Uterine Fibroids: Concerns During Pregnancy - Seeking Medical Advice

Question
Hello Dr. Rappaport. I wrote to you a week or so ago. I am a 26 year old. I have had 2 live births, one miscarriage, and am currently 14 weeks pregnant with # 4. I recently went to a NP who told me that I had a fibroid on the top of my uterus. It feels as big as a golfball. But she wants me to wait until I am 20-24 weeks along to have a sonogram to see how the fibroid is growing. I am very concerned about waiting that long. I cannot get a second opinion from another physician in the area because no other clinics accept medicaid. So I am writing to you to ask if you would have ordered a sonogram sooner, and what risks are involved when there is a fibroid on the fundus during pregnancy. I'm very frustrated and don't feel like I am getting adequate care (physically and emotionally). I would appreciate very much your opinion. Thank you!

Answer
The best time to get a sonogram to evaluate any fibroids is at 20-22 weeks gestation (from the first day of your period). At that time you can see if the fibroid is located above the fetus or below the fetus (nearer the cervical opening). If it is below the fetus, and the fibroid grows during the pregnancy, it may obstruct the passage of the fetus out the cervix and you will need a cesarean section to deliver the baby. If the fibroid is above the fetus, it may not affect the delivery at all, but if it continues to grow, it may impede the growth of the fetus.  In any case, there is nothing you can do at this time. Sometimes a fibroid that is growing will cause a miscarriage. but often there is no problem and a cesarean section is done and the baby is fine. A sonogram that is done earlier than 20 weeks is grossly inaccurate. Good luck.