What should I do if I did not receive a gynecological examination at all before I got pregnant and found out that I have fibroids after pregnancy when I was checking if the fetus was normal? Or, what should be taken into account during pregnancy for a woman who is pregnant with fibroids when small fibroids were found before pregnancy and the doctor thinks that surgery is not necessary for the time being? In principle, unless there are some compelling circumstances (described later), fibroids are usually not removed temporarily during pregnancy and are left to be dealt with during or after delivery, mainly because of the following concerns: (1) excessive blood loss may be caused by myoma removal surgery during pregnancy; (2) the surgery may lead to the occurrence of miscarriage and preterm delivery; and (3) the wound of the uterine muscle wall from myoma removal surgery may rupture the uterus in late pregnancy or during delivery. The gynecology department of Peking Union Medical College Hospital, Tan Xianjie, then, these “lingering” fibroids and growing together with the fetus, what considerations need to be taken into account during delivery? Or, to put it more bluntly, the question of whether to have a natural birth or a cesarean section. This is determined mainly by the location and size of the fibroids. Natural delivery: If the fibroid is located at the top of the uterus (fundus) or on the anterior and posterior walls of the uterus and is less than 8 cm in diameter, and the examination determines that the fibroid does not interfere with the entry of the fetus into the pelvis and delivery through the vagina, natural delivery can be attempted, and the fibroid can be treated after delivery, depending on the situation. It is important to note that the contraction, pulling and squeezing of the uterus during delivery can injure the fibroids and lead to their degeneration and infection, so it is necessary to pay attention to the recovery (rejuvenation) of the uterus after delivery and to use appropriate drugs and antibiotics to promote uterine contraction. Cesarean delivery with removal of fibroids: If the fibroids are located at the lower end of the uterus, affecting the entry of the fetus into the pelvis and delivery through the birth canal, or if the fibroids are larger than 8 cm in diameter, and if the fibroids may cause weak contractions of the uterus, a cesarean delivery should be chosen to remove the fetus and then remove the fibroids to avoid poor uterine recovery, prolonged malignant dew, or even infection after delivery due to the presence of the fibroids. In rare cases, excessive bleeding during or after myomectomy may also require hysterectomy. In addition, it is believed that the removal of fibroids during cesarean section has the risk of leaving fibroids behind. Because the fetus has just been delivered and the uterus is large and has not returned to its normal size, some small fibroids appear smaller and may be overlooked and left behind for later recurrence. However, in reality, the same problem exists when removing fibroids in non-pregnancy, and the doctor can largely avoid this by carefully palpating the search with his hands. As mentioned earlier, fibroid removal is not usually done for fibroids in pregnancy, but what are the compelling situations that occur that would require surgery for fibroids in pregnancy? These cases include: ① large fibroids (greater than 200px or even 250px in diameter), because too large fibroids are prone to red degenerative changes; ② patients with many symptoms, frequent abdominal pain, frequent uterine contractions or vaginal bleeding symptoms; ③ fibroids with heavy degenerative changes that irritate the peritoneum, with acute abdominal pain, low fever, elevated white blood cells and other symptoms of limited peritonitis; ④ fibroids in close proximity to the placenta. This condition may cause poor uterine contraction after delivery, resulting in postpartum bleeding or retained placenta. So, what do I need to pay attention to if I have surgery for fibroids during pregnancy? The timing of surgery is usually chosen in the middle of pregnancy, usually around 14-16 weeks. This is the period when the uterus is not significantly enlarged and at the same time the fetus is more stable. It can be expected that it will be more difficult to perform myomectomy during pregnancy. Whether the procedure is performed laparoscopically or openly requires the surgeon’s judgment based on the condition of the fibroid. Unless it is a subplasmic fibroid with a tip, open surgery is more prudent. In addition to the need to pay more attention to gentle operation during surgery, postoperative treatment should also be intensified to preserve the fetus.