A review of evidence-based management of uterine fibroids TOG 2016 Flashcards
What is the lifetime pervalence of fibroids?
30%
Risk factors for developing fibroids
Black
Overweight
P0
Fhx
What proportion of women are symoptomatic?
1 in 4
Diagram showing
Subserosal
Submucosal
Intramural
Cervical
Median fibroid growth over 9months of a fibroid?
9%
UAE is as effective as surgery for how long?
For 5 years
Following UAE after 1 year, what proportion of women are asymptomatic or significantly improved symptoms
80-90%
After UAE what proportion of women required second intervention after 5 years?
1 in 3
What proportion of women having UAE will need hysterectomy?
2.9%
Pregnancy outcomes following UAE
Higher rates CS, PPH and 1st trimester miscarriage
Complications of UAE > 30 days
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)
What grade fibroids can be removed hystoerscopicallu
Submucosal Grade 0 (entire in endometrium) and Grade 1 <50% intramural
Gold standard for removal of submucosal fibroids.
FIGO classification of fibroids. What is grade
0 - 8?
0 Pedunculated
1 <50% intramural
2 >50 intramural
3 Contact endometrium
4 Intramural
5 Subserosal >50%
6 Subserosal <50%
7 Subserosal peduncalted
8 Other
If fertility is not a concern, what additional procedure can be performed? How much does this decrease blood loss at 1 year?
TCRF + endometrial ablation
90% of women showed a decrease of menstrual blood loss at 1year.
What is the gold standard of removal of Grade 0 fibroid during hysteroscopy?
Rectoscopic slicing
Similarities and difference for laparotomy for hysterectomy vs myomectomy?
Similar surgical complications (haemorrhage, repeat surgery, rehospitlaisation)
But hysterectomy has higher rate of bladder/bowel injury.
What is considered the best treatment for symptomatic fibroids for women that wish to retain childbearing capacity?
Laparoscopic myomectomy
What techniques can be used to reduce blood loss during surgery?
Pre-op GnRH analogue or SPRM
Use of vasocontriction agent (vasopressin)
Torniquets during surgery
What are the pros & cons of laparoscopic vs open myomectomy?
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.
What proportion of hysterectomies are performed due to uterine fibroids in USA
1/3
