Fibroids Flashcards
What is the incidence of fibroids among women with infertility?
5-10%
Sufficient/insufficient evidence that fibroids limit fecundity with/without ART?
INsufficient (lack of prospective RCT, most observational studies, difficult to study different sizes/locations of fibroids, few studies in under-represented women)
Which of the following is correct re: hysteroscopic removal of submucosal myomas:
- Improves clinical pregnancy rates
- Decreases early clinical pregnancy loss
- Increases LBR
- Post-op imaging or hsc is not necessary
Improves clinical pregnancy rates
What is the recurrence rate of fibroids after myomectomy?
10-25% at 40 months
Presence of submucosal myomas significantly reduce ___ and ___ rates
Fair evidence that hysteroscopic resection of submucosal fibroids increases ___ rates
Insufficient evidence that hysteroscopic myomectomy affects ___ or ___
Reduce implantation and pregnancy rates
Increases clinical pregnancy rates
Insufficient evidence for pregnancy loss or LBR
Use ___ to remove Type 2-3 fibroids via hysteroscopy
Resectoscope
Larger fibroids have more/less TGF-beta
More TGF-beta
Fibroids involving the endometrium have more/less HOXa10
Less HOXa10, which reduces implantation
*unknown amount for Type 3
Indications for myomectomy
- Cavity-distorting myoma
- Bulk symptoms
- Intramural > 5 cm
- If impeding access to ovaries for egg retrieval or impeding ovum capture for tubes
Uterine sarcoma risk factors
- Postmenopausal
- Tamoxifen use
- Pelvic radiation
- HLRCC
How to reduce risk of bleeding during myomectomy
What has not been proven to reduce blood loss?
- Vasopressin
- Pre-op misoprostol (400 mcg 1 hours prior to surgery)
- Gelatin-thrombin matrix (Floseal)
No evidence showing IV TXA reduces blood loss!
Vasopressin toxicity
Hypotension, bradycardia, cardiac arrest, pulmonary edema
Use dose 20 units/100 mL saline
How long to wait to conceive after myomectomy
- Hysteroscopic
- Lsc/Robotic/Open
Hysteroscopic - 4 weeks
Lsc/Robotic/Open - 3-6 months
