Red degeneration in pregnancy

UTERINE fibroids are the most common pelvic tumours in women, and the incidence of fibroids is typically found to be two to three-fold greater in black women.

Obstetrician-gynaecologist (ObGyn) at Seymour Park Dr Michelle Bailey said they arise in reproductive age women and typically present with symptoms of heavy or prolonged menstrual bleeding or pelvic pain/pressure, and may also have reproductive effects such as infertility and adverse pregnancy outcomes.

Dr Bailey said fibroids infrequently cause acute pain from degeneration or torsion of a pedunculated tumour (tumour supported by an elongated stalk of tissue).

“Red degeneration is one of the five types of degeneration that can occur with fibroids and is most commonly noted during pregnancy, where 30 per cent of fibroids present will increase in size,” she said.

Dr Bailey said the signs and symptoms of patients with fibroids undergoing red degeneration include:

1. Pain in the abdomen.

2. A low-grade fever.

3. Tenderness over the uterus.

One woman, now six months pregnant, shared her experience with All Woman and said she started experiencing pain in week 20 of her pregnancy.

She said as a result she wasn’t able to do anything and was eventually placed on one week’s bed rest.

“After my doctor explained that it was a problem with red degeneration, she further stated that fibroids depend on blood supply to grow and the baby was using up that blood supply, causing the fibroids to degenerate. My cervix was checked to make sure I wasn’t in labour. I was given a lot of medication. I spent $20,000 that day on medication for pain, antibiotics and progesterone,” she said.

The woman explained that at first the issue took her by surprise as she was previously told she wouldn’t have to worry about her fibroids during pregnancy.

“I was assured it (fibroids) would not affect the baby, because though I have multiple fibroids, they are small in size. But in reading stories of other women, that was not the case. I went to another doctor and he said he was concerned and I was “high risk”, hence why I was placed on progesterone. Other women have told me that it is worse than labour pain, but I wouldn’t know as I’ve never had a child before,” she said.

She added that she’s just sticking to the treatment prescribed and hoping for a safe delivery and a healthy baby.

The ObGyn said there are a few theories as to why red degeneration occurs, such as:

1. The rapid growth of the fibroids, especially in the first trimester of pregnancy, will result in the fibroid or tissue outgrowing its blood supply.

2 Change in the architecture or kinking of the blood supply to the fibroid can occur, leading to necrosis (death of the cells) and pain.

3. The pain results from the release of chemicals from cellular damage within the fibroid itself.

She added that all of the above leads to cell death and necrosis, causing pain.

Dr Bailey said uterine fibroids are diagnosed with the use of an ultrasound, and degeneration is suspected when pain is present when scanning directly over the fibroid.

“In special cases, a magnetic resonance imaging (MRI) with contrast is used to make the diagnosis of degenerating fibroids,” she said.

With regards to treatment, Dr Bailey said while red degeneration especially in pregnancy can be very painful, it is not life threatening.

“The discomfort resulting from red degenerating fibroids is self-limited and usually lasts from days to a few weeks. Special medications used to reduce inflammation such as non-steroidal anti-inflammatory drugs (NSAID) have good effect in alleviating the symptoms. NSAIDs, however, should not be used in the late third trimester of pregnancy. Rarely is surgery to remove the fibroids necessary,” she said.