Hello doctor, I am 7 weeks pregnant. During the 6th week of pregnancy an ultrasound was done and a fibroid in the right side of the uterus measuring 8.7 * 7.0 cm was detected. Right now I am suffering from severe pain intermittently on the right side of pelvic region and right thigh. I am attaching the test reports and prescription herewith. At present I am taking only folic acid tablets and I have not yet started other tablets in the prescription. Kindly advice.
Hello. I have gone through the reports (attachment removed to protect patient identity) and there is definitely a large intramural fibroid in the uterus impinging into the uterine cavity. Ideally this should have been operated upon before your planned conception but nevertheless as you are 7 weeks pregnant, now with a viable fetus and fibroid was an accidental finding during ultrasound so the present management approach would have to be focused on sustaining and preserving the pregnancy further. For info,there are high chances of threatened abortion or placental separation in the early weeks of pregnancy due to such large fibroids, as the pregnancy grows due to inadequate room for growth and fibroid generally not allowing the uterine wall to stretch leading to hemorrhage. Also no operative removal can be attempted now as there can be torrential bleed and chances would be that you may loose your pregnancy.So surgery is out. The management has to be conservative hence with an aim to prevent abnormal uterine contractions with Duvadilan tablet (Isoxsuprine) and progesterone support with Susten SR 400mg daily to allow adequate placentation and trophoblastic growth so that chances of separation are minimized. Immediate aim would be 14 weeks till tablet Duvadilan and Susten would be continued and if the pregnancy grows naturally and crosses 14 weeks, it is a good sign. Also once pregnancy would grow, the fibroid which is estrogen dependent for growth, in the present high progestogenic environment it shall start thinning out by 30 to 40 percent accomodating pregnancy further. Once 14 weeks are crossed then next aim would be 34 weeks as there are high chances of preterm labour and premature rupture of membranes after 24 weeks and before 36 weeks. This is to be watched for and regular obstetric check up would hence be diligently required. So, as of now start tablet Duvadilan and Susten SR without delay and prefer bed rest so as to avoid any bleeding /threatened abortion. Pain is likely to be there .You may use tab Paracetamol only 500mg as and when required for pain relief but in a gap of 8 hours. This is safe in pregnancy . Also hot fomentation for 15 minutes each thrice a day can be helpful. Bed rest is important for the initial 14 weeks. This is a high risk pregnancy due to large fibroid and should be vigilantly dealt under gynaecologist supervision. Any bleeding vaginally should be followed within 6 hours with an ultrasound by your gynaecologist, so be alert on that part. Initial 14 weeks are crucial. Folic acid 5 mg daily, Duvadilan 10 mg thrice a day and tablet Susten SR 400 mg once at night, for 4 weeks. Bed rest ideally till 12 to 14 weeks. For further queries, consult an obstetrician and gynaecologist online.--->