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Fibroid uterus in detail ..... odstetrics and gynecolgy

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my obstetrics and gynecology seminar in final year,,,, 2012...

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Fibroid uterus in detail ..... odstetrics and gynecolgy

  1. 1. Fibroid uterus • Disease is prevalent in one among every four women as per studies  The commonest benign tumour of uterus  Commonest benign solid tumour in female
  2. 2. Terminology & Definition • “womb stone” • “scleromas” • “Fibroid” • “myoma”  Benign tumors Arising from the myometrium or muscles of its vessel walls Composed of smooth muscles interspersed with varying amounts of fibrous tissue  myoma, fibromyoma, leiofibromyoma, fibroleiomyoma, and fibroma
  3. 3. Aetiology & Pathogenesis   origin of uterine leiomyomas is incompletely understood  But cytogenetic studies have yielded some clues  Each tumor develops from a single muscle cell – a progenitor myocyte Cytogenetic analysis has demonstrated that myomas have multiple chromosomal abnormalities.
  4. 4. • Twenty percent of abnormalities involve translocations between chromosomes 12 and 14. • Seventeen percent involve a deletion of chromosome 7. • Twelve percent involve a deletion of chromosome 12. • oestrogen and progesterone receptors are found in higher concentrations in uterine myomas. • There also appear to be similarities between fibroids and keloid formation
  5. 5. Sites
  6. 6. CLASSIFICATION OF UTERINE FIBROIDS BODY(CORPOREAL) CERVICAL INTERSTITIAL(75%) SUBSEROUS (15%) SUBMUCOUS(5%) SESSILE PEDUNCULATED SUBSEROUS BROAD LIGAMENT WANDERING (PSEUDO) (PARASITIC) ANTERIOR POSTERIOR CENTRAL LATERAL
  7. 7. MORPHOLOGY
  8. 8. BODY/CORPOREAL FIBROIDS GROSS APPEARANCE  CIRCUMSCRIBED DISCRETE ROUND FIRM,GRAY WHITE TUMORS SIZE VISIBLE NODULES TO MASSIVE TUMOR CUT SECTION  SMOOTH AND WHITISH  WHORLED APPEARANCE
  9. 9. Secondary changes
  10. 10. Degenaration atrophy hyaline change calcification cystic degenaration red degenaration Torsion Infection Sarcomatous change – 0.2%
  11. 11. egg shell calcification tvs
  12. 12.  Atrophic  Hyaline  yellow, soft gelatinous areas  Cystic liquefaction follows extreme hyalinization  Calcific circulatory deprivation precipitation of ca carbonate & phosphate  Septic circulatory deprivation necrosis  infection  Myxomatous (fatty) uncommon, follows hyaline or cystic degenration
  13. 13. Red (carneous) degeneration  Commonly occurs during pregnancy  Edema & hypertrophy impede blood supply aseptic degeneration & infarction with venous thrombosis & hemorrhage  Painful but self-limiting  May result in preterm labor & rarely DIC 2-MALIGNANT TRANSFORMATION  Transformation to leiomyosarcomas occurs in 0.1-0.5%
  14. 14. symptom   Asymptomatic  Abnormal uterine bleeding---- 30%  Pain abdomen ---  Mass per abdomen
  15. 15. Abnormal uterine bleeding • The most common symptom is menorrhagia • Heavy / prolonged bleeding (menorrhagia)  iron deficiency anemia • But intermenstrual spotting and disruption of a normal pattern are other frequent complaints • location of the myomas, submucous versus intramural, is not related to bleeding symptoms • symptoms of bleeding were related to the size of myomas • The older theory that the amount of menorrhagia is directly related to an increase of endometrial surface area has been disproven.
  16. 16. PAIN • Dull aching pain of Feeling a mass • RED DEGENERATION • TORSION HAEMORRHAGE, • ACUTE INFECTION • EXPULSION OF A SUBMUCOUS FIBROID • Back pain radiating to the lower extremities • Dysparunea
  17. 17. PRESSURE EFFECTS • If large may distort or obstruct other organs like ureters, bladder or rectum urinary symptoms, hydroureter, constipation, pelvic venous congestion & LL edema • Rarely a posterior fundal tumor extreme retroflexion of the uterus distorting the bladder base urinary retention • Parasitic tumor may cause bowel obstruction • Cervical tumors serosanguineous vaginal discharge, bleeding, dyspareunia or infertility
  18. 18. INFERTILITY “Woman postpones her pregnacy later fibroid postpones it” • The relationship is uncertain • Myomectomy is indicated only in long-standing infertility and recurrent abortion after all other potential factors have been investigated and treated. • submucous myomas that distort the uterine cavity are the myomas that may affect reproduction
  19. 19. VICTOR BONNEY INVENTOR: MYOMECTOMY CLAMP AND SCREW “ …in my early years as a gynaecological surgeon, a case occurred which profoundly affected my outlook. A lady, recently married, wishing above all things to have a child, underwent a subtotal hysterectomy on account of a single sub‐mucous fibroid.”
  20. 20. Master pelvic surgeon and pioneer of conservative surgery for the ovary and fibroids
  21. 21. Clinical Examination
  22. 22.  Clinically, the diagnosis of uterine myomas is usually confirmed by physical examination. Upon palpation, an enlarged, firm, irregular uterus may be felt.  The three conditions that commonly enter into the differential diagnosis include pregnancy, adenomyosis, and an ovarian neoplasm.  The discrimination between large ovarian tumors and myomatous uteri may be difficult on physical examination, because the extension of myomas laterally may make palpation of normal ovaries impossible during the pelvic examination.  The mobility of the pelvic mass and whether the mass moves independently or as part of the uterus may be helpful diagnostically.
  23. 23. INCIDENCE OF CLINICALLY DETECTABLE FIBROIDS IN PREGNANCY VARIES FROM 1 IN 500 TO 1 IN 1000.
  24. 24.  INCREASE IN SIZE– oestrogen and progestrone  RED DEGENERATION – charecterised by rapid enlargement of fibroid, acute onset of pain over the fibroid, mild pain and vomiting……..self limiting……  INFECTION of the fibroid in peuperium  TORSION OF A PEDUNCULATED FIBROID
  25. 25.  Position size and type of fibroid determine their effect on pregnancy  Most complications occur when the fibroid is submucous and close to the placental implantation site.
  26. 26.  Miscarriage and preterm labour.  Both in first and second trimester
  27. 27.  Malpresentations  Non-engagement of head  Uterine inertia  Obstructed labour  PPH and retained placenta  Difficulty at CS
  28. 28.  Puerperal infection and morbid puerperium
  29. 29. Thanks to VISHNU H LAL & AL VAHSAB

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