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□ Tan Xianjie
With the development of medicine, the uterus was removed by the uterine fibroids, so that there are fewer and fewer tragedies that have completely lost fertility.However, because uterine fibroids are a kind of estrogen -dependent tumor and are accompanied by women of fertility age, the relationship with pregnant children is complicated and entangled.
In early pregnancy, the presence of fibroids is not conducive to fertilized eggs in bed and growth and development. The incidence of abortion is 2 to 3 times that of women with normal fibroids.The large muscle wall fibroids or submucosal fibroids can prevent fetal abnormalities from moving in the uterine cavity.Fibroids can affect the normal shrinkage of the uterus and extend the birth process. Large fibroids in the pelvic cavity can block the birth canal and cause difficulty in giving birth.Fibroids can also affect postpartum uterine contraction and cause postpartum bleeding.
On the other hand, uterine smooth muscle cells increased after pregnancy, and fibroids increased, the most significant within 4 months of pregnancy.The rapid increased fibroids are prone to insufficient blood supply and degenerative changes. Among them, red -like changes are the most common.Patients have fever, abdominal pain, vomiting, local tenderness, and even cause miscarriage and premature birth.
It can be seen that the relationship between uterine fibroids and pregnant children is really cutting, and it is still chaotic.However, we can still try to sort out from the following aspects.
What should I do if I was preparing to get pregnant, but found uterine fibroids?Generally speaking, if you do not consider the relationship with pregnant children, only those with special positions, high menstrual flow, endless menstruation, anemia and other symptoms, or fibroids with diameter more than 5 cm need surgery.For women who are preparing to get pregnant, the treatment indicators should be more widely wider.
For submucosal fibroids located in the uterine cavity, the embryo bed may be hindered in the future, which leads to abortion.Therefore, no matter if there is any symptoms, it is recommended to deal with it before pregnancy.It is currently believed that subtinum titting is best surgery through uterine laparoscopy.Hysteroscopy is also a type of minimally invasive surgery. It is a special camera lens through the vagina and cervical tubes, and surgery is performed through special equipment.
So, how big the uterine fibroids before pregnancy must be surgery?There is no clear standard at present.Some medical units, such as the Beijing Union Hospital, believe that if the uterine fibroid diameter does not exceed 4 cm of muscle wall fibroids or subdivid fibroids, patients can consider pregnancy.However, patients need to be informed that fibroids may grow rapidly during pregnancy, causing red degeneration due to ischemia, or when the uterine position changes, subtinum fibroids are reversed, causing abortion or premature birth.
If the fibroids are located at the lower end of the uterus, that is, the cervix, or the diameter of the uterine fibroids in other parts is less than 4 cm, but the patient has a history of infertility or a number of natural miscarriage, and no other clear reasons can be found.Fibroma is eliminated and then pregnant.
Assuming that uterine fibroids are performed before pregnancy, how long should I be pregnant after surgery to get pregnant?This is a question that cannot be answered before surgery, and it needs to be judged according to the situation during the operation.Generally speaking, if the fibroids are located between the muscle wall or below the plasma, the number is not large, and there is no obvious damage to the integrity of the uterine wall during the exclusion process.Many, a lot of incisions were opened on the uterus, and the process was particularly difficult to remove the process, or to enter the uterine cavity, it is recommended that for at least one year or even two years.Of course, for the subdivial fibroids connected to the uterine, if the surgery is smooth, the integrity of the uterine wall is almost harmful, and you can get pregnant 3 months after surgery.
(The author is the chief physician of the obstetrics and gynecology department, professor, doctoral supervisor of the Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, and the third "Name Doctor of the State")