A review of evidence-based management of uterine fibroids TOG 2016

Question 1

What is the lifetime pervalence of fibroids?

Answer 1

30%

Question 2

Risk factors for developing fibroids

Answer 2

Black
Overweight
P0
Fhx

Question 3

What proportion of women are symoptomatic?

Answer 3

1 in 4

Question 4

Diagram showing
Subserosal
Submucosal
Intramural
Cervical

Answer 4

Question 5

Median fibroid growth over 9months of a fibroid?

Answer 5

9%

Question 6

UAE is as effective as surgery for how long?

Answer 6

For 5 years

Question 7

Following UAE after 1 year, what proportion of women are asymptomatic or significantly improved symptoms

Answer 7

80-90%

Question 8

After UAE what proportion of women required second intervention after 5 years?

Answer 8

1 in 3

Question 9

What proportion of women having UAE will need hysterectomy?

Answer 9

2.9%

Question 10

Pregnancy outcomes following UAE

Answer 10

Higher rates CS, PPH and 1st trimester miscarriage

Question 11

Complications of UAE > 30 days

Answer 11

Vaginal discharge - 16% at 12 months
Expulsion fibroids maternal 10%
Endometritis 0.5%
Amenorrhoea (age dependant, <1% under 40yrs)
Change in sexual function (worse 10%, improved 26%, unchanged in most)

Question 12

What grade fibroids can be removed hystoerscopicallu

Answer 12

Submucosal Grade 0 (entire in endometrium) and Grade 1 <50% intramural

Gold standard for removal of submucosal fibroids.

Question 13

FIGO classification of fibroids. What is grade
0 - 8?

Answer 13

0 Pedunculated
1 <50% intramural
2 >50 intramural
3 Contact endometrium
4 Intramural
5 Subserosal >50%
6 Subserosal <50%
7 Subserosal peduncalted
8 Other

Question 14

If fertility is not a concern, what additional procedure can be performed? How much does this decrease blood loss at 1 year?

Answer 14

TCRF + endometrial ablation
90% of women showed a decrease of menstrual blood loss at 1year.

Question 15

What is the gold standard of removal of Grade 0 fibroid during hysteroscopy?

Answer 15

Rectoscopic slicing

Question 16

Similarities and difference for laparotomy for hysterectomy vs myomectomy?

Answer 16

Similar surgical complications (haemorrhage, repeat surgery, rehospitlaisation)

But hysterectomy has higher rate of bladder/bowel injury.

Question 17

What is considered the best treatment for symptomatic fibroids for women that wish to retain childbearing capacity?

Answer 17

Laparoscopic myomectomy

Question 18

What techniques can be used to reduce blood loss during surgery?

Answer 18

Pre-op GnRH analogue or SPRM
Use of vasocontriction agent (vasopressin)
Torniquets during surgery

Question 19

What are the pros & cons of laparoscopic vs open myomectomy?

Answer 19

Lap pros: Less post op pain, fever, shorter hospital stay, less blood loss.

Lap cons: Longer operating time, more difficult to perform for huge or multiple fibroids.

Question 20

What proportion of hysterectomies are performed due to uterine fibroids in USA

Answer 20

1/3