Abstract. Uterine fibroids are among the most common benign gynecological diseases in women of reproductive age and may affect the course of pregnancy, delivery, and perinatal outcomes. The aim of this study was to evaluate the course of pregnancy in women with uterine fibroids and to identify the main obstetric and perinatal complications. The study assessed clinical and anamnestic characteristics, size, number, and localization of fibroid nodes, pregnancy-related symptoms, delivery outcomes, and neonatal indicators. The results showed that larger and multiple fibroid nodes were more frequently associated with pelvic pain, increased uterine tone, abnormal fetal presentation, preterm delivery, cesarean delivery, and postpartum hemorrhage. Low birth weight and the need for neonatal observation were also observed among newborns. The findings indicate that the size, number, and localization of uterine fibroids should be considered when assessing pregnancy risk. Individualized clinical and ultrasound monitoring may contribute to the early detection of complications and improve the management of pregnancy and perinatal outcomes.