Fibroids are common. Fibroids may impact on fertility and obstetric outcomes, but often do not. Deciding which fibroids may be of obstetric concern requires consideration of all patient circumstances, more so than the details of the fibroids themselves. Fibroids can be of significant impact at the time of any caesarean delivery, and specific care is required. Myomectomy may impact on subsequent obstetric outcomes. Uterine rupture is rare but can be catastrophic, and is not per se avoided by a decision for Cesarean birth. The technique of myomectomy may impact on the risk of subsequent rupture. Non surgical techniques of fibroid management offer promise for the patient desiring to preserve fertility, however further study is required to asses their role and safety.