Bangalore Call Girls Marathahalli π 9907093804 High Profile Service 100% Safe
Β
3. leiomyoma
1. Dr. Chaduvula Suresh Babu
Professor
Dept. of OBGYN
GIMSR
Visakhapatnam, AP, India
2. ο It is a benign tumour arising from smooth
muscle cells of the Uterus and smooth
muscle cells of vasculature.
ο Histologically it has both smooth muscle
fibrils along with fibrous tissue
9. ο Oestrogen dependent ?
ο 1. uncommon before puberty and regress in
menopause
ο 2. grows in pregnancy
ο 3. contains more oestrogen receptors
ο 4. frequent association with anovulation
10. ο Genetic Factors:
ο Translocation between chrom. 12 & 14
ο Trisomy 12
ο Deletion β chromosome 3 or 7
ο Rearrangement of short arm of chromosome
6
11. ο Uterine and Extra-uterine
ο Uterine β Body and Cervix
ο Uterine Body β Intramural, sub-serous,
sub-mucus
ο Cervix β central, lateral, posterior
ο Extra-uterine β Broad ligament, Round
ligament and utero-sacral ligament,
Parasitic, Wandering fibroid
16. ο Well circumscribed, multiple, discrete,
whitish
ο False capsule
ο Whorled appearance
ο Trabeculated
ο More vascular in periphery
than central
18. οDegenerations of Fibroid
ο Hyaline degeneration β most common
ο Cystic
ο Fatty
ο Calcific degeneration
ο Atrophic
ο Red or Carneous degeneration in Pregnancy
ο Sarcomatous - rarest
21. ο Degeneration
ο Pressure and Pain
ο Hydroureter and Hydronephrosis
ο Anovulation
ο AUB
ο Infertility
ο Infection β sub-mucus
ο Incarceration β in pouch of Douglas
ο Torsion
ο Sarcoma
22. ο Menorrhagia
ο Metrorrhagia
ο Dysmenorrhea β congestive and spasmodic
ο Infertility β 2-10%
ο PID
ο Pressure and Pain
ο Abdominal Lump
ο Ascites and Polycythemia
23. ο Abortion
ο Preterm Labour
ο IUGR
ο Malpresentation and Malposition
ο Obstructed Labour
ο PPH
ο Inversion
ο Delayed Involution
ο Red degeneration and increase in size of
tumor
24. ο Pallor
ο Obese
ο Lump - if it I2 week size and more, firm,
non-tender, mobile, lower border not felt
ο PSE β cervix pulled up
ο PVE β irregularly enlarged, nodular,
transmission of movement felt and no groove
felt
25. ο Ultrasound
ο Hypoechoeic, well circumscribed lesion,
mixed echogenic
ο Gold standard test
ο Trans-abdominal
ο Trans-vaginal
36. Aromatase inhibitors
ο Directly inhibit estrogen synthesis & rapidly
produce hypoestrogenic state.
Fadrozole is tried in couple of studies
ο 71 % reduction occurred in 8 weeks
ο Appears to be promising therapy.
37. ο Myomectomy β Infertility patients
By laparo or Hysterocopy guided or
conventional
Before Myomectomy β
1. adequate blood to be arranged,
2. consent for hysterectomy
3. GnRH therapy for 3 months
38. ο For submucous myoma causing infertility,
RPL, AUB or pain
ο Criteria :- < 5 cm in size
< 50 % intramural component
< 12 cm2 uterine size
ο Gn RH analogue may be given preoperatively
ο Advantages are short procedure , rapid recovery
& all disadvantages of laprotomy avoided.