Uterine fibroids introduction and Management

2. INTRODUCTION
•UTERINE FIBROID IS A LEIOMYOMA (BENIGN (NON-
CANCEROUS) TUMOR FORM FROM SMOOTH MUSCLE TISSUE)
THAT ORIGINATES FROM THE SMOOTH MUSCLE LAYER
(MYOMETRIUM) OF THE UTERUS.
•SYNONYMS: MYOMA, FIBROMYOMA.
•MOST COMMON BENIGN NEOPLASM IN THE FEMALE.
•INCIDENCE: 20 TO 40% OF REPRODUCTIVE AGE WOMEN.

4. DEFINITION
“UTERINE FIBROIDS ARE NONCANCEROUS GROWTHS OF THE
UTERUS THAT OFTEN APPEAR DURING CHILDBEARING YEARS.”
•UTERINE FIBROIDS AREN'T ASSOCIATED WITH AN INCREASED
RISK OF UTERINE CANCER AND ALMOST NEVER DEVELOP INTO
CANCER.

5. RISK
FACTORS
Heredity
Race
Pregnancy and childbirth
Oral contraceptives

6. ETIOLOGY

7. Idiopathic
Family history
Hormones- estrogen,
progesterone
Growth Factor

8. OTHER FACTORS-
•ONSET OF MENSTRUATION AT AN EARLY AGE
•DIET
•LOW LEVELS OF VITAMIN D
•DRINKING ALCOHOL
•OBESITY
•NULLIPARITY

9. TYPES/
CLASSIFICATION

10. Body or corporeal fibroids
Intramural or interstitial fibroids
Pedunculated fibroids- Sub serosal
fibroids, Submucosal fibroids
Cervical Fibroids

11. CLINICAL FEATURES
ASYMPTOMATIC  FIBROID SIZE<4CM
ABNORMAL UTERINE BLEEDING 
MENORRHAGIA > 64% WOMAN PRESENT
WITH HEAVY BLOOD LOSS. METRO
MENORRHAGIA PRESENT IN CASES OF
INFECTED / ULCERATED FIBROID POLYP.
• INFERTILITY
• PAIN LOWER ABDOMEN
• ABDOMINAL SWELLING (LUMP)
• PRESSURE SYMPTOMS

13. DIAGNOSIS
HISTORY COLLECTION
PHYSICAL EXAMINATION

14. FIBROID SIGNS
G/E- PALLOR
P/A- IF >12 WEEKS SIZE, FIRM, NODULAR, ARISING FROM PELVIS,
LOWER LIMIT CAN’T BE REACHED, RELATIVELY WELL DEFINED,
MOBILE FROM SIDE TO SIDE, NONTENDER, DULL ON PERCUSSION, NO
FREE FLUID IN ABDOMEN.
P/S- CERVIX PULLED HIGHER UP.
P/V- UTERUS ENLARGED, NODULAR, UTERUS NOT SEPARATELY FELT,
TRANSMITTED MOVEMENT PRESENT, NOTCH NOT FELT.

15. FIBROID USG: WELL DEFINED HYPOECHOIC LESIONS.
PERIPHERAL CALCIFICATION WITH DISTAL
SHADOWING IN OLD FIBROIDS

16.  TAS & TVS-
SIZE, SITE AND NUMBER OF FIBROIDS
DIFFERENTIATES THE TUMOR FROM OTHER SWELLING
AS OVARIAN TUMOR.

18. HYSTEROSCOPY- TO VISUALIZE A SUB MUCOUS
FIBROID OR A SMALL FIBROID POLYP.

19. MRI-
MOST ACCURATE IMAGING
MODALITY FOR DIAGNOSIS OF
FIBROID. IT DOES PRECISE FIBROID
MAPPING & CHARACTERIZATION.
DETECTS ALL FIBROIDS
ACCURATELY.
OVARIES ARE EASILY SEEN
DETECTS SMALL MYOMAS (0.5 CM)

21. LAPAROSCOPY- IT IS HELPFUL, IF THE UTERINE SIZE IS
LESS THAN 12 CMS AND ASSOCIATED WITH PELVIC
PAIN AND INFERTILITY.

22. ENDOMETRIAL BIOPSY- TISSUE SAMPLE IS
TAKEN TO SEND IT FOR BIOPSY PROCEDURE TO
FIND OUT THE TYPE OF FIBROID MALIGNANCY.

23. COMPLICATIONS
•MENORRHAGIA
•ABDOMINAL PAIN
•PREMATURE BIRTH, LABOR PROBLEMS, MISCARRIAGE
•INFERTILITY
•TWISTING OF THE FIBROID
•ANEMIA
•URINARY TRACT INFECTIONS
•SOME PREGNANT WOMEN WITH FIBROIDS HAVE HEAVY BLEEDING
IMMEDIATELY AFTER GIVING BIRTH.

