fibroid uterus is benign smooth Muscule tumours that occur within the uterus and is the most common benign tumours of the female genital tract incidence the incidence of fibroid in pregnancy is about 1 in 1000 and it depends on population characteristics .

1. PREGNANCY WITH FIBROID
UTERUS
SUBMITTED TO: MRS PUSHPA KERKETTA
SUBMITTED BY : NEHA NUPUR
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2. CONTENTS
• INTRODUCTION
• DEFINITION
• CLASSIFICATION
• CAUSES
• RISK FACTORS
• CLINICAL SIGNS AND SYMPTOMS
• EFFECT OF FIBROID ON PREGNANCY
• Effect of pregnancy on fibroid
• Degeneration
• Treatment
• Indication for caesarean
• Complication
• Nursing diagnosis
• Evaluation
• Bibliography

3. INTRODUCTION
• FIBROID UTERUS IS THE COMMON BENIGN
TUMOUR OF UTERUS , DURING PREGNANCY
WITH SONOGRAPHY IT HAS BEEN
DIAGNOSED .

4. • FIBROID UTERUS IS BENIGN SMOOTH MUSCULE TUMOURS THAT
OCCUR WITHIN THE UTERUS AND IS THE MOST COMMON
BENIGN TUMOURS OF THE FEMALE GENITAL TRACT
INCIDENCE
• THE INCIDENCE OF FIBROID IN PREGNANCY IS ABOUT 1 IN 1000
AND IT DEPENDS ON POPULATION CHARACTERISTICS .
DEFINITION

5. DEFINITION
• “A BENIGN(NON-CASEOUS) TUMOR ARISING FROM THE SMOOTH MUSCLES
LAYER AND ACCOMPANYING CONNECTIVE TISSUE OF THE UTERUS” FIBROID
IS CHIEFLY COMPOSED OF SMOOTH MUSCLE FIBRES & A SMALL AMOUNT OF
CONNECTIVE TISSUE. THE NAME FIBROID IS A MISNOMER, MORE
APPROPRIATE TERM FOR THIS TUMOR OF SMOOTH MUSCLE IS MYOMA OR
LEIOMYOMA.

7. CLASSIFICATION OF FIBROIDS
• INTRAMURAL FIBROIDS
• SUBSEROSAL FIBROIDS
• SUBMUCOUS FIBROIDS WITHIN BODY OF UTERUS CERVICAL
INTRALIGAMENTARY

9. CAUSES
• THE EXACT CAUSE IS UNKNOWN .
• WOMAN WHO IS SMOKE TEND TO BE RELATIVELY OESTROGEN DEFICIENT AND
HAVE BEEN FOUND TO HAVE A LOWER INCIDENCE OF FIBROID UTERUS .
• IT IS 3 TO 9 TIMES MORE COMMON IN BLACK WOMEN THEN WHITE WOMEN
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11. RISK
FACTORS
• AGE 35 TO 45 YEARS .
• NULLIPAROUS OR LOW PARITY .
• OBESITY .
• EARLY MENARCHE LESS THAN 10 YEARS .
• STRONG FAMILY HISTORY OF CIGARETTE SMOKING .
• STRONG FAMILY HISTORY OF DIABETES
HYPERTENSION .

12. • MORE THAN 50% ASYMPTOMATIC
• ACUTE ONSET OF PAIN OVER THE TUMOUR
• MALAISE OR EVEN RISE IN TEMPERATURE
• DRY OR FOR TONGUE
• ABNORMAL UTERINE BLEEDING (HEAVY AND PROLONGED
PERIODS)
• PAIN- CONSTANT PELVIC PAIN OR BACKACHE
• ACUTE PAIN OCCURS IN CASE OF TORSION, INFECTION,
EXPULSION, RED DEGENERATION, VASCULAR COMPLICATIONS .
CLINICAL SIGNS AND
SYMPTOMS

14. • TENDERNESS AND RIGIDITY OVER THE TUMOUR
• PRESSURE EFFECT
-BLADDER- FREQUENCY OF URINE
- RETENTION WITH OVERFLOWN INCONTINENCE
- URETER- HYDROURETER HYDRONEPHROSIS
- BOWEL- CONSTIPATION TENESMUS
- PELVIC VEIN- EDEMA LEGS
• LUMP IN ABDOMEN AND PELVIC PRESSURE (FIBROIDS AS LARGE AS WEIGHING
100 POUND HAPPEN REPORTED)
• MENORRHAGIA( THE MOST COMMON SYMPTOM). BLOOD COUNT SHOWS
LEUCOCYTOSIS
CLINICAL SIGNS AND
SYMPTOMS

