Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCOG - Part 2 > Fibroids > Flashcards

Fibroids Flashcards

1
Q

What are fibroids

A

Benign tumours arising from the myometrium of the uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of fibroids

A
  1. Subserosal
  2. Intramural
  3. Submucosal
  4. Pedunculated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is submucosal fibroid

A

develop near the outer serosal surface of the uterus and extend into the peritoneal cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

symptoms of Subserosal fibroids

A

Asymptomatic; may cause pressure symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Intramural fibroids

A

fibroids develop within the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

symptoms of intramural fibroids

A

May cause HMB, dysmenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of submucosal fibroids

A

May cause HMB, pain, and subfertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are submucosal fibroid

A

develop near the endometrial surface of the uterus and extend into the uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are pedunculate fibroids

A

attached to the myometrium by a pedicle. May cause torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

History (symptoms and signs) of Fibroids

A
  • Symptoms depend on the size, number, and location of the fibroids
  • Heavy & prolonged bleeding (most common)
  • Abdominal swelling, pelvic or abdominal pain or discomfort.
  • Dyspareunia.
  • Pressure symptoms – constipation or urinary symptoms such as
    frequency or difficulty in voiding.
  • Acute, severe abdominal or pelvic pain following torsion of a pedunculated fibroid or ‘red degeneration’.
  • Subfertility, miscarriage.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Abdominal examination in case of fibroids

A

mass arising from the pelvis, smooth/multi-nodular, firm, mobile from side-to-side.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pelvic examination in case of fibroids

A
  • mass arising out of the pelvis, with an irregular knobbly shape, a firm or hard consistency, and can be moved slightly from side-to- side.
  • Any movement of the abdominal mass moves the cervix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prevalence of fibroids

A

Prevalence increases progressively from puberty until the menopause.
- 40–60% of women have fibroids by 35 years of age.
- which is increased to 70–80% by 49 years of age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Do fibroids resolve with age

A

Usually shrink after menopause as they are promoted and maintained by oestrogen and progestogen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Prevalence of fibroids is higher in which groups?

A
  • Black women
  • Women with early onset of puberty.
  • Obese women – probably due to higher oestrogen levels.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Gynecological risks due to fibroids

A
  • HBM – anaemia, affects QOL.
  • Compression of ureters by large fibroids - hydronephrosis.
  • Torsion of pedunculated fibroid – acute pain.
  • Leiomyosarcoma – minimal risk.
  • Fertility issues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pregnancy complications due to fibroids

A
  • 1st and 2nd trimester miscarriage.
  • Higher rates of CS
  • Preterm delivery.
  • Malpresentation, mechanical complications in labour.
  • PPH.
  • Acute pain requiring hospital admission (5–6%) – red degeneration of
    fibroid owing to avascular necrosis (when rapid growth of a fibroid, promoted by high levels of sex hormones, outgrows its blood supply).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

DD of fibroids

A
  • Adenomyosis: difficult to distinguish from fibroids may be associated with it
  • Pregnancy
  • Benign causes of a pelvic mass: benign ovarian mass –
    hemorrhagic cyst, dermoid cyst, or endometrioma.
  • Malignant causes of a pelvic mass: ovarian cancer,
    endometrial cancer, leiomyosarcoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigations for diagnosis of Fibroids

A
  1. USS
  2. Saline or contrast sonographyL improves assessment of SM fibroids
  3. 3D USS
  4. MRI: superior to conventional US
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when to refer asymptomatic fibroids to 2ry care

A
  • Fibroids are palpable abdominally.
  • Intra-cavity fibroids.
  • Uterine length on USS>12 cm.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Do we advise hysterectomy for asymptomatic fibroids

A

Do not advise hysterectomy for asymptomatic fibroids solely to improve detection of adnexal masses, to prevent impairment of renal function, or to rule out malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Medical management of symptomatic fibroids

A
  1. NSAIDs
  2. Contraceptive steroids (COCs)
  3. LNG-IUS
  4. Anti-Progesterone agents (mifepristone)
  5. Aromatase Inhibitors
  6. GNRH agonists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do fibroids cause HMB ?

