Fibroid Management

FIBROID MANAGEMENT

Q. 1

All are methods of managing fibroid uterus. Except :

 A

Myomectomy

 B

Radio frequency ablation

 C

Embolisation of uterine artery

 D

Laser myomectomy

Q. 1

All are methods of managing fibroid uterus. Except :

 A

Myomectomy

 B

Radio frequency ablation

 C

Embolisation of uterine artery

 D

Laser myomectomy

Ans. B

Explanation:

Ans. is b i.e. Radiofrequency ablation

Emblotherapy :

  • Uterine artery embolization is done using polyvinyl° alcohol or gel foam°, in patients not suited for or not desirous of surgical therapy.
  • Uterine blood flow is obstructed producing ischemia and necrosis.
  • It shrinks the fibroid by 40-50% in selective young women.°
  • Results : These patients experience
  1. lowered fertility rate°
  2. risk of placental insufficiency and°
  3. uterine rupture in subsequent pregnancy° because of interference with the blood supply and embolotherapy induced necrosis of the leiomyoma.

Due to lack of long term outcome data women who desire future childbearing are not currently considered candiates for uterine artery embolisation

Post op Complications : • Pain°

  • Fever°
  • Pulmonary embolism°
  • Complete amenorrhea° Extra Edge

Indications for operating an Asymptomatic fibroid° :

  • Fibroids larger than 12-14 weeks pregnancy.°
  • Rapidly growing fibroids.°
  • Subserous and pedunculated fibroid prone to torsion.°
  • If it is likely to complicate a future pregnancy°
  • If there is doubt about its nature°
  • Unexplained infertility and unexplained recurrent abortion.° 
  • Uncertain diagnosis.°

Indications of Medical management° :

  • To treat anemia and recover Hb levels before surgery.°
  • To reduce the size of large fibroid and facilitate surgery.°
  • Treatment of women approaching menopause to avoid surgery.°
  • In women with medical contraindication to surgery or those who are postponing surgery.°
  • For Preservation of fertility in women with large myomas before conservative surgery like myomectomy.°

Indications of surgical management° : Fibroids causing symptoms like

  • Menorrhagia°
  • Pressure symptoms° : Urinary Retention (by a cervical or broad ligament fibroid)
  • Chronic pelvic pain with° severe dysmenorhea
  • Acute pelvic pain as in° torsion of a pedunculated fibroid or prolapsing Sub-mucosal fibroid
  • Infertility caused by cornual fibroid
  • Recurrent abortions due to submucous fibroid.

Q. 2

Drugs that reduce the size of fibroid are :

 A

Danazol

 B

 

Progesterone

 C

RU-486

 D

Estrogen

Q. 2

Drugs that reduce the size of fibroid are :

 A

Danazol

 B

 

Progesterone

 C

RU-486

 D

Estrogen

Ans. A

Explanation:

Ans. is a  i.e. Danazol; and GnRH analogues


Q. 3

Sucheta, a 29 year old nulliparous women com­plains of severe menorrhagia and lower abdomi­nal pain since 3 months. On examination there was a 14 weeks size uterus with fundal fibroid.

The treatment of choice is :

 A

Myomectomy

 B

GnRH analogues

 C

Hystrectomy

 D

Wait and watch

Q. 3

Sucheta, a 29 year old nulliparous women com­plains of severe menorrhagia and lower abdomi­nal pain since 3 months. On examination there was a 14 weeks size uterus with fundal fibroid.

The treatment of choice is :

 A

Myomectomy

 B

GnRH analogues

 C

Hystrectomy

 D

Wait and watch

Ans. A

Explanation:

Ans. is a i.e. Myomectomy  

First lets see whether we would like to go for medical management or surgical intervention. The patient is presenting with :

  •  Severe menorrhagia°
  • Chronic lower abdomen pain°
  • Size of fihroici = 14 weekca

These 3 indications are strong enough for surgical intervention. Other indications for surgical Management are :

  • Acute pain in abdomen as in Torsion of pedunculated fibroid or prolapsing submucosal fibroid°
  • Pressure symptoms like constipation°
  • Dysuria°
  • Infertilty (when other causes of infertility have been ruled out) and habitual abortion caused by submucous fibroid.°

Now comes the question – whether Myomectomy or hysterectomy should be done.

