The incidence of myoma showed that from 200 pregnancy there was one case of myoma. It is estimated that 20-30% of American women have myoma utery at the age of 40 years (Callahan et al, 2001).
Myoma utery growth during pregnancy. This is due to the hormone estrogen that increases during pregnancy. Myoma can grow quickly and giant in size due to edema or hypertrophy. When there is edema and hypertrophy, myoma vascularisation being reduced. This causing hyaline degeneration. Hyaline degeneration causes the uterus is palpabled soft so mistaken as cystoma (usually myoma is palpabled hard). If there is bleeding and its diameter reaches >3 cm, myoma may experience necrobiosis. Necrobiosis causing pain at the age of 12-22 weeks of pregnancy.
In young subserous myoma and young intramural myoma does not affect the pregnancy. However, if myoma already protruding or pouch-stemmed into the utery cavity can cause the following;
- Fertility is reduce because the process of nidation and placentation are disrupted.
- The risk of abortion increased by 2-fold.
- Premature Birth
- Malposition fetus in the womb (eg. location of latitude).
- Malpresentation (eg. butt presentation)
- Obstruction of the birth canal if myoma is located in the cervix so the fetus can not get out, as a result had to be done Sectio Caesaria.
- Disturbance contractions during childbirth
- Post Partum haemorrhage
- Retention of placenta
None of submucosal myoma nor intramural myoma are treated during pregnancy. Removal of myoma bodies (myomectomy)is postponed until the Post Partum. If myomectomy is conducted while pregnant it will cause hard bleeding that is difficult to overcome. If this happens an hysterectomy (removal of the uterus) must be done. Exceptions for stemmed subserous myoma. In the case of stemmed subserous myoma, surgery may be done during pregnancy because the myoma located outside of the uterus so that is safe, does not interfere with the product of pregnancy.
Symptoms of pain due to necrobiosis experienced during pregnancy can be treated with analgesic. If myoma growth and obstruct to the birth canal, adoption was not done until the womb reach the age of aterm (37 weeks) and before the time of delivery. SC is carried out if it has been aterm and at the same time with subserous myoma removal/ myomectomy. If intramural or submucosal, myoma just left behind. If the patient had not wanted more children, myomectomy is combined with hysterectomy when the SC is being conducted.