15. • MOST OF THE TIME NO SYMPTOMS ARE PRESENT
• PATIENT MAYBE ELDERLY PRIMI OR KNOWN CASE OF FIBROID, THERE MAY
BE HISTORY OF INFERTILITY OR BAD OBSTETRIC HISTORY
• SYMPTOMS LIKE PAIN IN ABDOMEN ,RETENTION OF URINE, CONSTIPATION
• SOMETIMES FETAL PART ARE NOT EASILY PALPATED OR FHS ARE NOT
AUSCULTATED PROPERLY
• SIZE OF THE UTERUS MAY BE MORE THAN THE WEEKS OF GESTATION
• RARELY ACUTE SYMPTOMS DUE TO RED DEGENERATION OR TORSION CAN
OCCUR
• CONFIRMATION IS COMMONLY AND EASILY DONE BY ULTRASOUND
CLINICAL DIAGNOSIS

17. EFFECT OF FIBROID ON PREGNANCY
• PREGNANCY
• ABORTION -SUBMUCOUS FIBROID CAN LEAD TO RECURRENT ABORTIONS
,OTHERWISE IN SUB SEROUS AN INTRAMURAL FIBROID ABORTION INCIDENCE IS
NOT HIGH. IT IS DUE TO DISTORTION OF THE CAVITY AND INTERFERENCE TO
THE GROWTH OF UTERUS. ABORTION MAY BE INCOMPLETE AND CAN LEAD TO
SEPSIS
• PRESSURE SYMPTOMS - GROWING FIBROID DURING PREGNANCY AFFECTS
FUNCTION OF SURROUNDING ORGANS LIKE BLADDER, URETER AND RECTUM

18. EFFECT
OF
FIBROID
ON
PREGNANC
Y
• MARK PRESENTATION
• RETRO DISPLACEMENT OF URETERS UTERUS
• NON ENGAGEMENT OF THE PRESENTING PART
• RECTUM CONSTIPATION
• RETENTION OF URINE

19. EFFECT OF FIBROID ON PREGNANCY
• LABOUR
• MALPRESENTATION- IT IS VERY COMMON DUE TO DISTORTION OF THE CAVITY
• UTERINE INERTIA- IT INTERFERES WITH UTERINE CONTRACTIONS PARTICULARLY
MULTIPLE FIBROIDS
• PREMATURE LABOUR- IT MAY BE DUE TO OVERSTRETCHING AND IRRITATION
OF THE UTERUS
• DYSTOCIA- WHEN FIBROID IS SITUATED IN ISTHMIC OR CERVICAL REGION OR IN
BROAD LIGAMENT IT OBSTRUCT THE DESCENT OF PRESENTING PART

20. • POSTPARTUM HAEMORRHAGE - USUALLY OCCURS DUE TO SUBMUCOUS
FIBROID, THERE IS AN INCREASED CHANCE OF RETAINED PRODUCTS .PROPER
CONTRACTIONS AND RETRACTION OF UTERUS CAN ALSO NOT OCCUR WHEN
PLACENTA IS IMPLANTED ON FIBROID
• MANUAL REMOVAL OF PLACENTA- CHANCES OF MANUAL REMOVAL OF
PLACENTA INCREASE DUE TO MORBIDLY ADHERENT PLACENTA ON FIBROID.
• PUERPERIUM
 SUB INVOLUTION
 SECONDARY POSTPARTUM HAEMORRHAGE
 PUERPERAL SEPSIS
 INVERSION: FUNDAL SUBMUCOUS FIBROID MAY CAUSE INVERSION OF UTERUS

