CLINICAL TEACHING

ON
FIBROID UTERUS

SUBMITTED TO: SUBMITTED BY:

MRS.ROSI , S.SHARMILI,

MSC(N) IIND YEAR,

DEPARTMENT OF OBG, ICON.

ICON.

SUBMITTED ON:
NAME OF THE STUDENT TEACHER : S.SHARMILI

SUBJECT : OBSTETRICS AND GYNECOLOGY

TOPIC : FIBROID UTERUS

HOUR : I HOUR

DATE AND TIME :

CLASS : M.Sc (NURSING) IIND YEAR

LEVEL OF THE STUDENT : M.Sc (NURSING) IYEAR

NUMBER OF THE STUDENT : 03

TEACHING METHOD : CLINICAL TEACHING,

TEACHING AIDS : POWERPOINT,BLACK, CHART, LEAFFLET,ROLLER BOARD

EVALUATOR : MRS.ROSI,

DEPARTMENT OF OBG,

ICON.
GENERAL OBJECTIVES:
Student will gain adequate knowledge regarding forceps and to develop desirable attitude and the skill to implement the
procedure in various hospital settings.

SPECIFIC OBJECTIVES:

At the end of the class, the students will be able to:

 define uterine fibroid

 discuss the prevention of uterine fibroid

 enlist the types of uterine fibroid

 enumerates the signs and symptoms of uterine fibroid

 listout the causes of uterine fibroid

 enlist the risk factors of uterine fibroid

 list down the complication of uterine fibroid

 enumerates the diagnosis of uterine fibroid

 listout the prevention of uterine fibroid

 describe the management of uterine fibroid

INTRODUCTION:
Uterine fibroid are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas
(lie-o-my-O-muhs) or myomas, uterine fibroid aren't associated with an increased risk of uterine cancer and almost never develop into
cancer. Fibroid range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus.
You can have a single fibroid or multiple ones. In extreme cases, multiple fibroid can expand the uterus so much that it reaches the rib
cage and can add weight.
S.N SPECIFIC TIM CONTENT TEACHER AV.AIDS LEARNERS EVALUATION
O OBJECTIVES E S ACTIVITY
ACTIVITY

1. define uterine DEFINTION: Defining Roller Listening What is uterine

fibroid uterine board fibroid?
“Leiomyomas originate from
fibroid
smooth muscle cells of the uterus or
less commonly from the smooth
muscle cells of uterine blood vessels”.
Or Historically, this tumour is
composed of smooth muscle and
fibrous connective tissue, so named as
uterine leiomyomas, myomas or
fibromyoma.
2. Discussing Power Asking What are the
discuss the
PREVALENCE: doubts
prevalence of the point prevalence of

uterine fibroid Nearly 20-80% of females will prevalence of uterine fibroid?

develop fibroid by the time they uterine
become 50 years of age. The majority fibroid
of women with fibroid are usually in
their 40s and early 50s. Not all fibroid
affected women experience symptoms.
It might be difficult to deal with
 fibroid for those who do experience
symptoms.

According to reports, 24% of Indians

in cities and 37.65% of people in rural
areas develop fibroid. More than ten
lakhs / year incidents of uterine fibroid
are seen in India. Its incidence is as
follows:

AGE GROUP:(INCIDENCE)

15-25 years (0.8%)

26-35 years (21.6%)

enlist the types 36-45 years (33.9%) What are the

3 Pamphlet Taking notes
of uterine types of uterine
Enlisting the
>45 years (43.6%)
fibroid fibroid?
types of
TYPES OF UTERINE uterine
FIBROID: fibroid
Uterus is a pear-shaped organ
which is situated in between the
bladder and the rectum. Uterus is
divided into three layers - (outer,
middle and inner layer). Uterine
fibroid can grow from any of these
layers. There are six types of uterine
fibroid, classified based on its location

 Intramural fibroid

 Suberosal fibroid

 Submucosal fibroid

 Pendunculated fibroid

 Cervical fibroid

 Broad ligament fibroid

1. INTRAMURAL
FIBROIDS:

Intramural fibroid are the benign

growths and the most common type of
uterine fibroid. These grow within the
muscles of the uterus wall. It further
classified based on the growth
location:

 Anterior intramural fibroid: If

the growth is seen with the front
muscle wall of the uterus.

