Uterine Anomalies Flashcards
What are fibroids?
Where can they be?
Benign tumours of the the smooth muscle cells of the uterine myometrium. (leiomyomata)
They can be:
-Subserosal: growing on the outside of the uterus.
- Intramural: growing in the uterine wall (most common)
- Submucosal: growing in the uterine lining
- Pedunculated: growing on small stalks on the inside or outside of the uterus
What are the risk factors for developing fibroids?
Afro-carribean
FH
Unopposed oestrogen (less common in parous women and those who have taken the COCP)
What are the symptoms associated with fibroids?
50% are asymptomatic
Symptoms include:
- Menorrhagia (most common symptom)
- Dysmenorrhoea
- Urinary symptoms (frequency,retention)
- Hydronephrosis
How are fibroids diagnosed?
Clinical history + transvaginal or abdominal USS.
If unsure of diagnosis MRI can be used.
What are some complications associated with fibroids?
Torsion of a pedunculate fibroid
Complications in pregnancy (bleeding, obstruction, premature labour)
Small risk of malignancy (0.1%)
How can fibroids be managed?
Expectant management: monitoring over time with examination and USS.
Medical management:
- NSAIDs (mefenamic acid) and tranemexic acid
- COCP or mirena to help excessive bleeding
- GnRH agonists can be used to shrink fibroid and can induce amenorrhoea. (only licensed for 6 months as reduces bone density)
Surgical management:
- Hysteroscopic or laparoscopic* myomectomy (removal of fibroids)
- Hysterectomy
*more likely to preserve fertility
What are the indications for intervention in fibroids?
Bulky symptoms
Excess bleeding
Concern of malignancy due to rapid growth
Causing hydronephrosis
Distortion of the uterine cavity in a women contemplating pregnancy
What is an endometrial adenoma and what are they also known as?
An endometrial polyp: a focal growth of endometrial tissue.
Malignant in less than 1%
Which women are more likely to have endometrial adenomas?
Related to oestrogen exposure therefore more common in:
- Older women greater than 40
- Nulliparous women
What problems can endometrial polyps cause and how are they treated?
They can cause menorrhagia and intermenustral bleeding.
They are related by resection with dithermy.
What is a haematometra?
This is when menstrual blood accumulates in the uterus because of an outflow obstruction.
Embryologically how is the uterus formed?
By fusion of the 2 mullerian ducts.
If these fail to fuse properly there can be a range of congenital uterine abnormalities.
What is didelphys?
When there is failure of the mullein ducts to fuse causing there to be 2 separate uterine cavities.
What is a unicorniate uterus?
Where one of the mullein ducts failed, leaving a single duct shaped uterus.
Where the uterus is formed from one only of the paired Müllerian ducts while the other Müllerian duct does not develop or only in a rudimentary fashion
Has a single horn and a banana shape
What is a bicornuate uterus?
A heart shaped uterus, depending on the degree it can affect pregnancy.
