Uterine Abnormalities Flashcards
Management of Fibroids
Medical For menorrhagia + fibroids Tranexamic Acid NSAIDs Progestogens
GnRH agonist to shrink prior to surgery
restrict to 6/12 –> decrease BMD
can be used in women close to menopause
Surgical
Hysteroscopy: transcervical resection of submusocal fibroids <3cm
Myomectomy
Open (pre-treat with GnRH) or laparoscopic (don’t pre-treat)
Blood less may be heavy –> risk of transfusion / hysterectomy
Performed if medical Tx failed but fertility preserved
Perioperative vasopressin injection into myometrium can reduce blood loss
Adhesions from myomectomy can reduce fertility
increase risk of uterine rupture during labour if endometrial cavity opened or fibroids large/multiple
Other
Uteirne artery embolisation
MRI guided ablation
Adenomyosis
Presence of endometrium in myometrium
painful, regular and heavy menstruation
Mildly enlarger tender uterus
Inx
MRI
Tx Medical Mirena, IUD COCP NSAIDs
Surgical
Hysterectomy - can trial GnRH to see if hysterectomy likely to be effective in reducing symptoms
Associated with endometriosis and fibroids
Oestrogen dependent: Symptoms subside after menopause
Endometritis
Infection secondary to: STI IUD RPCs Surgery (C-section, surgical termination)
In post-menopausal women –> malignancy
Signs/Symptoms
Tender uterus, signs of systemic infection
Pyometra: pus accumulates and unable to escape
Treat cause and Antibiotics
Intrauterine Polyps
Benign tumours that grow into uterine cavity
Menorrhagia
IBM
Prolapse into cervix
Most enodmetrial in origin but some can be derived from submucosal fibroids
Found in women taking tamoxifen for breast cancer
Can contain endometrial hyerplasia or carcinoma
Inx
USS
Hysteroscopy
Tx
Resection or avulsion
Usually curative
Haematometra
Accumulation of menstrual blood in uterus
Uncommon
Causes
Canal occluded by fibrosis after previous endometrial resection, cone biopsy or carcinoma
Congenital: imperforate hymen, blind rudimentary uterine horn
Congenital Uterine Malformations
Associated with renal problems
Obstetric complications Transverse lie Preterm labour Recurrent miscarriages Retained placenta