 Posterior intramural fibroid: If

the growth is seen within the back
muscle wall of the uterus.

 Fundal intramural fibroid: If

the growth is seen within the top
muscle wall of the uterus.

2. SUBSEROSAL FIBROIDS:

Subserosal fibroid are the benign

growths and grow on the outer muscle
of the uterus wall. These are also the
common type of uterine fibroid. It can
grow bigger as a single growth or
multiple small growth and typically
can cause severe pelvic pain.
3. SUBMUCOSAL FIBROIDS:

Submucosal fibroid are the benign

growth of the uterus and commonly
seen during reproductive age of
women. It grows into the uterine
cavity, situated directly below the
uterine inner lining. Typically, these
are the least common type of uterine
fibroid but can cause severe symptoms
such as prolonged and heavy
menstrual bleeding during or between
periods, pelvic pain or lower back
pain.

4. PENDUNCULATED FIBROIDS:

Pendunculated fibroid are benign

growths of the uterus. These fibroid
are a stalk-like growth and a narrowed
connection to the uterine wall. These
can grow both outside and inside the
uterus. It further classified based on
 the growth location:

 Pendunculated submucosal
fibroid: a stalk-like growth on the
outer muscle of the uterine wall

 Pendunculated subserosal
fibroid: stalk-like growth into the
uterine cavity, situated directly
below the uterine inner lining

5. CERVICAL FIBROIDS:

Cervical fibroid are benign

growths of the uterus. It develops in
the cervix, the lower part of the uterus.
These are the rare type of uterine
fibroid but can cause symptoms such
as heavy menstrual bleeding during or
between periods in the form of large
blood clots, anaemia, pain in the
enumerates the What are the
pelvic area or lower back pain,
signs and signs and
frequent urination.
symptoms of symptoms of
Enumerating
4 uterine fibroid 6. BROADLIGAMENT FIBROID: the signs and Leaflet Active uterine fibroid?
symptoms of listening
Broad ligament fibroid are a
uterine
benign muscle growth which develop
fibroid
from the broad ligament hormone-
sensitive smooth muscle or the uterine
smooth muscle. Typically, Broad
ligament fibroid is the rare type of
uterine fibroid but can cause
symptoms such as chronic pain in the
pelvic area, the bladder compression,
and bowel dysfunction.

SIGNS AND SYMPTOMS OF

UTERINE FIBROID:

 Prolonged or heavy menstrual

flow (menorrhagia) is the most
common symptom

 Pelvic pressure or pain sensation

which could be suspected as large
fibroid

 Pelvic discomfort or low back

 pain

 Pelvic discomfort or low back

pain

 Painful intercourse (dyspareunia)

 Urine symptoms such as urine

listout the frequency, urine urgency, urine What are causes
causes of retention of uterine
listing the Taking notes
uterine fibroid fibroid?
 Constipation (difficulty in causes of Chart
5 emptying the bowels, usually uterine
associated with hardened stools) fibroid

 Increase in pregnancy
complications such as recurrent
miscarriage, premature labour,
foetal malpresentation, labour
complications including
Caesarean delivery and placental
enlist the risk What are the risk
abruption
factors of Enlisting the Asking factors of uterine
uterine fibroid  Infertility risk factors doubts fibroid?
6 Power
of uterine point
 fibroid

CAUSES OF UTERINE
FIBROID:

 Imbalance of the estrogen and

progesterone hormones

 Gene Changes (Genetic

mutations)

 Other insulin-like growth factors

 Increased extracellular matrix

(ECM)