21. EFFECTS OF PREGNANCY AND LABOUR ON
FIBROID
• SIZE SHAPE CONSISTENCY
• FIBROID IS OESTROGEN DEPENDED TUMOUR DURING PREGNANCY THERE IS
INCREASED SECRETION OF OESTROGEN LEADS TO INCREASED SIZE OF FIBROID.
• MICROSCOPICALLY THERE IS INCREASED EDEMA
• SHAPE OF FIBROID IS ALSO CHANGED SOMETIMES IT BECOME FLAT AND
BECOME DIFFICULT TO PALPATE .
• ALSO THERE IS UPWARD DISPLACEMENT OF FIBROID EXCEPT ISTHMIC AND
CERVICAL FIBROIDS

22. DEGENERATION
• RED DEGENERATION: RATE OF GROWTH OF FIBROID IS MORE. BLOOD SUPPLY
CANNOT COPE UP SO THE SURFACE AREA BECOMES NECROSED IT USUALLY OCCURS
IN SECOND TRIMESTER OF PREGNANCY
• OBSTRUCTION TO THE VENOUS OUTFLOW FROM THE TUMOUR IS ALSO CONSIDERED
RESPONSIBLE. MICROSCOPICALLY THERE IS VASCULAR THROMBOSIS AND NECROSIS
.CUT SURFACE SHOW MULTIPLE BLOOD SPOT GIVES APPEARANCE OF RAW BEEFSTEAK
• SEVERE CONSTITUTIONAL SYMPTOMS LIKE PAIN, MALAISE, FEVER, VOMITING CAN
OCCUR
• CYSTIC DEGENERATION- DUE TO INCREASE IN SIDE NECROSIS AND HYALINE
DEGENERATION OCCURS AND ULTIMATELY FIBROID BECOME CYSTIC

23. CONT.
• INFECTION: AFTER DELIVERY SUBMUCOUS FIBROID MAY GET INFECTED AND
CAN CAUSE PUERPERAL SEPSIS
• INJURY :DURING PASSAGE OF FETUS THROUGH BIRTH CANAL FIBROID IS
BRUISED AND COMPRESSED BETWEEN FETAL HEAD AND PELVIS AND LEAD TO
PPH
• EXPULSION: WITH DELIVERY OF FETUS AND PLACENTA PEDUNCULATED
SUBMUCOUS FIBROID MAY BE EXPELLED OUT
• RUPTURE OF SUB SEROUS VEIN OF THE FIBROID CAUSING INTRA PERITONEAL
HAEMORRHAGE IS RARE

25. TREATMENT
• IN ASYMPTOMATIC AND UNCOMPLICATED AND UNCOMPLICATED PATIENTS NO TREATMENT
IS REQUIRED
• ONLY FREQUENT ANTENATAL VISITS ARE MANDATORY AND COUNSELLING PATIENT ABOUT
COMPLICATIONS WHICH MAY OCCUR
• IN COMPLICATED AND SYMPTOMATIC PATIENT TREATMENT IS GIVEN ACCORDING TO
COMPLICATION
• IN IMPACTION ONE SHOULD MANUALLY REMOVE THE IMPACTION
• IN RETENTION OF URINE SELF RETAINING CATHETERIZATION SHOULD BE DONE

27. S
TREATMENT
• IN RED DEGENERATION TREATMENT IS ALWAYS
CONSERVATIVE THAT IS BED REST, HIGHER ANTIBIOTIC,
ANALGESICS AND SEDATION
• TORSION OF SUBSEROUS PEDUNCULATED FIBROID. IT
CAUSES ACUTE ABDOMEN AND LAPAROTOMY WITH
MYOMECTOMY IS INDICATED .TWO RARE CONDITIONS
CONFUSED WITH TORSION
 TORSION OF PREGNANT UTERUS ITSELF
INTRA PERITONEAL HAEMORRHAGE FROM A RUPTURED VEIN
ON THE SURFACE OF A FAVE ROD FIBROID

29. UTERINE ARTERY EMBOLIZATION
• UTERINE ARTERY EMBOLIZATION IS A PROCEDURE IN WHICH AN INTERVENTIONAL
RADIOLOGIST USES A CATHETER TO DELIVER SMALL PARTICLES THAT BLOCK THE BLOOD
SUPPLY TO THE UTERINE BODY. THE PROCEDURE IS DONE FOR THE TREATMENT
OF UTERINE FIBROIDS.

