gynecology presentation

1. Uterine Fibroids
BY: RITIKA BHATIA
GROUP1902

2. Fibroids
• Synonyms : Myoma, Leiomyoma, Fibromyoma
• Most common benign neoplasm in uterus and female pelvis
• Incidence : 20 to 40% of reproductive age women
• Uterine fibroids are not cancer, and they almost never turn
into cancer.

3. Epidemiological risk factors
Increased risk
• Increased risk
• Age 35 to 45 years
• nulliparous or low parity
• strong family history
• Obesity
• early Menarche
• hypertension
Decreased risk
• ↑↑ parity
• Exercise
• ↑↑intake of green vegetables
• Progesterone only
contraceptives
• Cigarette smoking

4. Etiology
• It arises from smooth muscle cells of myometrium
• Exact etiology not known
• Monoclonal origin ( arising from single cell) Various growth
factors like TGFβ , EGF, IGF-1, IGF-2, implicated in the
development of fibroids

5. Fibroid - Etiology
Genetic basis: Responsible for 40 % cases of fibroids
• Translocation between Chromosome 12 & 14
• Trisomy 12
• Higher incidence in nulliparous women
• Common in obese women
• May increase during pregnancy

6. Types of Fibroids
• All fibroids are interstitial to begin with and then enlarge.
• May remain intramural, become subserosal or submucosal
• Subserosal may become pedunculated &
occassionally parasitic receiving blood
from other organs usually omentum
• Submucous fibroid may become pedunculated and
present in the vagina through the cervix
• Large submucous fibroid may pull down the cervix
resulting in chronic inversion

8. Classification of Fibroids

9. Clinical presentation
• Asymptomatic- most common
• Abnormal uterine bleeding – 30-50% of patients.More common
with submucosal but may occur with all types
• Anemia due to excessive blood loss
• Pelvic pain - Dysmenorrhoea – Spasmodic as well as
congestive
• Pressure symptoms
• Abdominal distention- with large fibroids
• Rapid growth- with pregnancy and malignancy
• Infertility – 2 to 10 % cases

11. Effects of fibroid on pregnancy :
• Pregnancy : Abortion
Pressure symptoms
Malpresentation
Retrodisplacement of uterus
• Labour : Preterm labour
Malpresentation
• Puerperium : Subinvolution
Sec. PPH
Inversion

12. Fibroid - Diagnosis
Investigations
• USG : Well defined hypoechoic lesions.
Peripheral calcification with distal
shadowing
in old fibroids
• Hysteroscopy : Submucous fibroids
• Saline infusion sonography- help
differentiate submucous from intramural
fibroids

13. Fibroid USG

14. Fibroid Diagnosis
MRI : It does precise fibroid mapping & characterization 
Detects all fibroids accurately
 D/D from adenomyosis
 D/D from adnexal pathology
 Ovaries are easily seen
 Detects small myomas(0.5 cm)
H S G : Not done for diagnosis. Done for infertility evaluation
filling defects may be seen.

15. Fibroid MRI

16. Fibroid MRI

17. Fibroid- Management
Expectant : asymptomatic incidental fibroids
Size < 12 weeks,
nearing menopause
• Regular follow up every 6 months
• Routine pelvic examination
• Baseline imaging to compare regression

18. Medical Management
• Not a definitive treatment
• For symptomatic relief from pain- NSAIDs
• Drugs used:
Progestogens, antiprogestogens(Mifepristone),
androgens ( Danazol, Gestrinone) & GnRH
analogues are used
• nowadays SERM – Raloxifen is also used in
combination with gnrh
• SPRM – Asoprisnil

19. Surgical Management
• Hysterectomy  Abdominal
 Vaginal
 LAVH, TLH
• Myomectomy  Abdominal
 Vaginal
 Hysteroscopic
 Laproscopic
• uterine artery embolisation

20. Thank You