fibroids Flashcards
how can fibroids change in pregnancy? how can this affect the pregnancy?
may increase due to oestrogen - this can cause large-for-dates pregnancy
what is red degeneration?
haemorrhage inside / disruption of blood supply to fibroid
red degeneration - symptoms
sudden onset:
pain
uterine or local tenderness
mild pyrexia + leucocytosis
red degeneration of fibroids - presentation in pregnancy
abdo pain
tender subrapubic area
firm palpable mass
urinary frequency
red degeneration - management? when will it get better?
bed rest + analgesia
should resolve in days
fibroids - complications in pregnancy
MOCH: malpresentation dependent on position of fibroid obstructed labour need for caesarean intra or post partum haemorrhage
what is an intramural fibroid?
in uterine wall
what is a subserosal fibroid?
beneath serosal layer of uterus + protrudes towards abdo cavityre
(serosa = equivalent to peritoneum)
what is a submucosal fibroid?
just beneath endometrium - lies under mucosa (mucous membrane) + protrudes into cavity
what can cause fibroids to grow and shrink? when does this occur naturally?
oestrogen-dependent:
pregnancy - can grow rapidly
menopause - stop growing/shrink
fibroids - presentation
asymptomatic menorrhagia pelvic pressure - feeling of a mass dysmenorrhoea / lower abdo pain in menstruation urinary symptoms subfertility
sometimes large uterus O/E
fibroids - diagnosis
tvUSS - quantify + assess size
then hysteroscopy / laparoscopy to confirm type
± biopsy
fibroids - management (if needed)
1° - IUS ± NSAIDs
2° - tranexamic acid, COCP
short term GnRH agonist - shrink it UAE - devascularise + involute it under LA endometrial ablation myomectomy hysterectomy
long term risks of GnRH agonists
effect of low oestrogen on bone + cardiovascular health
what is endometrial ablation?
OP procedure - destroys endometrium so it can’t shed
