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

2. 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

3. 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

4. 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.

5. • 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

7. Sites

9. 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

12. MORPHOLOGY

15. 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

16. Secondary changes

17. Degenaration
atrophy
hyaline change
calcification
cystic degenaration
red degenaration
Torsion
Infection
Sarcomatous change – 0.2%

23. egg shell calcification
tvs

24.  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

25. 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%

26. symptom

 Asymptomatic
 Abnormal uterine bleeding---- 30%
 Pain abdomen ---
 Mass per abdomen

27. 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.

28. 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

29. 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

30. 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

31. 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.”

32. Master pelvic surgeon and pioneer of
conservative surgery for the ovary and
fibroids

33. Clinical
Examination

34.  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.

35. INCIDENCE OF CLINICALLY DETECTABLE FIBROIDS IN
PREGNANCY VARIES FROM 1 IN 500 TO 1 IN 1000.

36.  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

37.  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.

38.  Miscarriage and preterm labour.
 Both in first and second trimester

39.  Malpresentations
 Non-engagement of head
 Uterine inertia
 Obstructed labour
 PPH and retained placenta
 Difficulty at CS

40.  Puerperal infection and morbid puerperium

41. Thanks to VISHNU H LAL & AL VAHSAB