A
  • Mass effect causing increased surface area
  • Interferes with uterine contractility
  • Increased vascularity
  • Altered prostaglandin production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

FIGO classification for fibroids ?

A

submucosal
0 submucosal
1- <50% intramural
2 ->50% intra mural

OTHERs
3- contacts endometrium but is intramural
4-intramural
5-subserosal but> 50% intra mural
6- subserosal <50% intramural
7-oendunculated

STEPW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Routes for myomectomy ?

A
  • Hysteroscopic
  • Abdominal - Open, Lap, Robotic
  • Hysteroscopic for submucosal - 0,1
  • Rest - Abdominal route
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

(fibroids) When is the risk of malignancy higher ? and how to minimize risk of malignancy spreading

A

Postmenopausal
Premenopausal - if solitary large lesion not responding to GnrH or ulipristal

1 in 2000

Avoid morcellation. If done - use bags for removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Disadvantage of using Gnrh prior to myomectomy?

A

Loss of surgical planes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which is better in ttt of fibroids Total or subtotal hysterectomy?

A

Total obviates the need for further surgery as it removes the cervix

Subtotal associated with lesser morbidity and faster recovery

So let the patient decide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do we decide the route of hysterectomy in ttt of fibroids

A

Abdominal preferred if no prolapse or associated pelvic pathology - adnexal mass, adhesions, endometriosis

Vaginal - preferred in presence of prolapse

In Abdominal - Lap preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Overall complication rate of hysterectomy?

A

4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Hysterectomy accounts for what portion of genitourinary tract injury ?

A

75%

1-2% is the rate for all gynaecological procedures combined
Of these, 75% due to hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Injury to GI tract during hysterectomy?

A

0.1-1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Vaginal cuff dehiscence most common after which procedure?

A

TLH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Urinary tract injury more common after which procedure?

A

TLH

35
Q

Out of ablation and hysterectomy
More likely to undergo future gynecological surgery in terms of repeat procedure?

More likely to have surgery for incontinence, prolapse ?

A

Ablation - more common on the 1st 2 years

Hysterectomy- more likely to undergo surgery for prolapse, Incontinence

36
Q

Mode of action of anti progesterone

A

Mifepristone acts at the level of the progesterone receptors,

found in high concentration in fibroids.

37
Q

effect of anti-progesterone on fibroids

A

-Reduction in fibroid volume of 26–74% (comparable to GnRHa, slower rate of recurrent growth after cessation of mifepristone treatment).
- amenorrhoea rates up to 90%
- stable bone mineral density.

38
Q

SE of Anti-progesterone

A
  • endometrial hyperplasia without atypia (14–28%)
  • transient elevations in transaminase levels (4%) requiring LFT monitoring.
39
Q

Mode of action of Aromatase inhibitors in ttt of fibroids

A

Aromatase inhibitors block ovarian and peripheral oestrogen production and decrease oestradiol levels.
Small studies showed reduction in leiomyoma size and symptoms.

40
Q

efficacy of GNRHa in ttt fibroids

A

35–65% reduction in fibroid volume within 3 months.

41
Q

Preoperative use of GNRHa in ttt of fibroids

A

Preoperative in women with anaemia and to reduce the size of fibroids and blood loss during surgery.

no significant difference in blood loss with preop. GnRHa has shown

42
Q

Sequential regimen of GNRHa in ttt of fibroids

A
  • GnRHa is first used to achieve downregulation
  • to which steroids are added after 1–3 months of therapy, gives maximal results.
  • However, the addition of progestin add-back therapy results in an increase in mean uterine volume to 95% of baseline within 24 months.
43
Q

Disadvantages of use of preoperative GNRHa

A

it may make the fibroids softer and the surgical planes less distinct, leading to difficulty in dissection.

