Uterine pathology

Question 1

Best treatment for a 3cm submucosal fibroid?

Answer 1

1. Hysteroscopic myomectomy + primed with GnRH analogue if fibroid is >3cm for 3 months
2. Hysterectomy is an option if she is post-menopausal

Pharmacological

• OCP/progestogen
• GnRH analogue

Question 2

What can be done for a patient who refuses surgical treatment for a 4cm intramural fibroid, 9cm uterine cavity?

Answer 2

OCP, then consider UAE or MRI guided focused ultrasound therapy

Question 3

Name 2 intra-operative method to reduce blood loss.

Answer 3

1. Adrenaline (vasopressor) for vasoconstriction infection
2. Diathermy coagulation
3. Clamping of arteries before cutting

Question 4

Risk of future pregnancy after myomectomy is done?

Answer 4

Uterine rupture

Question 5

Surgical treatment for endometrioma? Briefly explain. (2)

Risks involved? (5)

Answer 5

Laparoscopic ovarian cystectomy

• Created several ports in the abdomen, pump CO2 to create pneumoperitoneum
• Try to remove the cyst without perforation

Risk/ Drawbacks

1. GA risk
2. Hemorrhage
3. Injury to other organs (ureter, ovary, uterus, bladder, bowels)
4. Reduced ovarian reserve
5. Infection

Question 6

Management for gut perforation after surgery?

Answer 6

1. NPO, drip and suck (NG tube and IV fluid)
2. Resuscitation, ABC
   - 2 large bore IV assess, IV fluid in full rate
   - Insert Foley catheter
3. Closely monitor vitals and urine output
4. Blood test: CBC, L/RFT, clotting profile, crossmatch, ABG
5. Imaging: AXR
6. Broad spectrum antibiotics: IV cefuroxime + metronidazole
7. Emergency laparotomy

Question 7

S/E of OCP, progestogen, GnRH analogues respectively?

Answer 7

OCP

1. Thromboembolism, 2. CVS risk,
2. breast cancer in prolonged use

Progestogen

1. Breast tenderness
2. increased chance of ectopic pregnancy

GnRH analogues

1. Osteoporosis
2. Peri-menopausal symptoms