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Fibroid
- 2. Definition • A fibroid is a benign tumour of uterine smooth muscle, termed a ‘leiomyoma’
- 3. Some facts about fibroids • Termed benign and are rarely malignant • Estrogen dependent • Fibroids usually undergo atrophy after menopause • Size increases during the pregnancy period
- 4. Incidence • Fibroids are common in women of reproductive age • They are present in about 20 per cent of women over 30 years of age.
- 5. Seen in Nulliparous women >35 years Family history OCP or IUD users Obesity Non smokers African American women
- 6. pathology • Macroscopically Firm, composed of fibrous tissue and myometrial tissue If myometrial tissue is high termed myoma If fibrous tissue high fibromyoma
- 9. Types of fibroids 1)Sub mucous fibroid associated with endometrium. Grow beneath endometrium. Protrude into uterine cavity fibroid poyps. 2)intramural fibroid grow within the myometrium and result in enlargement of whole body of uterus 3)Sub serosal fibroid grow on outer surface of uterus 4)pedunculated fibroid attached to the uterus by a narrow pedicle containing blood vessels 5)Broad ligament fibroids associated with broad ligament. 6)Cervical Arising from the cevix.
- 13. Subserosal and pedunculated fibroids
- 14. Symptoms • Usually asymptomatic • With the increase in growth start to show symptoms
- 15. Menstrual disturbances *menorrhagia *Dysmenorrhea *intermensrrual bleeding • Pressure symptoms • Heaviness • Bloating • Varicose veins • Urinary retention • Frequency • urgency Distended abdomen Subfertility Dyspareunia Back pain Acute pain
- 17. Types of degeneration • 3 types of degeneration Red degeneration Hyaline degeneration Cystic degeneration CalcificationCommon in pregnancy and puerperium Increased vascularity of uterus and becomes painful and tender Commonest large tumors, degeneration in central part and tumor become soft in consistency Follow hyaline degeneration, and cavitation occur in central part of tumor. Womb stones Deposit caco3 and phosphate in post menopausal women
- 18. Red degeneration
- 19. Calcification
- 20. Complications • Anaemia due to excessive menstrual bood loss • A fibroid uterus can get impacted in the pouch of Douglas causing acute retention of urine • Pedunculated fibroid can undergo twisting and necrosis cause pain • Infection can occur in sub mucous fibroids usually following delivery or miscarriage.it can occur in interstitial fibroid following Caesarean section if the uterine incision extends in to the myoma • Malignant change can occur rarely 1% • Subfertility • (RED DEGENERATON)
- 21. Complications in pregnancy • Antenatal Ectopic Miscarriage Premature delievery Placenta praevia Placental abruption IUGR Red degeneration Anaemia Unstable lie
- 22. • Intranatal Malpresentation Obstructed labour Primary PPH difficult LSCS
- 23. • Post natal Secondary PPH Necrosis and infection Poor uterine involution
- 24. Complications in pregnancy • In late pregnancy- fibroids located in the cervix or lower uterine segment may cause an abnormal lie. • During labour- obstructed labour and increased incidence of Caesarean section .when fibroid occupy the lower segment ,incision needs to be placed in the upper segment. • After delivery- postpartum haemorrhage may occur due to inefficient uterine contraction
- 25. examination In general examination always look for pallor for anaemia Abdominal examination might indicate the presence of a firm mass arising from the pelvis at 12 to 14 weeks gravid uterus size it become palpable in suprapubic region. Abdomino pelvic lump its firm, nontender,irregular, mobile in transverse direction, mobility restricted vertically, If lateral it could also be adenexeal mass If mass moves with uterus likely to be leiyomyoma.
- 26. Differential Diagnosis • Pregnancy • Ectopic pregnancy • Malignancy • Ovarian neoplasm • Tuboovarian inflammatory mass • Pyometron • Haematometra • Pelvic kidney • Adenomyosis