Indication of Myomectomy : Myomectomy is specifically indicated in an infertiie woman or woman desirous of bearing child and wishing to retain her uterus.

Since, our patient, Sucheta is just 29 years and Nulliparous – Myomectomy should be done.


Q. 4

Treatment of choice in a perimenopausal woman with bleeding PV due to multiple fibroids Is :

 A

TAH with BSO

 B

TAH

 C

Vaginal hystrectomy

 D

Enucleation of fibroids

Q. 4

Treatment of choice in a perimenopausal woman with bleeding PV due to multiple fibroids Is :

 A

TAH with BSO

 B

TAH

 C

Vaginal hystrectomy

 D

Enucleation of fibroids

Ans. B

Explanation:

TAH


Q. 5 30 years old female presents in gynaec OPD with complaints of recurrent abortions and menorahagia. Her USG showed 2 sub-serosal fibroids of 3 x 4 cm on anterior wall of uterus and fundus, which is best line of management:-
 A TAH with BSO
 B Myolysis
 C Myomectomy
 D Uterine artery embolisation (UAE)
Q. 5 30 years old female presents in gynaec OPD with complaints of recurrent abortions and menorahagia. Her USG showed 2 sub-serosal fibroids of 3 x 4 cm on anterior wall of uterus and fundus, which is best line of management:-
 A TAH with BSO
 B Myolysis
 C Myomectomy
 D Uterine artery embolisation (UAE)
Ans. C

Explanation:

Laparoscopic myomectomy is  best treatment for  such  young infertile patients, but  it  requires subserosal pedunculated fibroids and surgical expertise.

Hysterectomy is advisable in patients who had completed their family.

Myolysis is myoma coagulation with laparoscopic lasers. (Nd- YAG) or bipolar needle & used in perimenopausal patients.

UAE is newer intervention for fibroid management in surgically unfit high risk patients, but it causes decreased fertility & carries risk of placental insufficiency and uterus rupture in subsequent pregnancy.


Q. 6

A 27 year old nulliparous woman complains of severe menorrhagia and lower abdominal pain since 4 months. On examination there is a 9 wks size uterus with fundal fibroid. The treatment of choice is:

 A

Myomectomy

 B

GnRh analogues

 C

Hysterectomy

 D

Wait and watch

Q. 6

A 27 year old nulliparous woman complains of severe menorrhagia and lower abdominal pain since 4 months. On examination there is a 9 wks size uterus with fundal fibroid. The treatment of choice is:

 A

Myomectomy

 B

GnRh analogues

 C

Hysterectomy

 D

Wait and watch

Ans. A

Explanation:

Resection of tumors is an option for symptomatic women who desire future childbearing or for those who decline hysterectomy.

This can be performed laparoscopically, hysteroscopically, or via laparotomy incision, and each is described in detail in the surgical atlas.

Myomectomy usually improves pain, infertility, or bleeding.

Menorrhagia improves in approximately 70 to 80 percent of patients following tumor removal.

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 9. Pelvic Mass. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.


Q. 7

A pregnant woman presents with red degeneration of fibroid, Management is:

 A

Myomectomy

 B

Conservative Rx

 C

Hysterectomy

 D

Termination of pregnancy

Q. 7

A pregnant woman presents with red degeneration of fibroid, Management is:

 A

Myomectomy

 B

Conservative Rx

 C

Hysterectomy

 D

Termination of pregnancy

Ans. B

Explanation:

In a pregnant female with red degeneration of fibroid, management is essentially conservative treatment with analgesia and rest.

Ref: Textbook of Obstetrics By D.C.Dutta, 5th Edition, Page 1327 ; Essentials of Obstetrics By Arulkumaran, 2004, Page 200


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