NCM 109_CE OB-GYNE: Notes 1

Myoma/Uterine Fibroids

 Are noncancerous growths of the uterus

that often appear during childbearing years
 Also called leiomyomas (lie-o-my-O-muhs)
or myomas
 Range in size from seedlings, undetectable
by the human eye, to bulky masses that can
distort and enlarge the uterus; can be single or
multiple.

Classification:

 Intramural fibroids - grow within the

muscular uterine wall Symptoms:
 Submucosal fibroids - bulge into the Many don’t have symptoms. In women who have
uterine cavity symptoms, the following can be observed or
 Subserosal fibroids - project to the outside experienced:
of the uterus
 heavy menstrual bleeding
 menstrual periods lasting more than a week
 pelvic pressure or pain
 frequent urination
 difficulty emptying the bladder
 constipation
 backache or leg pains

Diagnostic tests:

1. pelvic exam
2. MRI
3. Transvaginal ultrasonography
Causes:

 Genetic changes Medical/Surgical Management:

 Hormones
 Other growth factors Fibroids usually shrink and disappear during
menopause when estrogen is no longer produced.
The client with minor symptom is closely monitored.
Risk Factors: 

 Older women Medical Management:

 Obesity
 No history of pregnancy 1. Non-steroidal Anti-inflammatory Drugs
(NSAIDS) are prescribed in order to reduce the
 Race
pain sensation as well as minimize the blood
 Heredity
loss.
2. Tranexamic acid is given for patients
suffering from excessive blood loss.

Surgical Management:
1. Oophorectomy
- is done when ovaries are also included in
the damage. Surgical management is
indicated when the uterine size is much
enlarged. The abnormal bleeding is also
another indication for surgical removal since
continuous blood loss can result to anemia.
 Cystocele -  A prolapse of the bladder into
the vagina, the most common condition
 Urethrocele -  A prolapse of the urethra
(the tube that carries urine)
 Uterine prolapse
 Vaginal Vault Prolapse -  prolapse of the
vagina
 Enterocele -  Small bowel prolapse
 Rectocele - Rectum prolapse

2. Myomectomy

- are intended for patients that are included in

the reproductive age. Women who wanted
to conceive can opt for this after a complete
assessment.

3. Laparoscopy

- assisted vaginal hysterectomy is the newest

method of surgery wherein only a small
incision is done in order to minimize
bleeding.

Pelvic Organ Prolapse

- "Prolapse" refers to a descending or drooping of
organs. Pelvic organ prolapse refers to the
prolapse or drooping of any of the pelvic floor
organs, including:

 Bladder
 Uterus
 Vaginal
 Small bowel
 Rectum
It may be referred to as:
 Pelvic Inflammatory Disease (PID)
Is an infection of the female reproductive organs
such as the uterus, fallopian tubes, ovaries, and
cervix.

Causes:  

 Pregnancy, labor, and childbirth

 Obesity
 Respiratory problems with a chronic, long-
term cough
 Constipation
 Pelvic organ cancers
 Surgical removal of the uterus

Symptoms:
Causes:
 A feeling of pressure or fullness in the pelvic
area  STD/STI or sexually transmitted disease or
 Low back pain infection
 Painful intercourse
 A feeling that something is falling out of the
vagina
Risk Factors:
 Urinary problems such as leaking of urine or
a chronic urge to urinate
 Constipation  STD/STI
 Spotting or bleeding from the vagina  Multiple sexual partner
 Previous PID
 Sexually active less than 25 years of age
 Douche
Diagnosis:
 Use of IUD
 May be discovered during routine pelvic exam
Symptoms:
Treatment:
 Pain in the lower abdomen or pelvis
 Kegel exercise - to strengthen the pelvic  Heavy vaginal discharge with an unpleasant
floor muscle odor
 Insertion of a pessary into the vagina to  Irregular menstrual bleeding
support the drooping organs  Pain during intercourse
 Surgical treatment, either to repair the  Low back pain
affected tissue or organ or to remove the organ  Fever, fatigue, diarrhea or vomiting
 Painful or difficult urination
Diagnosis:

 Based on signs and symptoms

 Pelvic exam
 Pelvic laparoscopy

Complications:

 Scar formation leading to tubal blockage

 Ectopic pregnancy
 Infertility
 Long-term pelvic or abdominal pain

Treatment:

 Antibiotics