44
Q

GNRH antagonist effect in ttt of fibroids

A
  • advantage of not inducing an initial steroidal flare as seen with GnRH agonists.
  • Rapid effect of the GnRH antagonist
    allows a shorter duration of side effects with pre-surgical treatment.
  • Reduce fibroid volume by 25–40% in 19 days, thereby allowing surgery to be scheduled sooner
45
Q

interventions to reduce blood loss during myomectomy

A

evidence from a few RCTs is limited: misoprostol, vasopressin, bupivacaine plus epinephrine, tranexamic acid, tourniquet, and mesna may reduce bleeding during myomectomy.

46
Q

Surgical management of fibroids

A
  • hysterectomy
  • myomectomy (abd., laparoscopic, hysteroscopic)
  • UAE
47
Q

Advantages of hysterectomy in ttt of fibroids

A
  • Relieves symptoms
  • prevents recurrence
  • provides permanent contraception
  • allows treatment with oestrogen-only HRT.
48
Q

Risks of Abdominal myomectomy

A

hysterectomy
blood loss
risk of transfusion
adhesions.

49
Q

Rate pf recurrence of fibroids after abd myomectomy

A

depends on the number of fibroids;
single leiomyoma – 27% risk
multiple leiomyomas – 59% risk.

** preoperative use of GnRH agonists affects recurrence risk.**

50
Q

Advantages of laparoscopic myomectomy over abdominal

A
  • less haemoglobin drop
  • reduced operative blood loss
  • quicker recovery, diminished postoperative pain
  • fewer overall complications but longer operation time.
51
Q

Cautions during Patient selection to laparoscopic myomectomy

A

be cautious if:
- fibroids > 5–8 cm
- multiple fibroids
- or presence of deep IM leiomyomas

as it may be associated with increased operative time and blood loss.

52
Q

Recurrence rate pf fibroids after laparoscopic myomectomy

A
  • 12% at 1 year
  • up to 84% at 8 years.
53
Q

Conversion rate of laparoscopic to abdominal myomectomy

A

11%

54
Q

Rate of complication of laparoscopic myomectomy

A

8-11%

55
Q

Indications for hysteroscopic myomectomy

A

abnormal uterine bleeding caused by SM fibroids.

56
Q

Classification for hysteroscopic myomectomy

A

Classified based on the amount of leiomyoma within the uterine cavity:
* Type 0 – completely intra-cavitary.
* Type I – < 50% intramural.
* Type II – > 50% intramural.

57
Q

Rate of Successful removal at the initial hysteroscopy myomectomy

A

85–95%

58
Q

Rate of subsequent surgery after hysteroscopic myomectomy

A

Subsequent surgery is needed in ≈ 5–15% of cases,
and most of these cases involve a second hysteroscopic procedure.

59
Q

Complications of hysteroscopic myomectomy

A

Complication rate of 1–5%
* fluid overload with secondary hyponatraemia
* pulmonary oedema
* cerebral oedema
* intraoperative and postoperative bleeding
* uterine perforation
* gas embolism
*infection.

60
Q

How is UAE is done?

A

Femoral artery is cannulated and an embolic agent is injected into the uterine arteries to impair the blood supply to the uterus and fibroids.

This has a differential effect on f ibroids (that have a higher blood supply than the surrounding myometrium).

61
Q

Effect of UAE on fibroids

A

Fibroid shrinkage – 60% by the end of 6 months with further shrinkage up to one year.

62
Q

Indications for UAE

A
  • surgery is CI.
  • unwilling to have a blood transfusion.
  • previous unsuccessful surgery for fibroids.
63
Q

Absolute CI for UAE in case of fibroids

A
  • Current or recent infection of genital tract.
  • Patient refusing hysterectomy under any circumstances.
  • Doubtful diagnosis due to the clinical factors or inadequate imaging.
64
Q

UAE has more benefits in ttt of large or small fibroids

A

the outcome for smaller fibroids is better than for larger fibroids with similar complication rates.
Large fibroid is not a contraindication.
However, volume reduction might not be sufficient to satisfy patient’s expectations.

