Benign growths in the uterus that can develop during a woman's childbearing years.Highest incidence was seen in Pakistani women 78%, then rural Indian women 37.65%, urban India 24% and Nigerian women 30%. Arobosoba from Nigeria has reported prevalence of uterine fibroids in black women was more (26%), in comparison to Caucasian women (17.9%).

1. FIBROID
UTERUS
SR. SUSMITA HALDER
SISTER TUTOR
SCHOOL OF NURSING, ASIA HEART FOUNDATION

2. INTRODUCTION
Uterine fibroids are benign smooth muscle tumors
that occur within the uterus.
These are most common benign tumors of female
genital tract.
It is also known as uterine leiomyoma ,myoma or
fibromyoma.

3. INCIDENCE
• It has been estimated that at least 20% of women at the age of 30
have got fibroid in their wombs.
• Fortunately 50% of them remain asymptomatic.
• The incidence of symptomatic fibroid in the hospital outpatient is
about 3%
• A high incidence of 10% prevails in England. The incidence is even
higher in black women

4. TYPES OF OF UTERINE FIBROID
Uterine fibroids can be classified according to
anatomical location.
1. Corporal /body ( the fibroids are mostly located
in the body of the uterus and are usually
multiple)
2. Cervical ( The fibroids are mostly located in the
cervix of uterus. This can be supravaginal or
vaginal)

5. CORPOREAL FIBROIDS OF
UTERUS
1. Interstitial or intramural: (75%) : fibroidss are initially in intramural
position but subsequently some are pushed outwards or inwards.
2. Subperitoneal or subserous(15%) : In this condition the intramural
fibroid is pushed outwards towards the peritoneal cavity. The
fibroids are either personally or completely covered by
peritoneum.

6. • When it is completely covered by peritoneum it attains a pedicle – penductulated subserous fibroid.
• in some cases the pedicle may be turn through and the fibroid gets its nourishment from the
omental for mesenteric additions and is called – wandering or parasitic fibroid.
• Sometimes the intramural fibroid may be pushed out in between the layers of broad ligament and is
called- broad ligament fibroid.
3. Submucous (5%) : the intramuralfibroid when pushed towards the uterine cavity and is lying
underneath the endometrium it is called submucous fibroid. Submucous fibroid can make the uterine
cavity irregular and distorted. Penductulated mucous fibroid may come out through cervix it may be
infected or ulcerated to cause metrorrhagia. The type is very least common but it produces maximum
symptoms

7. CERVICAL FIBROIDS
• Cervical fibroids are rare.
• In the supravaginal part of cervix it may be interstitial or subperitoneal variety
and rarely polypoidal. Depending upon the position it may be anterior-posterior
lateral or central. Interstitial growths mein displays the cervix or expanded so
much that the external cost is difficult to recognise it also affects ureter
• In the vaginal cervix the fibroid is usually penductulated.
• A fibroid polyp arising from the uterine body when occupies and distance from
the cervical canal is called pseudo cervical fibroid

8. ETIOLOGY
Histogenesis
• Origin
• The etiology still remains unclear.
• the prevailing hypothesis is that it arises from new plastics in the
smooth muscle cell of myometrium
• The stimulus for initial neoplastic transformation is not known.

9. 1. Chromosomal abnormality: in about 40% of cases there is a
wearing type of chromosomal abnormality particularly in
chromosome 6 or 7 rearrangements and deletion takes place.
Somatic mutations in mitral cells may also be the cause for
uncontrolled cell proliferation.
2. Role of peptide growth factors: epidermal growth factor EGF,
insulin like growth factor 1 IGF1 , transforming growth factor
TGF, simulate the growth of leiomyoma either directly or via
oestrogen.
3. A positive family history is often present.

10. • Growth
it is predominantly and oestrogen dependent tumor. Oestrogen and
progesterone is incriminated as the cause. Oestrogen dependency is
evidence by
• Growth potential ATI is limited during childbearing period
• Increase growth during pregnancy
• They do not occur before menarche
• Following menopause there is cessationof growth and they undergo
atrophy after menopause

11. • It seems to contain more oestrogen receptors than adjacent
myometrium.
• Association of anovulation
• The growth potentiality varies. As a whole the rate of growth is
slow and takes about three to five years for the five to grow
sufficiently to be felt per abdomen (Evidence shows Ovarian
tumors grow in months.
• However fibroid grows rapidly during pregnancy or OCP users.
Rapid growth also may be due to degeneration or due to
malignant change

12. RISK FACTORS
INCREASED RISK
• Nulliparity
• Obesity
• Hyper oestrogenic
state
• Black women
REDUCE RISK
• Multiparity

13. CLINICAL FEATURES OF CORPOREAL FIBROID
PATIENT PROFILE
• Patients are usually nari Paris or having a long period of
secondary infertility
• Early marriage and frequent childbirth makes it even
higher amongst the multiparous women
• The incidence is at its peak in 35 to 45 years
• There is a tendency of delayed menopause.

