Fibroid Pain During Pregnancy: Causes, Relief, and Expert Advice

Question
Hi Dr. Rappaport:

I am a 36 year old, african american female, this is my first pregnancy, and I am 22 weeks along (LMP: 10/7/04).

I have been diagnosed with two large fibroid tumors:
1. In the lower uterine segment measuring 10.9 x 10.7 x 9cm, and  
2. A pedunculated fundal fibroid meausuring 10.8 x 13.6 x 9.4, which extends to the hilum of my liver.  

I had emergency surgery to remove my gall bladder on 2/26, and the second (larger) fibroid has been extremely painful since then.  I was in the ER two nights ago in agony - I thought my appendix was rupturing.  I never imagined that the fibroid could cause so much pain.

My OB has put me on Indomethacin (25MG) during the painful bouts with the fibroids through week 32 of pregnancy.  Additionally, I am on bedrest to combat premature labor.  Are there other treatments available to me at this point?  I can not imagine going through my final 18 weeks of pregnancy in such extreme discomfort.  

I'm not looking for a miracle, only some direction in alleviating the discomfort of these fibroids.

Thanks for your time and expertise.

Cristina

Answer
Other than continuing pain medication during the pregnancy, there is not much else that can be done to alleviate the discomfort from the fibroids. If you have a 10.9 X 10.7 X 9cm fibroid in your lower uterine segment, there is a good chance that you will have to deliver by cesarean section. The pedunculted fibroid should have  no impact on the pregnancy other than the discomfort from the pain. Certainly tocolytic agents and bedrest are a good idea and you may have to deliver the baby as soon as its lungs are mature in order to shorten your pregnancy if the pain proves too uncomfortable. Good luck to you.