1. UTERINE FIBROIDS
Bashi Mwewa

2. INTRODUCTION
• Uterine fibroids are noncancerous growths of the
uterus that often appear during childbearing age.
• It can grow inside, outside or within the uterine wall
they can also be attached to the uterus by the stem
like structure.
• A single cell divides repeatedly, eventually creating a
firm, rubbery mass distinct from nearby tissue. The
growth patterns of uterine fibroids vary — they may
grow slowly or rapidly, or they may remain the same
size. Some fibroids go through growth spurts, and
some may shrink on their own.

3. DEFINITION
• These are benign tumor of the smooth
muscles of the uterus characterised by
menstrual disturbances and enlargement of
the abdomen.

4. INCIDENCE
Fibroids are most common tumors of female
pelvis. They occur in female aged 35-50 years.
fibroids rarely occur before menarche.

5. PATHOLOGY
• The tumour arises from the myometrium and
grows slowly though sudden spurt of
growth.the tumour are relatively avascular but
carries its blood supply from the pseudo
capsular layer. since the entire blood supply is
derived from the pseudo capsular layer.the
growth of tumour often outdstrips its blood
supply ,and avascular degeneration of the
tumour arises.

6. CAUSES OF FIBROIDS
•
•
•
•
•
Idiopathic
Hereditary
Race
Infertility
Age

7. COMMON SITES OF UTERINE FIBROIDS

8. CLASSIFICATIONS
• SUBMUCOSAL-These grow just underneath
the inner uterine lining (endometrium)
• INTRAMURAL-These grow within the muscular
wall of the uterus in between layers of the
muscle(myometrium).
• SUBSEROSAL- These grow on the out side of
the uterus.
• CERVICAL-These are located in the wall of the
cervix.

9. SIGNS AND SYMPTOMS
 Menorrhagia due to increased endometrial
surface overlying the fibroids
 Inter menstrual bleeding
 Enlargement of the abdomen due to enlargement
of the fibroids
 Frequency, urgency and incontinence urine
 dysuria
 Backache
 Dyspeurania

10. SIGNS AND SYMPTOMS CONT….
Rectal pressure leading to constipation
Habitual abortion
On palpation the uterus feels bigger with
irregular shapes equivalent to pregnant uterus
Vaginal bleeding after menopause
Abdominal clamps
Pelvic pain

11. DIAGNOSIS
•
•
•
•
History taking
Laparoscopy
Pelvic ultra scan
MRI-This is more accurate than u/s and shows
the number of fibroids and their location

12. COMPLICATIONS
 Infertility-when the uterine cavity is dislodged by
tumour
 Anaemia-from continuous bleeding
 Possible intestinal obstruction-if tumours are
large or twist nearby organ.
 Spontaneous Abortion
 Ectopic Pregnancy
 Premature labor
 Dystocia
 Cancer

13. TREATMENT
• Treatment can be medically or Surgically

14. MEDICAL MGT
• Give Gonadotrophin Releasing Hormone- This
help in decreasing the size of fibroids before
surgery.
• This drug also gives an opportunity for a surgeon
to select optimal surgical intervention
• The maximum effect is about 12 weeks after
starting the treatment.
• The fibroid can reoccur 6 months after
discontinuing the drug.

15. SIDE EFFECTS
• Osteoporosis
• Mood changes
• Vaginal dryness

16. SURGICAL MANAGEMENT
1. HYSTEROSCOPY RESECTION-This is the removal
of the submucosal fibroids using instruments
inserted through the vagina and cervix into your
uterus.
2. ENDOMETRIAL ABLATION-They use this to
remove submucosal fibroids using cautry laser.
3. MYOMECTOMY-This is the surgical removal of
submucous fibroids. It can be performed
through laparascopy or laparatomy

17. SURGICAL MGT CONT….
4.HYSTERECTOMY-This is the surgical removal of
the uterus together with the fibroids

18. PRE OPARETIVE CARE
AIMS
To prepare the patient physically and
psychologically for surgery
To prevent intra and post operative
complication
To alley anxienty

19. Admission
• Patient is admitted 48-72 hours before surgery
in order to carry out all the necessary
preparation ordered by the surgeon and also
to orient the patient
Psychological care
• introduce yourself to establish good rapport

20. Psychological care cont…
• Explain the condition to both the patient and
the family members so that they can
understand the complication that may arise if
not treated.
• Explain the type of operation to both the
patient and the family members,if in doubt
invite the surgeon to explain fully

21. Psychological care
• Stress the importance of surgical treatment as
a helpful option , to help client develop
confidence in the surgical approach to
treatment.
• Explain to the patient that pain management
during and after surgery will be done using
strong analgesics to alley the fear related to
pain

22. Psychological care
• Allow the patient to ask questions and answer
them correctly to help express her fears and
anxiety about surgery
• Explain the possibility for blood transfusion to
avoid imposing treatment on the patient or
infringing on the patients religion beliefs

23. Informed consent
• after giving psychological care and the patient
the patient understand the condition and type
of surgery to be done
• Allow the patient to sign a consent form and
explain to her that its legal document
allowing the surgeon to carry out a surgical
procedure on her.

