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Gynaecologic tumours with pregnancy


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Gynaecologic tumours with pregnancy

  1. 1. GynaecologicTumours with Pregnancy<br /><br />
  2. 2. Fibroids with pregnancy<br />Incidence: 1%.<br /><br />
  3. 3. Effect of Fibroid on Pregnancy and Labour<br />1.Abortion: particularly in submucousmyomas due to:<br /><ul><li>distortion of the uterine cavity,
  4. 4. affection of the decidual development,
  5. 5. affection of the vascular supply to the implanted ovum.</li></ul>2. Ectopic pregnancy: if it interferes with the passage of the ovum.x<br /><br />
  6. 6. Effect of Fibroid on Pregnancy and Labour<br />7. Torsion of the uterus: very rare in subserousfundalmyoma.<br /> 8. Premature labour.<br /> 9. Nonengagement.<br /> 10. Prolonged labour: Inertia may be present due to interference with normal uterine contractions.<br /> 11. Obstructed labour: in cervical myoma or pedunculatedsubserousmyoma impacted in the pelvis.<br /><br />
  7. 7. Effect of Fibroid on Pregnancy and Labour<br />12. Postpartum haemorrhage: due to<br />> interference with uterine retraction,<br />> increased vascularity.<br />13. Puerperal sepsis.<br />14. Inversion of the uterus: rare.<br />15.Subinvolution of the uterus.<br /><br />
  8. 8. Effect of Fibroid on Pregnancy and Labour<br />> Increase in size: due to<br />a.oedema and increased vascularity,<br />b.hypertrophy of the uterine muscles.<br />> Softening: due to oedema and increased vascularity.<br />> Red degeneration.<br />> Torsion of a pedunculatedmyoma.<br />> Internal haemorrhage: from rupture of a surface vein.<br />> Infection: supervenes bruising during labour.<br />> Extrusion: of submucousmyoma may rarely occur in puerperium.<br /><br />
  9. 9. Management<br /> During pregnancy<br /> During labour<br /> Postpartum<br /><br />
  10. 10. Management>During pregnancy<br />During pregnancy:<br /> a. No treatment is indicated in the majority of cases.<br /> b. Myomectomy carries the risk of abortion and severe haemorrhage so it is indicated in the following conditions only:<br /><ul><li>Red degeneration which is not responding to the conservative treatment in the form of:
  11. 11. Torsion of a pedunculatedmyoma.
  12. 12. Internal haemorrhage from rupture of a surface vein.</li></ul><br />
  13. 13. Management>During labour<br />a. If the myoma lies above the pelvic brim not causing obstruction: vaginal delivery is allowed and myomectomy is done after 3-6 months if indicated.<br /> b. If the myoma lies in the pelvis causing obstruction: caesarean section is indicated, but myomectomy is contraindicated.<br /><br />
  14. 14. Management> Postpartum<br />> Give prophylactic antibiotic.<br />> Observe for postpartum haemorrhage.<br /><br />
  15. 15. Ovarian tumours with pregnancy<br />Incidence: 1:1500. The commonest is simple serous cyst followed by dermoid cyst.<br /><br />
  16. 16. Effect of Ovarian Tumours on Pregnancy and Labour<br />a.Abortion and preterm labour in large and complicated tumours.<br />b.Pressure symptoms.<br />c. Malpresentations and nonengagement.<br />d. Obstructed labour: if a pedunculatedtumour is impacted in the pelvis.<br /><br />
  17. 17. Effect of Pregnancy and Labour on Ovarian Tumours<br />1.Torsion: is the commonest complication particularly in pedunculatedtumours that lie above the pelvic brim. It is more common during puerperium than pregnancy due to;<br /> a. lax abdominal wall,<br />b. large intra-abdominal space after birth allows free mobility of the tumour.<br /><br />
  18. 18. Effect of Pregnancy and Labour on Ovarian Tumours<br />2. Rupture.<br />3. Infection.<br />4. Rapid growth.<br />5.Haemorrhage.<br /><br />
  19. 19. Management>Ovarian Tumours<br /> During pregnancy:<br /> During Labour<br />During puerperium<br /><br />
  20. 20. Management> During pregnancy:<br /> 1. Cyst less than 6 cm in diameter: is left and followed up by periodic examination and ultrasound as it is usually a functional corpus luteum cyst.<br />2. Cyst of 6 cm or more in diameter:<br /> a. Discovered in the first half of pregnancy: is removed after the 12th week when the placenta is formed so there is less liability for abortion.<br /> b. Discovered in the second half of pregnancy: is left to be removed in the first week of puerperium.<br />be removed in the first week of puerperium.<br /> 3. Complicated or malignant tumours:<br /> a. are removed immediately irrespective of the duration of pregnancy.<br /><br />
  21. 21. Management> During Labour<br />a. If the tumour lies above the pelvic brim- causing no obstruction: vaginal delivery is allowed and tumour is removed in the first week in puerperium.<br />b. If the tumour is impacted in the pelvis - causing obstruction: caesarean section with immediate removal of the tumour is done.<br /><br />
  22. 22. Management> During puerperium<br />Tumours discovered for the first time should be removed immediately for fear of torsion.<br /><br />
  23. 23. Cancer cervix with pregnancy<br /><br />
  24. 24. Pre-invasive Cancer (CIN)<br />1. Cytological examination: can be done during pregnancy taking in consideration that some features of dysplasia as increased cells showing mitosis are normally present during pregnancy.<br />2. Colposcopy: is easier to be done during pregnancy due to physiological eversion of the cervix.<br /><br />
  25. 25. Pre-invasive Cancer (CIN)<br />3. If CIN I or CIN II is detected: follow up only as many cases will regress.<br /> 4. If CIN III is detected: follow up is indicated till one month after delivery where conisation can be done or hysterectomy if the patient had taken the decision that she had completed her family.<br /><br />
  26. 26. Invasive Cancer Cervix<br />Incidence: very rare 1:10.000 because;<br />1.The mean age of cancer cervix is 45-50 years.<br />2.The associated infection prevents conception.<br /><br />
  27. 27. Effect of invasive carcinoma on pregnancy and labour:<br /> 1. Abortion and preterm labour: due to haemorrhage, infection and general health affection.<br /> 2. Cervical dystocia, obstructed labour, cervical laceration and/or uterine rupture may occur.<br />3.Puerperal sepsis.<br /><br />
  28. 28. Effect of pregnancy and labour on invasive carcinoma:<br />1. Rapid growth: as young patients tend to have a rapidly growing tumours.<br />2. Rapid spread: if vaginal delivery is allowed.<br /><br />
  29. 29. Management:<br />1. Early pregnancy:<br /> a. Wertheim’s operation or<br /> b. Hysterotomy followed by radiotherapy.<br />2. Late pregnancy:<br />a. Upper segment caesarean section followed by either Wertheim’s operation (caesarean hysterectomy) or radiotherapy.<br /><br />