Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
3. leiomyoma
1. Dr. Chaduvula Suresh Babu
Professor
Dept. of OBGYN
GIMSR
Visakhapatnam, AP, India
2. It is a benign tumour arising from smooth
muscle cells of the Uterus and smooth
muscle cells of vasculature.
Histologically it has both smooth muscle
fibrils along with fibrous tissue
9. Oestrogen dependent ?
1. uncommon before puberty and regress in
menopause
2. grows in pregnancy
3. contains more oestrogen receptors
4. frequent association with anovulation
10. Genetic Factors:
Translocation between chrom. 12 & 14
Trisomy 12
Deletion – chromosome 3 or 7
Rearrangement of short arm of chromosome
6
11. Uterine and Extra-uterine
Uterine – Body and Cervix
Uterine Body – Intramural, sub-serous,
sub-mucus
Cervix – central, lateral, posterior
Extra-uterine – Broad ligament, Round
ligament and utero-sacral ligament,
Parasitic, Wandering fibroid
18. Degenerations of Fibroid
Hyaline degeneration – most common
Cystic
Fatty
Calcific degeneration
Atrophic
Red or Carneous degeneration in Pregnancy
Sarcomatous - rarest
21. Degeneration
Pressure and Pain
Hydroureter and Hydronephrosis
Anovulation
AUB
Infertility
Infection – sub-mucus
Incarceration – in pouch of Douglas
Torsion
Sarcoma
22. Menorrhagia
Metrorrhagia
Dysmenorrhea – congestive and spasmodic
Infertility – 2-10%
PID
Pressure and Pain
Abdominal Lump
Ascites and Polycythemia
23. Abortion
Preterm Labour
IUGR
Malpresentation and Malposition
Obstructed Labour
PPH
Inversion
Delayed Involution
Red degeneration and increase in size of
tumor
24. Pallor
Obese
Lump - if it I2 week size and more, firm,
non-tender, mobile, lower border not felt
PSE – cervix pulled up
PVE – irregularly enlarged, nodular,
transmission of movement felt and no groove
felt
25. Ultrasound
Hypoechoeic, well circumscribed lesion,
mixed echogenic
Gold standard test
Trans-abdominal
Trans-vaginal
36. Aromatase inhibitors
Directly inhibit estrogen synthesis & rapidly
produce hypoestrogenic state.
Fadrozole is tried in couple of studies
71 % reduction occurred in 8 weeks
Appears to be promising therapy.
37. Myomectomy – Infertility patients
By laparo or Hysterocopy guided or
conventional
Before Myomectomy –
1. adequate blood to be arranged,
2. consent for hysterectomy
3. GnRH therapy for 3 months
38. For submucous myoma causing infertility,
RPL, AUB or pain
Criteria :- < 5 cm in size
< 50 % intramural component
< 12 cm2 uterine size
Gn RH analogue may be given preoperatively
Advantages are short procedure , rapid recovery
& all disadvantages of laprotomy avoided.