24. PHYSICAL PREPARATION
NUTRITION
• Patient should have good nutrition status
before surgery
• Give protein and vitamin supplement to
promote quick healing of the wound post
operatively.
• Give food rich in roughage to prevent
constipation

25. PHYSICAL PREPARATION
INVESTIGATION
• Ultra sound to visualise the location of fibroids
• Urinalysis is done in order to rule out diabetis
mellitus and other complications
• Blood should be collected for
haemoglobin/haematocrit estimation to rule out
anaemia
• Bleeding and clotting time to rule out bleeding
disorders, HB
• Blood for grouping and x-matching incase of need
for blood transfusion

26. SKIN PREPARATION
• Clean the skin around the operating site with
soup and water to prevent microorganism
from entering the operating site during
surgery
• Shave or trim the hair according to the
surgeons preference

27. BOWEL PREPARATION
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•
•
•
This is done to prevent constipation
Give enema
Give food rich in roughage
Encourage oral fluid after meal

28. BLADDER CARE
• Encourage patient to empty the bladder
before going to theatre to avoid urine
incontinence during surgery
• Insert the urine catheter so that the bladder is
ever empty to prevent damage during
operation.

29. PRE MEDICATION
• Give prescribed pre medication 30min to 1
hour before operation such as Diazepam
to reduce anxiety , Atropin to dry up
secretion
• Insert an iv line and administer intra
venous fluid to rehydrate and to keep the
vein open

30. HYGIEN
• If the patient is ambulant allow her to take a
bath to promote blood circulation
• Allow her to brush the teeth

31. OBSERVATION
• Check vital signs to act as baseline data to
compare with intra and post operative vital
signs
• observe general condition of the whether fit
for surgery or not.

32. JEWELLARIES
• Remove all jewelaries and put in the sisters
cupboard for safe keeping
• Cover the wedding ring with strapping if it can
not be removed.

33. DENTURES
Remove the dentures if any and put them in
cup with water to prevent dislodging during
intubation and cause airway obstruction
I will label and store in the sisters cupboard
for safe keeping to avoid loosing then
If patient has loose teeth,I will inform the
anaesthetist to ensure care during intubation

34. IDENTITY
I will put an identity band on the hand or
forehead
Stating the name , age ,sex , procedure , bed
number , ward and diagnosis
This are done so that patient can be easily
identified

35. GOWNING
• Remove patient’s clothes and dress her in a
theatre gown to prevent cross infection
• I will also cover patients hair to prevent cross
infection

36. TRANSPORTATION TO THEATRE
• Collect all documents for the patient eg case
record , investigation results

37. IEC
• Educate patient that physical activities will be
restricted for at least 2 months
• Heavy lifts and gardening , cooking restricted
for 2 months
• Educate patient that sexual intercourse should
be avoided until wound heals

38. POST OPERATIVE CARE
AIMS
• To ensure that patient recovers fully from the
effect of surgery and Anaesthesia
• To relieve pain
• To prevent complications such as
haemorrhage

40. ENVIRONMENT
• I will prepare necessary equipments such as iv
pole , suction machine , oxygen machine and
emesis bowl ready for use in case need arise
• I will nurse my patient in a warm and well
ventilated roomy to promote free air circulation.
• I will ensure that the room is quiet to promote
rest this will be achieved by playing radios and
TVs at low volume, oiling squeaking trollies and
answering phone promptly.

41. • The room will be well light for easy
observation

42. POSITION
• While in anaesthesia ,I will nurse the patient
in a semi prone position to facilitate free
drainage of secretions
• After the patient recover from anaesthesia I
will nurse her in a position of comfort to
reduce pain and promote rest
• On the first day post operatively I will prop up
the patient in semi fowlers position with head
supported by pillow to promote free lung
expansion

43. OBSERVATION
• I will check vital signs temperature, pulse
respiration and blood pressure 1/4hrly,
1/2hrly, hrly, 4hrly and twice daily as patient
improves to detect any abnormalities
• Elevation in temperature will indicate
infection
• Decrease in pulse will indicate internal
haemorrhage

44. • I will examine the operating site and check
dressing for any bleeding ,if any I will apply
pressure on the dressing to reduce bleeding
• Watch for post op chills and keep the patient
comfortably warm to prevent hypothermia
and cardiac stress

45. PAIN RELIEF
• Administer prescribed opiod analgesics e.g.
pethidine to relieve post operative pain.
• Later give oral mild analgesic e.g. brufen or
diclofenac as prescribed

46. • I will examine the