Uterine fibroid

It is benign uterine tumour consist of smooth muscles ,it can present anywhere in the uterine wall.it could be intrmural,subserosal,

Submucosal,cervical or pedunculated fibroid.

Incidence about 20_30% of reproductive age women.

Definition of fibroid

Asymptomatic. Menorrhagia. Dysmenorrhea and backache. Urinary frequency. Infertility. Iiregular uterine mass. Pregnancy

complication:abortion,AP.,malpresentation,obstructed labour and PPH.

Presentation of fibroid

History and clinical examination. Ultrasound. MRI. HSG ,Hycosy for pedunculated fibroid.

diagnosis

1_Just follow up if asymptomatic.

2_Medical treatment: *NSAID. *progesterone. *combined contraceptive pills. *danazole. *GNRH analouge.

management

3_surgical treatment:*myomectomy:involve incleation of fibroid through the uterine wall.Advantage:conservation of fertility and avoidance of hysterectomy.disadvantage:risk of bleeding ,reccurance of fibroid,adhesion formation.

To decrease the risk of bleeding during myomectomy the patient can be given GnRH three months before myomectomy this also can improve the Hb level before operation and decrease the size of fibroid, but this has many disadvantages:

*leads to loss the line of cleavage between the fibroid and the uterine wall which make the operation more difficult.

*osteoporosis :so any woman use it should take calcium supplementation.

*menopausal side effects like hot flushes and sweating due to the hypoesrogenic state created by this drug.

*expensive.

*hysterectomy: Advantage:no risk of recurrence and solving

the problem completly. Disadvantage:loss of fertility ,it is major

operation associated with many complication

Such as bleeding,blood transfusion,internal organ injury ,thromboembolism ,wound infection and anaesthetic complication.

Involve injection of radio opaque substance through the femoral artery under ultrasound guidance that cause obstruction of blood supply to the artery and shrinkage of the uterine fibroid.

Uterine artery embolization

Allergic reaction. Failure of procedure. Wrong embolization involving the ovary or

intestines. Premature ovarian failure. Vaginal discharge. Re enlargement of fibroid. Death.

complication