uterine fibroids

1. FIBROID
UTERUS
T.Haripriya
Clinical instructor
AACON

2. INTRODUCTION
Fibroid is the commonest benign
tumor of the uterus and also the
commonest benign solid tumor in female.
Histologically, this tumor is composed of
smooth muscle and fibrous connective
tissue, so named as uterine fibromyoma.

3. Definition
1. Uterine fibroids are the most common benign pelvic tumors in women of
reproductive age. They affect 20–40% of those women but are found in 75%
of women. This is due to the fact that most fibroids are asymptomatic.
2. Fibroids are common benign uterine smooth muscle tumours that may occur
singly or multiply and vary greatly in size.
3. Uterine fibroids or leiomyoma are benign tumors of the uterine muscle, called
myometrium. They contain receptors for female reproductive hormones
(estrogen and progesterone) and other enzyme receptors related to estrogen
production .

4. Etiological factors
 Age,
 Any hormonal disturbances
 Hereditary history
 Any previous history of uterine
disorder

5. Types of fibroid uterus
1. Sub-serosal Fibroids are found superficially under the outer lining of the
uterus, the serosa. They can grow to the interior part of the wall or completely
under the serosa.
2. Intramural Fibroids are the most common. They are situated in the middle
layer of the uterine muscle.
3. Submucosal Fibroids grow in the myometrium near the inner lining of the
uterus, called endometrium. they can become pedunculated and protrude into
the uterine cavity

6. Cont.
4. Pedunculated Fibroids are benign (noncancerous) growths in the uterus.
These fibroids are attached to the uterine wall.
These fibroids can grow both inside and outside the uterus. Inside the
uterus, this type of growth is called a pedunculated submucosal fibroid.
Outside the uterus it’s called a pedunculated subserosal fibroid.

8. Clinical manifestations
Increase in size and number. A uterine tumor rapidly growing after
menopause is unlikely to be a fibroid
Menorrhagia (prolonged and heavy bleeding within normal cycle).
Infertility.
Secondary dysmenorrhea (new onset of period pain).
Pressure symptoms from the bowel and bladder, e.g. constipation,
frequency, chronic urinary tract infections (UTIs).
Chronic pelvic pain, dyspareunia.

9. Cont.
Pregnancy-associated symptoms:
Spontaneous abortion
Recurrent abortion
Abdominal pain and pressure signs in
pregnancy
Premature rupture of membranes
Dystocia( Difficulty or obstructed
labor
Post-partum hemorrhage.
Less common symptoms
include:
 For submucosal, pedunculated
fibroids: protrusion through cervical
Os with pain and bleeding.
 separation from the uterus.

10. Diagnostic findings
 Complete history collection
 Physical examination
 Speculum examination reveals cervical mucus or discharge and
ulcerations
 Ultrasound is very helpful in differentiating it from other conditions
such as ovarian tumor.
 Laboratory investigations ,CBC is done to determine if the pt have
iron deficiency anemia because of chronic blood loss.
 Urinalysis to detect UTI.
 Endometrial biopsy is preformed by taking tissue sample from
uterus.

11. Special diagnostic studies
 Hysterosalpingogram ( an
ultrasound exam is done while
contrast fluid is injected into the
uterus from cervix
 Hysteroscopy (HSC) ( to look at the
uterus by passing a small fiberoptic
camera through the opening of the
cervix determines fibroid is
presented r not

12. Therapeutic management
Expectant
management
Surgical
management
Medical
management

13. Medical management
Symptomatic treatment
Analgesics.
Iron and folic acid to correct anaemia
Tranexamic acid or non-steroidal anti-inflammatory drugs
Gonadotropin-releasing hormone analogs
Progesterone antagonists

14. Surgical Management
 Abdominal hysterectomy(A hysterectomy
is the removal of the uterus with or without
the ovaries and the tubes.
 Myomectomy (Myomectomy means the
excision of fibroids from the myometrium
without removing the uterus)
 Laparoscopic myomectomy or
Hysterectomy

15. Cont.
A myomectomy is a surgical procedure
used to remove non-cancerous
growths, also called uterine fibroids or
leiomyomas, that are found growing in
the uterus of women who are of
childbearing age. The advantage of
laparoscopic surgery is faster recovery
with a shorter hospital stay and fewer
complications.

17. Preoperative Nursing Management
1.Pain Management
2.Fluid Replacement
3.Bleeding Control
4.Patient Education

18. 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 oxygen
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 obstetrician 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.

19. Cont.
♣Intake and output chart is monitored.
♣Explain the patient about follow up visits.
♣Administer iron and folic acid as prescribed.
♣Encourage verbalization of feelings of patient
♣Monitor active fluid loss from wound drainage, bleeding.
♣Encourage patient to drink plenty of oral fluid
♣Monitor serum electrolytes.

20. Cont.
♣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 status.
♣Encourage intake of protein and calorie-rich foods.
♣Help in developing effective coping strategies.

21. Complications
Degeneration
Necrosis
Infection
Hemorrhage
In pregnant mother;
 Necrosis
 Spontaneous abortion.
 Premature labor and delivery.
 Abruption of placenta.
 Post-partum hemorrhage.

22. Nursing diagnosis
1. Impaired urinary incontinence related to presence of local tissue edema or
hematoma.
2. Ineffective Tissue Perfusion related to postoperative tissue inflammation.
3. Sexual dysfunction related to change in sexual response pattern.
4. Constipation or Diarrhoea related to manipulation of the bowel or weakening
of abdominal musculature.
5. Knowledge deficit related to Information misinterpretation.
6. Risk for low self esteem related to effect on the sexual relationship.