14. SYMPTOMS
• 75% of fibroids remain asymptomatic. They are accidentally
discovered by physician during routine examination or at leopard to
me or laparoscopy.
• The symptoms are related to an atomic type and size of tumor.
• The site is more important than the size. A small submucous fibroid
may produce more symptoms than a big subserous fibroid.

15. MENSTRUAL ABNORMALITIES
A . In 30% of cases mineral is the classic symptom of symptomatic fibroid.
Menstrual loss is progressively increased with successive cycles due to
• Increase surface area of endometrium
• Interference with normal uterine contractility due to interposition of fibroid
• Condition and dilation of adjacent endometerial venous plexus is caused by
obstruction of tumor.
• Endometrial hyperplasia due to hyper oestrogenic state.
• Pelvic congestion
• Imbalance of thromboxane A2 and prostacyclin with deficiency of thromboxane A2.

16. B. Metrorrhagia or irregular bleeding may be due to
• Ulceration of submucous fibroid polyp
• Torn vessels from slugging base of a polyp
• Associated endometrial carcinoma.
C. dysmenorrhea. : the congestive variety may be due to associated
pelvic congestion or endometriosis.
• Spasmodic type is associated with extrusion of polyp and its
aspiration from uterine cavity
• Subserous or broad ligament fibroids are usually on associated with
menstrual abnormalities.

17. D.Infertility – infertility may be a major complaint the probable known attributing factors are
UTERINE
• Distortion and or elongation of uterine cavity which leads to difficult sperm ascent
• Preventing kramak contraction due to fibroids during intercourse leads to impaired sparm
transport
• Congestion and dilatation of endometrial venous plexus
• Atrophy an ulceration of endometrium
• Menorrhagia and dyspareunia
TUBAL – cornua block duty position of fibroid.
OVARIAN – anovulation
PERITONEUM- endometriosis

18. OTHER SYMPTOMS ARE
• Pregnancy related problems like abortion preterm labour and intrauterine growth restriction. The
reasons are defective implantation of class inter poly developed endometrium reduce space of for
growing foetus and placenta. Shoulder dystocia postpartum hemorrhage are also common.
• Pain per abdomen: usually painless ,pain may be due to associated pelvic pathology such as tumor,
endometriosis , pelvic inflammatory disease etc
• Patient may have a sense of heaviness in lower abdomen she may feel a lump in the lower abdomen
even without any other symptoms

19. CLINICAL FEATURES OF CERVICAL FIBROID
• In non pregnant state the symptoms are predominantly due to pressure effects on
the surrounding structures
• Anterior cervical: bladder symptoms like frequency or even retention of urine are
species the retention is more due to pressure then elongation of urethra.
• Posterior cervical: rectal symptom is the form of constipation
• Lateral cervical: vascular obstruction may lead to hemorrhoids and edema of legs
the ureter is post laterally and below the tumor
• Central cervical: Is producers predominant bladder symptoms.
It is mainly asymptomatic during pregnancy but produces obstruction during labour.

20. SIGNS
1. General examination reveals varying degrees of pallor depending upon the
magnitude and duration of menstrual loss
2. Abdominal examination reveals tumor may not be sufficiently enlarge to be felt per
abdomen. Bath is enlarged to 14 weeks or more of the following features are noted.
3. Upon palpation
• It fields farm more hard may be due to cystic degeneration
• Margins are well defined accept the pole which cannot be reached suggestive of
pelvic in origin
• Surface is nodular and mobility is restricted

21. 4. This swelling is dull on percussion.
5. Pelvic examination reveals the uterus is regularly enlarged by
the swelling per abdomen.
• Uterus isnot well separated from swelling such as groove is not
filled between the uterus and the mass
• Movement of cervix along with the tumor is felt per abdomen

22. FATE OF A FIBROID!
( COMPLICATIONS)
• Surface necrosis
• Polypoid change following pedicle formation
• Infection
• Degeneration including sarcomatous change
• Sarcomatous change are rare
• Hemorrhage due to rupture of surface vein of subserous fibroid
• Polycythemia due to erythropoietic function by the tumor
• Torsion of subserous penductulated fibroid.

23. Any doubt? 🤨
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I’ve few questions for you. 

24. QUESTIONS ✍️
1. What is uterine fibroid? 1
2. What are the signs and symptoms of uterine fibroid?
5
3. Explain treatment modalities of fibroid uterus.
9
1+5+9=15

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