31. • LABOUR SHOULD BE MANAGED ACCORDING TO SITE AND SIZE
OF FIBROID
• ONE SHOULD BE VERY VIGILANT FOR PROGRESS OF LABOUR
TREATMENT DURING LABOUR

32. • MALPRESENTATION
• DYSTOCIA
• PRECIOUS PREGNANCY
• FIBROID IS SITUATED IN CERVICAL CANAL OR IS ISTHMIC
REGION OR BROAD LIGAMENT CAUSING CERVICAL DYSTOCIA OR
MECHANICAL OBSTRUCTION
INDICATIONS OF CAESAREAN

33. • INCISION IS PUT IN LOWER UTERINE SEGMENT AS FAR AS POSSIBLE
ONLY WHEN ANY PART OF LOWER SEGMENT IS NOT ACCESSIBLE
CLASSICAL CAESAREAN SECTION IS DONE
• MYOMECTOMY SHOULD BE AVOIDED DURING CAESAREAN AND
DURING PREGNANCY AS BLOOD LOSS IS MORE DUE TO INCREASED
VASCULARITY AND INCREASED SIZE. CAESAREAN HYSTERECTOMY
MAY ALSO BE REQUIRED FOR UNCONTROLLABLE PPH
• IF PATIENT HAS COMPLETED CHILDBEARING CAESAREAN
HYSTERECTOMY MAY BE PERFORMED
• PEDENUCLATED SUBSEROUS FIBROID CAN BE REMOVED DURING
CAESAREAN
DURING CAESAREAN

34. MEDICATIONS
• ORAL CONTRACEPTIVE PILLS
• GNRH AGONISTS
• THE ANTIHORMONAL DRUG RU-486 (MIFEPRISTONE)
• DANAZOL (DANOCRINE)
• ANTIFIBRINOLYTICS (TRANEXAMIC ACID)
• NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
• PROGESTERONE RECEPTOR MODULATOR NAMED ELLAONE

35. COMPLICATIONS
• MENORRHAGIA.
• ABDOMINAL PAINS
• PREMATURE BIRTH, LABOR PROBLEMS, MISCARRIAGES
• INFERTILITY

36. COMPLICATIONS
LEIOMYOSARCOMA
• TWISTING OF THE FIBROID
• ANEMIA
• URINARY TRACT INFECTIONS
• A C-SECTION MAY BE NEEDED
• SOME PREGNANT WOMEN WITH FIBROIDS HAVE HEAVY BLEEDING
IMMEDIATELY AFTER GIVING BIRTH.

38. NURSING DIAGNOSIS
• ACUTE PAIN RELATED TO POST OPERATIVE WOUND AS MANIFESTED BY FACIAL
EXPRESSION AND PAIN SCALE SCORE
• IMBALANCED NUTRITION LESS THAN BODY REQUIREMENTS RELATED TO PAIN
AS MANIFESTED BY DECREASED FOOD INTAKE.
• IMPAIRED BOWEL ELIMINATION , CONSTIPATION RELATED TO DECREASED
ACTIVITY, PAIN ON STRAINING •

39. NURSING DIAGNOSIS
• DISTURBED SLEEP PATTERN RELATED TO PAIN AND HOSPITALIZATION
• RISK FOR INFECTION RELATED TO THE SURGERY
• LOW SELF-ESTEEM RELATED TO CHANGES IN FEMININITY AS EVIDENCED BY
WITHDRAWAL, DEPRESSION.

40. EVALUATION
• WHAT DO YOU UNDERSTAND BY PREGNANCY WITH FIBROID UTERUS ?
• ENLIST THE TYPES OF FIBROIDS ?
• WHAT ARE CAUSE OF FIBROIDS ?
• ENLIST SOME RISK FACTORS ?
• WHAT ARE THE DIAGNOSTIC MEASURES ?
• EXPLAIN ABOUT THE EFFECT OF FIBROIDS ON PREGNANCY.

41. BIBLIOGRAPHY
• DUTTA DC, TEXTBOOK OF OBSTETRICS;3RD EDITION;KAYLEE PUBLICATION;
PAGE; NO 288
• BHASKAR NIMA,MIDWIFERY AND OBSTETRICAL ; 3RD EDITION ; EM MESS
MEDICAL
PUBLICATION PAGE NO.408
• WWW.WIKIPEDIA.ORG
• WWW.SLIDE SHARE.COM
• WWW.MEDICIENT.COM