The NIG Library of medicine describes multi- fibroid uterus obstruction as a relatively common condition amongst women of childbearing age especially of African descent.A fibroid is a benign growth on the uterus and rarely develops into cancer. Fibroids are also known as leiomyomas or myomas.
The presence of fibroids in a woman’s uterus/womb varies in terms of size, location, and the effect they have on the woman’s reproductive abilities. For some, they can present as small growths that do not pose any challenges to the woman’s health and reproductive potential and are usually an incidental finding on ultrasound that is not initially meant to investigate their presence or location; while in others, they can grow considerably and lead to a number of complications such as heavy bleeding during menstrual periods, difficulty in falling or maintaining pregnancy as well as obstruction of the birth canal necessitating alternate delivery routes.
There have been cases where fibroids can grow to such an extent that the woman would look like she is at full term of pregnancy. Their size or the size of the uterus is medically described using equivalents of pregnancy sizes (number of weeks of pregnancy, i.e. at the level of the umbilicus it is said to be equivalent to a 20-to-22-week pregnancy).
Although their presence can be clinically suspected depending on the woman’s complaints when she presents to her GP or Gynaecologist, their presence is confirmed on ultrasound done by the doctor.
According to available data, fibroids may be found in 10.7% of pregnancies, and 10-30% of these patients might develop significant adverse outcomes, and this is emotionally, physically, and financially daunting for the patients affected. This is what our patient, Ms Segofalang Kgaile experienced in her pregnancy.
Ms Kgaile, a 30-year-old lady expecting her first baby towards end August, had to make an informed decision with her Obstetrician and Gynaecologist, Dr Rethabile Khalema, regarding the best options for delivery after Dr Khalema found a large fibroid >10cm in diameter blocking the birth canal where the baby is supposed to come through. Their discussion had to go into details and consider the possible risks associated with multi-fibroid uterus obstruction in pregnancy, namely:
• Risk of spontaneous miscarriage
• Severe pain during pregnancy due to changes in the fibroid
• Preterm labour
• Placental abruption
• Foetal malpresentation
• Post partum haemorrhage and its associated complications
Dr Khalema is a Feto-Maternal Specialist trained at the University of Pretoria, has extensive experience in high-risk obstetric cases, as well as Mother and childcare. She is passionate about creating a safe environment for mothers, aiming at a healthy mom and baby at the end of the pregnancy. During the discussion, Dr Khalema provided the parents with a clear clinical scenario of the challenges associated with the maternal condition, and with this information the expectant parents opted for a planned caesarean section on 20 August 2024, at a gestational age of 39 weeks before she went into spontaneous labour. Understandably, the parents were quite nervous and excited at the same time. She has been continuously supported by her partner, Mr Kebalepile throughout their pregnancy.
An elective c/section was provided as the only route of delivery due to the obstructive nature of the large fibroid to the birth canal. On a medical basis, an obstructive fibroid poses a risk to the progress of labour as it does not allow the head to get into the birth canal and leading to delivery of the baby. As a result, an elective or planned c/section before the mother goes into labour provides a more controlled, predictable, and relatively safe route of delivery for the baby.
Although the presence of fibroids poses several risks to the mother, such as the risk of excessive bleeding secondary to inability of the uterus to contract, an experienced obstetric surgeon, proper planning and good communication between the obstetrician and anaesthetist at delivery as well as the use of prophylactic medication that increases the uterine contractility (uterotonics), the bleeding can be minimised and the maternal condition stabilized.
Ms Kgaile’s beautiful son arrived safely on the 20th of August 2024 at around 15h00, weighing 3.9kgs, with Dr Khalema as the main surgeon, Dr Hoffman as the assistant surgeon, Dr Jerome Mogorosi as the anaesthetist and Dr Thabo Bisiwe as the paediatrician (doctor for the baby) - a formidable team indeed.
Welcome to the Busamed family and thank you Ms Kgaile for trusting Dr Khalema to walk this journey with you and your husband and choosing Busamed Bram Fischer Private Hospital to safely bring your baby into the world.
