside pregnancy
- Three places a fibroid can grow
- What each location means
- Why the location is worth naming
How often in pregnancy
Prevalence shifts with when you look, what you count and who you scan
- Why the reported numbers disagree
- 12%
- How age and background shift the odds
What pregnancy does to them
Hormone-driven growth, outgrown blood supply, and pain
- Hormones drive the growth
- When a fibroid outgrows its own blood supply
- Other reasons a fibroid hurts
- Enlarged myomatous uterus early in pregnancy
- What to notice in that scan
- How much do they grow?
- Most pregnancies pass off quietly
Complications
Pregnancy loss, preterm birth, abruption, obstructed labour and bleeding
- The list to have in your head
- Complications of Leiomyomas in Pregnancy
- Complications of Leiomyomas in Pregnancy (continued)
- The recognised complications
- Why some of these end in caesarean
- Who is at risk of placental abruption
- Fibroid low in the uterus
- Low fibroid lying against the cervix
- What that low fibroid did
- A big fibroid can starve the placenta
- Growth restriction and the placenta
- Rarer things fibroids have caused
- Ureter and kidney squeezed by the pregnant uterus
- Reading that MRI
- How strong is the evidence?
- Why we keep scanning
- Risks around the delivery itself
- Closing the uterus can be difficult
- What happens after delivery
- Most shrink, some do not
How fibroids look on scan
Edges, echoes, the pseudocapsule, degeneration and Doppler
- The single most useful sign: a sharp edge
- How bright is it?
- A fibroid brighter than the muscle around it
- The squashed rim around a fibroid
- Large anterior fundal fibroid with its pseudocapsule
- What to notice there
- Small ones look plain, big ones look messy
- Four ways a fibroid degenerates
- Degeneration changes the picture
- Calcium and the shadow it casts
- Where the blood flows tells you something
- Two large subserosal fibroids on MRI
- What that MRI shows
- Why MRI is sometimes added
Submucosal fibroids and what to do
Measuring how far a fibroid pushes into the cavity
- Why the cavity matters most
- Who needs definitive treatment
- Working out if hysteroscopy will work
- The two tools that answer it
- The FIGO cut-off worth remembering
Pulling it together
What to carry away from this topic
- The core ideas
- What raises the risk
- What to look for on the scan
- References
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition