ELCS due to fibroid next to cervix

[PustyRussell]

Hoping someone can advise...

I was told I had a fibroid during my 12 week scan. This wasn't present during my first pregnancy. Dd1 was born naturally.

At 30 weeks I had another scan. The sonographer tells me that there is a 7cm posterior fibroid is right next to my cervix and it seems likely it will prevent the cervix dilating and therefore a natural birth (but obviously gave a disclaimer that the consultant will decide).

Today (34 weeks + 6) I have had an appointment with the consultant. She said that they will "wait to see what happens" as during birth the babies head might squash the fibroid and allow a natural birth or it might not and I'll need an EMCS.

I feel like I'd prefer the option of an ELCS rather than the uncertainty of a natural birth.

Has anyone had any similar experiences or any advice?

Thanks

[Annianni]

I was the same as you with Ds2.
A small fibroid was spotted after early bleeds and scans.

It quickly grew to be the size of a grapefruit and was putting pressure on ds.

Ds ended up being trapped by the fibroid with no way out.

I had to see a consultant every few weeks, extra scans etc.

They kept talking about waiting to see what happened, which terrified me.
But after several meetings they decided an ELC would be best.

In the end I had an elc at 38+2 (i think)

I was in the main theatre and had 25!? people in with me, they put stents in my groin arteries first,
(i'd had an epidural), incase the fibroid started bleeding.
And a gynae surgeon was also in theatre incase I needed an emergency hysterectomy.

They gave me a GA for the actual CS.
They had to cut me vertically, like in the olden days, as the fibroid was on the front wall of my womb.
I've got a lovely 8 inch scar from it.

But the operation was fine, and ds was fine, just sleepy from the GA.

The surgeons were making jokes about how my CS was the most expensive they'd done that year.

Ds is 2.6 now.
If you have any questions, feel free to pm me.

[PustyRussell]

Thanks Annianni.

It sounds like you really went through the mill!!

Luckily, mine is at the back of my uterus and seems to be a slow grower (only grew just under a cm between 20 week and last scan).

What I can't understand how the sonographer seemed certain that I'd need a section when the consultant seemed keen on seeing how things went?

I really would rather avoid the potential of an emergency section on the back of a rubbish labour.

[Annianni]

The sonographer's I saw, said I'd need a CS.
The consultant first said I'd need one, then said they were undecided... Then said they'd see what happened (which is when I got scared)
But finally they decided to do an ELC thank god

Luckily for me, there was another woman in a similar situation who was further along than me.
So they had a practice run so to speak, and everything went as clockwork with my op.

I had a home birth with my first, so the whole hospital thing was scary to me.

They did say my dh could be in theatre with me, but on the morning of the op, changed their minds and he had to wait outside.

I was the first op of the day, ds was born at 11-15 but he was taken to the prem unit (with dh) as I was still in theatre till after lunch.
I finally got to hold Ds2 at about 1-30.

Good luck!

When's your next check up?

[PustyRussell]

It's the 'we will wait to see' that concerns me!

Next appt with mw is tomorrow, next appt with consultant is in 4 weeks (at 38+5) once I've had another scan. I'm not sure what else they will find with another scan?

I'm going to chat to the midwife tomorrow and see whether I can push for an elective.

Thanks for all the info!

[Annianni]

Finger's crossed for you.

The concern with my fibroid was always, how it would react during the birth/CS.
The risk of it bleeding was the main thing.

If the fibroid wasn't blocking the way out, I would have had a normal birth I think.
Just with people on stand by incase I bled too much.

[IamSlave]

Hello

I had a friend who had firbroids and started to give birth naturally and things got very nasty, she had emergency section, loads more firbroids than thought or something, it was horrific.

Why risk it? When you can have a nice safe section, with little risk?

[PustyRussell]

My thoughts exactly Iam!

I didn't feel comforted when she said the fibroid 'might' get squashed and that I 'might' need an emergency section.

I would much rather deal with making decisions to minimise the possible risks and not take unnecessary risks.

Hopefully I will get more sense/guidance from my midwife tomorrow...??

[MrsCocoa]

Ah. You've reminded me of my first pregnancy. Sonographer left it to the Doctor (in fact a nervous medical student) to reveal his discovery. Went something like this: ' we've found a growth in your womb, it may block the baby's exit and you might need a section, and even if it is malignant we wouldn't be able to do anything until the baby is out.'

After a night without sleep I returned and asked to speak to another Doctor who was very reassuring about the probability of the growth being benign, but explained they could not be sure about the impact of the position on delivery, until later in the pregnancy. It turned out to be fine, the fibroid remained smallish, and was ultimately not in a problematic place. I was even waved through for a home birth (but ended up with a section for different reasons).

Second pregnancy was an elective section; the surgeon remarked afterwards in theatre that the fibroids had made for an 'interesting' procedure. So you might want to ask about this too to get the full picture?

[TobyLerone]

Wow, how odd. I have been told the exact same thing by a useless consultant last week. I'm only 25+4, and they want to scan me again at 36 weeks and make a decision then.

They have told me exactly the same about the risks -- that my cervix could fail to dilate, that the baby could get stuck etc etc. And that if the fibroid is not actually blocking the cervix, they will have me have a normal labour until such time as something goes wrong, when they will dash me off for an EMCS.

I saw my midwife today and she said to push for an ELCS in this case. I actually don't want a CS at all, and she knows that, but if there is an increased chance that I'll have to have one anyway, I'd much prefer it to be under my control, awake, with DH there.

If I'm super lucky the fibroid will have moved right out of the way by the time I'm 36 weeks, but it hasn't moved so far. I goes from being directly over my cervix to about 1cm to the right of it. I've had 6 scans so far!

