By PPH Foundation

For most women, fibroids do not prevent a healthy pregnancy or safe delivery. However, because fibroids can affect labour and increase the risk of complications, including postpartum haemorrhage, understanding their impact is an important part of birth preparedness. According to the American College of Obstetricians and Gynecologists, ACOG, careful assessment and individualized care are essential for women with uterine fibroids during pregnancy (ACOG, 2021).

Fibroids, also known as uterine leiomyomas, are non-cancerous growths that develop in or around the uterus and are among the most common conditions affecting women of reproductive age. Many women are unaware they have fibroids until they become pregnant and undergo routine ultrasound examinations. During pregnancy, rising levels of oestrogen and progesterone may cause some fibroids to increase in size, although others remain unchanged or even shrink after delivery (ACOG, 2021).

Not every fibroid affects pregnancy. Their impact depends largely on their size, number and location within the uterus. Small fibroids often cause few or no complications, while larger fibroids or those located in the lower part of the uterus may interfere with the baby's position, labour or delivery.

Evidence increasingly shows that uterine fibroids are associated with several adverse pregnancy outcomes. Qin et al. (2024), in a systematic review and meta-analysis involving more than 237,000 pregnancies, found that women with fibroids had a significantly higher risk of fetal malpresentation, placenta previa, preterm birth, caesarean delivery and postpartum haemorrhage. The study further reported that larger fibroids were associated with an even greater likelihood of these complications.

Labour may also be affected. Fibroids located near the cervix or lower part of the uterus may obstruct the baby's descent through the birth canal, while others may reduce the effectiveness of uterine contractions, resulting in prolonged labour. These situations often require closer monitoring and, in some cases, operative or caesarean delivery (ACOG, 2021).

According to Dr. Kireki Omanwa, President of the Kenya Obstetrical and Gynaecological Society and Co-Lead of the End Postpartum Haemorrhage Initiative, a diagnosis of fibroids should not be a source of fear.

"Most women with fibroids will have successful pregnancies and healthy babies. The presence of fibroids simply means the pregnancy should be monitored more closely so that any potential complications are identified early and managed appropriately. Early antenatal care gives both the mother and her healthcare team the best opportunity to prepare for a safe delivery."

One of the reasons healthcare providers closely monitor women with fibroids is the increased risk of postpartum haemorrhage. Following childbirth, the uterus normally contracts to compress the blood vessels that supplied the placenta and stop bleeding. The World Health Organization, WHO, explains that effective uterine contraction is critical in preventing excessive bleeding after birth (WHO, 2012). Large fibroids within the muscular wall of the uterus can interfere with these contractions, increasing the risk of uterine atony, the leading direct cause of postpartum haemorrhage. Women with fibroids are also more likely to experience prolonged labour or require caesarean delivery, both of which may further increase the risk of excessive bleeding after birth (Qin et al., 2024; FIGO, 2022).

Dr. Omanwa explains that understanding these risks allows healthcare teams to prepare before complications occur rather than responding after an emergency has developed.

"Every fibroid is different. Some never interfere with pregnancy at all, while others may affect labour or increase the likelihood of bleeding after delivery. That is why every pregnant woman with fibroids deserves an individualized birth plan based on her specific circumstances. Delivering in a health facility with skilled birth attendants and access to emergency obstetric care significantly improves outcomes for both mother and baby."

Routine antenatal visits remain the best opportunity to monitor pregnancies complicated by fibroids. Ultrasound examinations help assess fibroid growth, monitor the baby's development and guide decisions on the safest mode of delivery. Women should also seek immediate medical attention if they experience heavy vaginal bleeding, severe abdominal pain, reduced fetal movements or signs of preterm labour.

While most women with fibroids experience healthy pregnancies and successful births, recognising the potential link between fibroids and postpartum haemorrhage allows healthcare providers to prepare appropriately. WHO (2012) and FIGO (2022) emphasise that early identification of women at increased risk, individualized birth planning and delivery in facilities equipped to manage obstetric emergencies are essential to reducing complications and improving maternal outcomes. Through informed decision-making and timely care, every mother can have a safer childbirth experience.

References

American College of Obstetricians and Gynecologists. 2021. Management of Symptomatic Uterine Leiomyomas. ACOG Practice Bulletin No. 228. Obstetrics & Gynecology, 137(6), e100–e115.

International Federation of Gynecology and Obstetrics, FIGO. 2022. FIGO recommendations on the management of postpartum haemorrhage. International Journal of Gynecology & Obstetrics, 157(Suppl. 1), 3–50.

Qin H, Lin Z, Vásquez E, et al. 2024. The influence of uterine fibroids on adverse outcomes in pregnant women: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 24, 318.

World Health Organization. 2012. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization.

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