FIBROIDS AND INTRAUTERINE FETAL DEATH

An intrauterine fetal death (IUFD) is said to have occurred when a conceptus whose gestational age is greater than 8 weeks dies.

The following are challenges that can lead to IUFD 

Chromosomal abnormality that is not compatible with life 

Congenital infection 

Progesterone deficiency 

Antiphospholipid syndrome 

Fibroids 

Fibroid is an important reason for recurrent IUFDs.

Fibroid in the intramural or submucous areas over which you have the chorion frondosum can prevent the full development of the placenta 

The placenta is completely formed and functioning from 10weeks after fertilization

These are four layers of tissue separating the maternal blood from the fetal blood 

These include the following: 

The endothelial lining of the fetal blood vessels 

The mesoderm 

Cytotrophoblast

Syncytiotrophoblast 

In its early stages it is a relatively loose structure, but becomes more compact as it matures. Between 12 and 20 weeks’ gestation the placenta weighs more than the fetus because the fetal organs are insufficiently developed to cope with the metabolic process of nutrition 

Later in pregnancy some of the fetal organs, such as the liver begin to function, so the cytotrophoblast and the syncytiotrophoblast gradually degenerate and this allows easier exchange of oxygen and carbon dioxide.

In the presence of fibroid this process of maturity of the placenta can be hampered leading to poor passage of oxygen and nutrients from the maternal circulation to the baby. The maternal blood circulates slowly, enabling the villi to absorb food and oxygen and excrete waste. It appears the presence of fibroids further slows down the maternal blood flow to the blood spaces in the placenta. This makes it difficult for a growing fetus to meet its demands for oxygen and nutrients.

Death can occur.

The following can be seen on scan

No heart beats

Fetal scalp oedema

Significant overlap of fetal skull bones (Spalding’s sign)

THE ISSUE OF CAESAREAN MYOMECTOMY AND CAESAREAN SECTION IN PREGNANCY COEXISTING WITH FIBROIDS

THE ISSUE OF CAESAREAN 

MYOMECTOMY AND CAESAREAN 

SECTION IN PREGNANCY COEXISTING WITH FIBROIDS

Caesarean section in a woman with fibroids should be done 

by an obstetrician because of the challenges that can arise, 

which requires expertise to handle. They usually bleed more 

than women without fibroids during caesarean section. Blood 

should be grouped and cross-matched for them. Fibroids 

blocking access to the baby can be removed before delivering 

the baby. 

Other fibroids should be left in-situ to avoid excessive blood 

loss. Occasionally, it may be necessary to do a De lee vertical 

incision in the womb instead of a transverse lower uterine 

segment incision, if fibroids are present in the lateral aspects 

of the lower segment to avoid cutting into them. Cutting into 

fibroids provokes a lot of bleeding.

Sometimes a classical incision on the uterus (vertical incision 

in the body of the uterus) may be the only option for safe 

delivery if fibroids occupy most of the lower aspect of the 

uterus. Sometimes, the baby is sitting as it were on top of a 

huge fibroid. Removing such a fibroid will still not guarantee 

a vaginal birth in the next pregnancy. 

Caesarean section is still recommended. Women who had a 

classical uterine incision should be delivered by caesarean

section in the next pregnancy by thirty-four (34) weeks of 

gestation to avoid uterine rupture. Generally, if the fibroid is 

not blocking access to the baby during a caesarean section, it

should be left alone to avoid death from excessive bleeding. 

Such bleeding is usually difficult to stop.

WINNING THE BATTLES AGAINST FIBROIDS

PREGNANCY RELATED CHALLENGES DUE TO FIBROIDS

FORGERS OF LIES

THE UNSFAE DELIVERY

THE UNSFAE DELIVERY