QuestionI am 33 years old and 20 wks pregnant with my 4th child (in 4 years) EDD Feb.1, 2006 (LMP 4/27/05). I have a 7.8 cm by 9.6 cm located in the lower left quadrant of my uterus next to my cervix. My Dr. is talking about a cesarean and has already scheduled an ultrasound when I'm 32 wks pregnant to check the size of the fibroid. The first 3 children were delivered vaginally. I had problems with hypotension and almost had a cesarean with the 2nd child. I did wind-up with vulvar vestibulitis following that delivery. The 3rd child was concieved in 1 shot using topical lidocaine (to reduce pain with the vulvar vestibulitis). During the 3rd delivery, that Dr. cut the episiotomy and stiched me to help relieve the pain from the vulvar vestibulitis. This has worked wonderfully and I've had virtually no problems since. He was going to surgically remove the vestibule, but I went from 4 cm to holding the baby in 25 minutes and the epidural did not take. The Dr. did not want to remove the vestibule w/o anesthesia.
My questions are;
1) How necessary is a cesarean when you have a fibroid?
2) At what point in pregnancy should a determination about delivery be made?
3) How could another vaginal delivery affect the repairs done for the vulvar vestibulitis following the 3rd delivery?
4) What precautions should I take due to the location/ size of the fibroid during this pregnancy?
Thank you!
AnswerWhether you have a cesarean section or not due to the fibroid depends on the location of the fibroid in the uterus and the size of the fibroid. As the pregnancy progresses, the fibroid may grow even larger than it is at this time. Fibroids are "fed" by estrogen, and you have lots of estrogen during pregnancy. If the fibroid is locatd in the uterus between the fetus and the cervix (opening of the womb), you will not be able to deliver vaginally. If, however, the passage of the fetus in the birth canal is not impeded by the presence of the fibroid, you may be able to deliver vaginally. The best time to tell is by repeating the sonogram at 38 weeks gestation.If the fiboid has grown to such a size or is in such a location as to make vaginally delivery difficult or impossible, then a cesarean delivery should be considered. If you do have a vaginal delivery, you may cause somoe damage to the vestible and repair may be necessary. It will have to be evaluated at the time of the vaginal delivery. There is nothing you can do at this time to change the course of fibroid growth. Repeat the sonogram at 38 weeks and discuss all alternatives with your care-giver.
