Surgical Management Of HMB

Question 1

Management of normal uterus w/ or w/o fibroid <3 cm

Answer 1

Endometrial ablation

Question 2

How does endometrial ablation work

Answer 2

Removes or destroys the womb lining and stops heavy bleeding. Results in clinically relevant reduction in bleeding and improvement in QOL.

Question 3

Could endometrial lining grows back after ablation

Answer 3

Yes, in some women and needs tobe repeated

Question 4

Endometrial ablation indications

Answer 4

• HMB w/ severe impact on QOL
• ineffective medical ttt
• Normal uterus & small fiborids <3 cm
• Uterus smaller than a 10-week pregnancy.

Question 5

Selection criteria for Endometrial ablation

Answer 5

• Family is complete.
• Willing to continue contraception if not sterilized.
• Normal-sized uterine cavity (for most procedures).
• Willing to undergo hysterectomy, if required.

Question 6

Absolute CI of endometrial ablation

Answer 6

• woman wishes fertility.
• Genital tract malignancy
• Unexplained vaginal bleeding.
• Active pelvic infection.
• Uterine abnormalities: septate uterus.
• Previous uterine surgery leaving the uterine wall < 8 mm thick

Question 7

Relative CI of endometrial ablation

Answer 7

• Uterine cavity length > 12 cm (14 cm for microwave EA).
• Irregular uterine cavity with submucous fibroids > 3 cm.
• Previous classical CS.
• Other gynaecological problems that could lead to hysterectomy in the future

Question 8

What is uterine artery embolization

Answer 8

blood supply to the fibroids is blocked and this causes them to shrink; it may reduce bleeding, fertility is potentially retained.

Question 9

Absolute CI to UAE

Answer 9

• Asymptomatic fibroids
• Recent or current infection of the genital tract
• Pregnancy
• uncertain diagnosis due to clinical factors or inadequate imaging
• When patient declines hysterectomy (as small proportion needs hysterectomy after UAE)

Question 10

Relative CI of UAE

Answer 10

• Narrow stalk pedunculated submucous fibroid (can get detached and block the cervical canal)
  • Large intracavitary submucous fibroid (may result in sloughing of the fibroid and cause cervical obstruction and occasional sepsis)
  • Pedunculated subserosal fibroids (may detach the pedicle and may need laparoscopic removal of these fibroids)
  • If woman wants to preserve fertility and has symptomatic fibroids (ovarian failure can occur in 1%–2% although more common in women over 45 years and those who are nearing menopause)

Question 11

Percentage of patients will be asymptomatic after 1 year of UAE

Answer 11

80-90%

Question 12

Endometrial ablation destroys which histological layers of the uterus ?

Answer 12

Entire endometrium + superficial myometrium up to 5 mm

Question 13

main sypmtoms associated with postablation tubal sterilization syndrome PATSS

Answer 13

1. Constant unilateral pelvic pain: d.t. retrograde menstruation accumulate in obstructed tubes
2. Vaginal spotting

Question 14

what depth of myometrium needs to be destroyed to prevent endometrial regeneration

Answer 14

5 mm