24. MANAGEMENT
MEDICAL/ PHARMACOLOGICAL

25. Oral
contracep
tive pills-
reduce
the heavy
flow
GnRH
agonists
(e.g.,
leuprolide)-
used pre-
postoperativ
ely to shrink
the size of
the tumor.
Antihor
monal
drug RU-
486
(mifepri
stone)
Danazol
(Danocrine)-
decreasing
the number
of hormones
made by the
ovaries
Antifibrinoly
tics
(tranexamic
acid)-
inhibitors of
fibrinolysis
Nonsteroidal
anti-
inflammator
y agents- to
treat
symptomati
c symptoms

26. SURGICAL

27. UTERINE ARTERY EMBOLIZATION/
EMBOLOTHERAPY

29. UTERINE ARTERY LIGATION

30. LAPAROSCOPIC OR ROBOTIC
MYOMECTOMY

31. HYSTEROSCOPIC MYOMECTOMY

32. ENDOMETRIAL ABLATION AND RESECTION
OF SUBMUCOSAL FIBROIDS

33. ABDOMINAL MYOMECTOMY

34. HYSTERECTOMY
A SURGICAL OPERATION TO REMOVE ALL OR PART OF THE
UTERUS IN CASE OF LIFE THREATENING CONDITION OF THE
WOMEN I.E., MENORRHAGIA, POST-MENOPAUSAL PERIOD.
MOST COMMON SURGICAL TREATMENT DONE IN INDIA.

37. TECHNIQUES OF HYSTERECTOMY
•ABDOMINAL HYSTERECTOMY
•VAGINAL HYSTERECTOMY
•LAPAROSCOPIC-ASSISTED VAGINAL
HYSTERECTOMY
•LAPAROSCOPIC-ASSISTED
SUPRACERVICAL HYSTERECTOMY
•TOTAL LAPAROSCOPIC HYSTERECTOMY

38. NURSING INTERVENTIONS
•THE NURSE DETERMINES WHAT THE EXPERIENCE MEANS TO THE PATIENT AND ENCOURAGES HER
TO VERBALIZE HER CONCERNS.
•EXPLANATIONS ARE GIVEN ABOUT PHYSICAL PREPARATIONS AND PROCEDURES THAT ARE
PERFORMED.
•THE PATIENT NEEDS REASSURANCE THAT SHE WILL STILL HAVE A VAGINA AND THAT SHE CAN
EXPERIENCE SEXUAL INTERCOURSE AFTER TEMPORARY POSTOPERATIVE ABSTINENCE WHILE
TISSUES HEAL.
•THE NURSE NEEDS TO APPROACH AND EVALUATE EACH PATIENT INDIVIDUALLY IN LIGHT OF THESE
FACTORS.
•A NURSE WHO EXHIBITS INTEREST, CONCERN, AND WILLINGNESS TO LISTEN TO THE PATIENT’S
FEARS WILL HELP THE PATIENT PROGRESS THROUGH THE SURGICAL EXPERIENCE.

39. CONT…
•THE NURSE ASSESSES THE INTENSITY OF THE PATIENT’S PAIN AND ASSISTS THE
PATIENT WITH ANALGESIA AS PRESCRIBED.
•THE NURSE COUNTS THE PERINEAL PADS USED, ASSESSES THE EXTENT OF
SATURATION WITH BLOOD, AND MONITORS VITAL SIGNS.
•ABDOMINAL DRESSING IS MONITORED FOR DRAINAGE IF AN ABDOMINAL
SURGICAL TECHNIQUE WAS USED.
•NURSE SHOULD INSTRUCT TO CONTACT THE NURSE OR SURGEON IF BLEEDING IS
EXCESSIVE.
•THE PATIENT IS ENCOURAGED AND ASSISTED TO CHANGE POSITIONS FREQUENTLY.
•NURSE HELPS THE PATIENT TO AMBULATE EARLY IN THE POSTOPERATIVE PERIOD.

40. CONT…
•INTAKE AND OUTPUT CHART IS MONITORED.
•EXPLAIN THE PATIENT ABOUT FOLLOW UP VISITS.
•ADMINISTER IRON AND BT AS PRESCRIBED.
•ENCOURAGE VERBALIZATION OF FEELINGS
•MONITOR ACTIVE FLUID LOSS FROM WOUND DRAINAGE,
BLEEDING.
•ENCOURAGE PATIENT TO DRINK PRESCRIBED FLUID AMOUNTS

41. CONT…
•MONITOR SERUM ELECTROLYTES.
•ENCOURAGE CLIENTS TO INCREASE FLUID INTAKE
•OBSERVATIONS OF CHANGES IN MENTAL STATUS, BEHAVIOR OR LEVEL OF
CONSCIOUSNESS.
•NOTE THE CATHETER PATENCY WAS SETTLED (WHEN USING CATHETER)
•ASSESS NUTRITIONAL STATUS, INCLUDING WEIGHT, HISTORY OF WEIGHT LOSS
AND SERUM ALBUMIN.
•ENCOURAGE INTAKE OF PROTEIN AND CALORIE-RICH FOODS.
•HELP IN DEVELOPING EFFECTIVE COPING STRATEGIES.

42. SUMMARY…

43. THANK YOU!