Gynaecologic tumours with pregnancy
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Gynaecologic tumours with pregnancy






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Gynaecologic tumours with pregnancy Gynaecologic tumours with pregnancy Presentation Transcript

  • GynaecologicTumours with Pregnancy
  • Fibroids with pregnancy
    Incidence: 1%.
  • Effect of Fibroid on Pregnancy and Labour
    1.Abortion: particularly in submucousmyomas due to:
    • distortion of the uterine cavity,
    • affection of the decidual development,
    • affection of the vascular supply to the implanted ovum.
    2. Ectopic pregnancy: if it interferes with the passage of the ovum.x
  • Effect of Fibroid on Pregnancy and Labour
    7. Torsion of the uterus: very rare in subserousfundalmyoma.
    8. Premature labour.
    9. Nonengagement.
    10. Prolonged labour: Inertia may be present due to interference with normal uterine contractions.
    11. Obstructed labour: in cervical myoma or pedunculatedsubserousmyoma impacted in the pelvis.
  • Effect of Fibroid on Pregnancy and Labour
    12. Postpartum haemorrhage: due to
    > interference with uterine retraction,
    > increased vascularity.
    13. Puerperal sepsis.
    14. Inversion of the uterus: rare.
    15.Subinvolution of the uterus.
  • Effect of Fibroid on Pregnancy and Labour
    > Increase in size: due to
    a.oedema and increased vascularity,
    b.hypertrophy of the uterine muscles.
    > Softening: due to oedema and increased vascularity.
    > Red degeneration.
    > Torsion of a pedunculatedmyoma.
    > Internal haemorrhage: from rupture of a surface vein.
    > Infection: supervenes bruising during labour.
    > Extrusion: of submucousmyoma may rarely occur in puerperium.
  • Management
    During pregnancy
    During labour
  • Management>During pregnancy
    During pregnancy:
    a. No treatment is indicated in the majority of cases.
    b. Myomectomy carries the risk of abortion and severe haemorrhage so it is indicated in the following conditions only:
    • Red degeneration which is not responding to the conservative treatment in the form of:
    • Torsion of a pedunculatedmyoma.
    • Internal haemorrhage from rupture of a surface vein.
  • Management>During labour
    a. If the myoma lies above the pelvic brim not causing obstruction: vaginal delivery is allowed and myomectomy is done after 3-6 months if indicated.
    b. If the myoma lies in the pelvis causing obstruction: caesarean section is indicated, but myomectomy is contraindicated.
  • Management> Postpartum
    > Give prophylactic antibiotic.
    > Observe for postpartum haemorrhage.
  • Ovarian tumours with pregnancy
    Incidence: 1:1500. The commonest is simple serous cyst followed by dermoid cyst.
  • Effect of Ovarian Tumours on Pregnancy and Labour
    a.Abortion and preterm labour in large and complicated tumours.
    b.Pressure symptoms.
    c. Malpresentations and nonengagement.
    d. Obstructed labour: if a pedunculatedtumour is impacted in the pelvis.
  • Effect of Pregnancy and Labour on Ovarian Tumours
    1.Torsion: is the commonest complication particularly in pedunculatedtumours that lie above the pelvic brim. It is more common during puerperium than pregnancy due to;
    a. lax abdominal wall,
    b. large intra-abdominal space after birth allows free mobility of the tumour.
  • Effect of Pregnancy and Labour on Ovarian Tumours
    2. Rupture.
    3. Infection.
    4. Rapid growth.
  • Management>Ovarian Tumours
    During pregnancy:
    During Labour
    During puerperium
  • Management> During pregnancy:
    1. Cyst less than 6 cm in diameter: is left and followed up by periodic examination and ultrasound as it is usually a functional corpus luteum cyst.
    2. Cyst of 6 cm or more in diameter:
    a. Discovered in the first half of pregnancy: is removed after the 12th week when the placenta is formed so there is less liability for abortion.
    b. Discovered in the second half of pregnancy: is left to be removed in the first week of puerperium.
    be removed in the first week of puerperium.
    3. Complicated or malignant tumours:
    a. are removed immediately irrespective of the duration of pregnancy.
  • Management> During Labour
    a. If the tumour lies above the pelvic brim- causing no obstruction: vaginal delivery is allowed and tumour is removed in the first week in puerperium.
    b. If the tumour is impacted in the pelvis - causing obstruction: caesarean section with immediate removal of the tumour is done.
  • Management> During puerperium
    Tumours discovered for the first time should be removed immediately for fear of torsion.
  • Cancer cervix with pregnancy
  • Pre-invasive Cancer (CIN)
    1. Cytological examination: can be done during pregnancy taking in consideration that some features of dysplasia as increased cells showing mitosis are normally present during pregnancy.
    2. Colposcopy: is easier to be done during pregnancy due to physiological eversion of the cervix.
  • Pre-invasive Cancer (CIN)
    3. If CIN I or CIN II is detected: follow up only as many cases will regress.
    4. If CIN III is detected: follow up is indicated till one month after delivery where conisation can be done or hysterectomy if the patient had taken the decision that she had completed her family.
  • Invasive Cancer Cervix
    Incidence: very rare 1:10.000 because;
    1.The mean age of cancer cervix is 45-50 years.
    2.The associated infection prevents conception.
  • Effect of invasive carcinoma on pregnancy and labour:
    1. Abortion and preterm labour: due to haemorrhage, infection and general health affection.
    2. Cervical dystocia, obstructed labour, cervical laceration and/or uterine rupture may occur.
    3.Puerperal sepsis.
  • Effect of pregnancy and labour on invasive carcinoma:
    1. Rapid growth: as young patients tend to have a rapidly growing tumours.
    2. Rapid spread: if vaginal delivery is allowed.
  • Management:
    1. Early pregnancy:
    a. Wertheim’s operation or
    b. Hysterotomy followed by radiotherapy.
    2. Late pregnancy:
    a. Upper segment caesarean section followed by either Wertheim’s operation (caesarean hysterectomy) or radiotherapy.