GYN: General Gynaecology -- Fibroids

Question 1

Surgical treatment for 3cm submucosal fibroid with fertility preserved

Answer 1

Hysteroscopic myomectomy, prime with GnRH agonist

Question 2

Medical treatment for fibroids

Answer 2

Transamin + NSAIDs, COCP, Depo-Provera, Mirena, GnRH agonist

Question 3

Intra-operative methods to reduce blood loss

Answer 3

vasopressin infusion, diathermy coagulation, clamping of arteries before cutting

Question 4

Symptoms associated with fibroids

Answer 4

1. Menstrual symptoms: menorrhagia, dysmenorrhoea
2. Pressure symptoms: adominal discomfort, urinary symptoms (frequency, retention of urine)
3. Subfertility
4. Acute pain
5. Preganancy-related complications

Question 5

Pre-operative management to reduce blood loss in myomectomy

Answer 5

GnRH agonist

Question 6

Signs in hysteroscopy that confirms uterine perforation

Answer 6

• Length of hysteroscope inside > size of uterus
• Gush of blood
• Visualise bowel
• Sudden collapse of uterus / failure of distention