Good luck, OP

[PustyRussell]

Mrs Cocoa, can I ask, how big was your fibroid and where was it?

I'm struggling to find any solid information...even articles from Google Scholar aren't giving me any definitives.

Although it does seem that just over 48% of women with large (greater than 5cm) fibroids in the lower uterus end up having c sections vs 13% 'normal' women. However, it doesn't specify whether these are elective or emergency.

It's astonishing that they don't supply you with information. Instead, you have to dig about for it by yourself!

[MrsCocoa]

Pusty - sorry, but hazy on detail. Recall that first scan suggested it was larger than the second, and that whilst there was originally a question mark about it potentially blocking my cervix it became clearer once I was closer to term that it was well out of the way. Was a few years ago...

[PustyRussell]

Toby...it must be the party line to wait to see how it goes!

They spotted mine in my first scan. Sonographer seemed mildly concerned. I had a different sonographer for second scan who also suggested that it may interfere with a 'normal' birth. I was then sent for a scan at 30 weeks. Again, it was a different sonographer who, after 1 hr of scanning because the fibroid is right next to the babys head and my
cervix, said it was 7cm in diameter and was "in the way".

I am not against having a normal delivery (DD1 was au naturel), but if there is nearly a 50% chance that women with fibroids end up with c section deliveries, I'd rather have an ELCS rather than an EMCS after a knackering , unsuccessful labour!!

Hope all goes well for you and your little one!

[SquidgyMummy]

I had a fibroid; discovered at 12week scan.
Am in France and Obstetrician very cautious (especially given my age then 40) and first DC, so had an ELCS.
In my case i did lose a fair bit of blood and needed some iron transfusions.
Would definitely push for a planned C-section

[TobyLerone]

Sounds like it's common to get conflicting information, too.

Everyone I've seen so far has been somewhat concerned about the fibroids I have and the risks involved. Then I saw the consultant last week (after having been admitted to hospital the week before with contractions/threatened preterm labour they put down to the fibroids), and he basically said "what do you want me to do about it?" He couldn't have been more casual if he tried. Oddly I didn't feel reassured by that!

[KikiShack]

I was in a very similar situation to you OP, large fibroid blocking the cervix at 12 and 20 week scans. I forget what the 30 week scan said, since they had already decided to book me in for a 36 wk one I don't think they bothered checking my cervix at 30 weeks.

Anyway after being pretty sure I'd be steered towards an ELCS they changed their minds after 36 wks as my growing uterus had shifted the fibroid clean out the way! I think the uterus grows a lot in the last few weeks which is why they like to wait and see.

I'm currently 39+5 and eagerly awaiting LO's arrival, very pleased I can try for a natural birth. As well as the troublesome lower fibroid I have at least two more big ones (8cm+) higher up and some other small ones, but no doctors seem concerned so I'm not either.

Good luck with the rest of your pregnancy and I hope you get the delivery you want x

[monniemae]

This was me q recently.... At 32 weeks though my 11x10 fibroid had moved from blocking cervix to the side, with baby's head descended past it. I worried about all the research I'd dug up showing increased c section risk etc and considered pushing for elcs.

In the event I trusted the doctors who insisted the main issue was whether the baby's head could descend past the fibroid - and it had so I should go ahead. I gave birth on 20th of september and everything was fine!

So although I totally understand how it feels when you're hearing different things and it's all uncertain, it doesn't inevitably mean wait and see = disastrous labour ending in emcs.

If you feel sure though, you can insist. I had in my notes for eg that I would refuse induction and should be offered an elcs at 42 weeks.

[TobyLerone]

That's reassuring, monniemae :)

And congratulations!

[idlevice]

In the last trimester the lower segment of the uterus really grows & stretches so this can mean the fibroid moves out of the way as it moves with the uterus wall. This happened with my first pregnancy & I was told I could try for a natural birth, which I had. Unfortunately I had done no preparation as I'd been told at the 12week scan I'd need a vertical incision CS due to fibroid blocking the cervix. So prepare for both options!

If you decide to go for a CS anyway, make sure you're aware of any implications for future fibroid removal surgery and/or future pregnancies, should you want either, due to the scar placement - ask your doctors. With second pregnancy I was advised against a CS as it increases the risk of blood loss, as none of the body's natural reactions to blood loss come into play.

[PustyRussell]

Thank you ladies. It's good to hear examples where there have been no problems.

When you were speaking with the Doctor's did they explain to you the potential risks and the likelihood of different outcomes? The info I've had has been very vague.

I think what I'm struggling with is the lack of evidence-based information from the health professionals, so I'm researching and reading articles myself which is resulting in anxiety!

[idlevice]

I had no concrete information from anyone but got the most useful info from an older consultant with tonnes of experience. In fact, after my first pregnancy & birth I was half-seriously thinking of writing a book about fibroids & their possible effects on pregnancy/birth, I had all the chapter headings ready to go... I think the lack of definite information is because they can affect every woman's experience completely different, not to mention the general thing of "women's problems" always being low on the medical priority list/institutionalised misogyny thing (if you want to go that far!).

[PustyRussell]

Well, after a scan and finally getting to see a consultant, I am booked in for a cs next week!

The lovely lady consultant said that she'd put money on the fibroid being actually on my cervix, not on the uterus wall. She also said that there was too much uncertainty for a natural birth and that the risks involved in an elective cs would be fewer than those posed by a trial of labour.

Thank you for all the information...it does seem like an area where there isn't enough readily available information?!

[IamSlave]

Oh thats good news, you can relax now and enjoy the birth...seems like the sensible decision was made. Good luck for next week, how exciting.

[TobyLerone]

Good luck!