65
Q

Pre-requisites begore UAE

A

Do not give GnRHa within 2 months prior to the procedure

66
Q

Which is better in diagnosing fibroids and adnemyosis MRI or USS

A

MRI is superior

67
Q

Action of UAE on Fibroids in presence of adenomyosis

A

Less effective

68
Q

Immediate complications of UAE

A
  1. Groin Hematoma
  2. Arterial thrombosis
  3. Pseudo-aneurysm
  4. Non-target embolization (presence of ovarian–uterine anastomoses can compromise the ovary.)
69
Q

Early complications of UAE

A
  • post-embolization syndrome: pain, nausea, fever, flu-like symptoms with raised inflammatory markers and white cell count.

frequent and self-limiting

70
Q

Management of post-embolization syndrome

A
  • Frequent and self-limiting.
  • Manage with analgesics and anti-inflammatory drugs.
  • Re-admission may be required in 3–5% of cases.
71
Q

Late complications of UAE

A
  • Vaginal discharge (self-limiting) – 20–30%.
  • Fibroid expulsion – 10%, more w/ SM
  • Sexual dysfunction – 12%
  • Infection (endometritis) – 0.5%.
  • Amenorrhoea (POI) – 1.5–7%, but the majority of these patients are > 45 years old (25% risk in this age group)
72
Q

Precentage of further treatment of fibroids after UAE

A
  1. repeat UAE
  2. exploration of uterine cavity
  3. myomectomy
  4. hysterectomy
    * 25% if < 40 years
    * 10% if 40–50 years of ag
73
Q

What kind of contraception to be used in case of fibroids

A
  • W/o no uterine distortion: all methods can be used
  • W/ distortion: not IUD or IUS if can’t be fitted easily

not clear if hormonal methods has any effect on size of fibroids

74
Q

Clinical sign to Leiomyosarcoma

A

rapid growth in uterine size

75
Q

Incidence of leiomysarcoma

A

rare 2-3/1000

76
Q

Risk factors for sacrcomas

A
  • Increasing age
  • a history of prior pelvic radiation
  • tamoxifen use
  • a rare genetic predisposition.
77
Q

How to differentiate between sarcomas and other intrauterine lesions

A

MRI and Endometrial Biopsy

78
Q

Do Fibroids do absolute subfertility?

A

no, many women can concieve w/o interventions

79
Q

How can fbroids cause subfertility

A
  1. mechanical effect due to cavity distortion with IM and SM fibroids
  2. possible effect on uterine blood flow
  3. impaired implantation with IM fibroids.
80
Q

rate of fibroids presence in women w/ infertility

A

5–10% of women with infertility

fibroids are the sole factor in 1–2.4% of women with infertility.

81
Q

IVF outcome in women with fibroids

A
  • SM/IM fibroids distorting the uterine cavity cause a 70% reduction in pregnancy
  • Removal of these fibroids
    restores the pregnancy rate to that of the control group.
82
Q

Management of subfertility due to fiborids

A
  • Try naturally for 2 years, unless the woman is ≥ 34 years
  • SM fibroids: hysteroscopic resection.
  • Myomectomy: consider for a woman with fibroids who has undergone unsuccessful IVF cycles despite appropriate ovarian response and
    good quality embryos.
  • UAE: has not effect on pregnancy outcome after IVF
83
Q

SBA

What proportion of women using ulipristal acetate will develop Progesterone receptor modulator associated endometral changes PAEC?

A
  • 60%
  • up to 2/3 of women using it
  • resolve after 6 months of discontinuation
84
Q

SBA

Most common benign tumor in females

A

Uterine Leiomyoma
prevelance= 30%

MRCOG - Part 2 (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions