P5: Boney Myomectomy Clamp, Pessary & MVA

Question 1

Use of Bonney’s Myomectomy Clamp

Answer 1

Temporary hemostasis during myomectomy.

Question 2

Def of Myomectomy

Answer 2

Surgical removal of myoma only è preservation of functioning uterus.

Question 3

Indications of Myomectomy

Answer 3

Young patient (< 40 years) desiring fertility + small tumor (< 8 weeks).

Question 4

CI of Myomectomy

Answer 4

Question 5

Timing of Myomectomy

Answer 5

Postmenstrual (to ↓↓ bleeding) & 6 months after labor.

Question 6

Preoperative Prep. For Myomectomy

Answer 6

Question 7

Types of Myomectomy

Answer 7

• Abdominal
• Vaginal
• Laparoscopic myolysis
• Hysteroscopic resection

Question 8

Abdominal Myomectomy

Answer 8

Question 9

Abdominal Myomectomy

• Abdominal Incision

Answer 9

Pfannenstiel or midline subumbilical (if myoma is large).

Question 10

Abdominal Myomectomy

• Temporary Hemostasis

Answer 10

Question 11

Abdominal Myomectomy

• Uterine Incision

Answer 11

Should fulfill the following criteria:

a) Vertical, midline & in anterior uterine wall.

b) Allows removal of maximum number of myomas by tunneling technique.

Question 12

Abdominal Myomectomy

• Removal of myomas followed by obliteration of tumor bed

Answer 12

….

Question 13

Abdominal Myomectomy

• In pedunculated subserous myoma

Answer 13

Pedicle is doubly clamped, cut & ligated.

Question 14

Abdominal Myomectomy

• In broad ligament myoma

Answer 14

Round ligament is cut & ligated first.

Question 15

Abdominal Myomectomy

• Posterior wall myoma is removed by

Answer 15

Question 16

Abdominal Myomectomy

• Uterine cavity is opened

Answer 16

If submucous myoma is suspected.

Question 17

Vaginal Myomectomy

Answer 17

Question 18

Laparoscopic myolysis

Answer 18

For small subserous fibroid (< 5 cm).

Question 19

Hysteroscopic resection

Answer 19

For small submucous fibroid.

Question 20

Disadvantages of Myomectomy

Answer 20

Question 21

How to ↓↓ blood loss during myomectomy?

Answer 21

Question 22

How to ↓↓ blood loss during myomectomy?

• Preoperative

Answer 22

Question 23

How to ↓↓ blood loss during myomectomy?

• Operative

Answer 23

Question 24

Types of Vaginal Pessaries

Answer 24

Question 25

Types of **Vaginal Pessaries** - Ring Pessary

Answer 25

Question 26

Types of **Vaginal Pessaries** - Cup & stem pessary (Napier pessary)

Answer 26

Question 27

Types of **Vaginal Pessaries** - Hodge-Smith pessary

Answer 27

Question 28

Indications of **Vaginal Pessary**

Answer 28

Question 29

Indications of **Vaginal Pessary** - In Prolapse

Answer 29

Question 30

Indications of **Vaginal Pessary** - In RVF

Answer 30

Question 31

MOA of **Vaginal Pessary** - In Prolapse

Answer 31

Question 32

MOA of **Vaginal Pessary** - In RVF

Answer 32

Question 33

Size of pessary

Answer 33

Question 34

Care of pessary (precautions)

Answer 34

Question 35

Contraindications of **Vaginal Pessary**

Answer 35

Question 36

Complications of **Vaginal Pessary**

Answer 36

Question 37

MVA From Notes

Answer 37

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