RISK FACTORS OF
list down the UTERINE FIBROID: What are the
complication of Asking complication of
 Obesity List down the
uterine fibroid question uterine fibroid?
complication Handout
 Early menarche (the first
7 of uterine
occurrence of menstruation)
fibroid
 Nulliparity (females in whom
there has been no event of
pregnancy yet)
 Vitamin D deficiency
(hypovitaminosis D)

 A delayed onset of menopause

 High blood pressure

(hypertension)

 Uterine fibroid in family

 Early onset of puberty (Menarche)

COMPICATION OF
UTERINE FIBROID:

 Thromboembolism (obstruction of
a blood vessel by a blood clot)

 Constipation (difficult bowel

movements)

 Female reproductive organs

distortion (twisting or crushing
the female organs)

 Impaired blood flow which can

 lead to pregnancy complications

 Infertility

 Red degeneration during

pregnancy (torsion or twisting of
fibroid)

enumerates the RED DEGENERATION: What are

diagnosis of Taking notes diagnosis of
Red degeneration (a hemorrhagic
uterine fibroid uterine fibroid?
infarction of the uterine leiomyoma) Enumerating
during pregnancy is one of the severe the diagnosis Power
8 complications, in which the subserosal of uterine Point
Pedunculated fibroid is twisted due to fibroid
which further complications can arise
such as:

 Acute urinary retention (difficulty

in urinating)

 Acute renal failure (kidney

failure)

 Acute vaginal or intra-peritoneal

haemorrhage (internal bleeding at
 vagina)

 Mesenteric vein thrombosis (clot

in the vein)

 Intestinal gangrene (obstructed

blood circulation resulting in
death of intestine)

DIAGNOSIS OF UTERINE
FIBROID:

 ULTRASOUND ABDOMEN
AND PELVIS (USG): With the
aid of sound waves, the uterus and
other pelvic organs can be
visualized during an ultrasound
examination.

 HYSTEROSCOPY: A narrow
instrument called a hysteroscope
is used during hysteroscope to
view the inside of uterus. Through
the cervix and vagina, it is
inserted (opening of the uterus).
 This enables your medical
practitioner to see uterine fibroid
growths.

 HYSTEROSALPINGOGRAPH
Y (HSG): X-rays are used
specifically for
Hysterosalpingography. The
uterus and fallopian tubes' size
and form could undergo aberrant
modifications.

 SONOHYSTEROGRAPHY:
This procedure involves injecting
fluid via the cervix into the uterus.
listout the After that, ultrasound is utilized to
prevention of What are the
reveal the uterus' inside. The fluid
uterine fibroid prevention of
gives an accurate representation
uterine fibroid?
of the uterine lining.
Active
 LAPAROSCOPY: A thin Listing the listening
instrument called a laparoscope is prevention of
used during laparoscopy to allow uterine Pamphlet

your doctor to see into your

9 abdomen. It is inserted through or fibroid
just below the belly button
through a tiny cut. The
laparoscope can be used to see
fibroid that are external to the
uterus.

 BLOOD TESTS: The doctor

may prescribe additional tests to
rule out other possible causes of
abnormal menstrual bleeding,
such as a complete blood count
describe the (CBC) to check for the possibility
management of What are the
uterine fibroid of anaemia due to persistent blood
management of
loss and other blood tests to rule
uterine fibroid?
out bleeding disorders.

 COMPUTER TOMOGRAPHY Asking

doubts
 MAGNETIC RESONANCE Describing
TOMOGRAPHY (MRI) the
management Power

10 of uterine point
PREVENTION OF UTERINE
FIBROID: fibroid

 Low sugar diets can reduce the

risk of uterine fibroid

 Foods rich in beat-carotene,

foliate, fibre, vitamin C,E & K
diet like broccoli

 Cabbage, cauliflower can help

reduce risk of uterine fibroid

 Regular exercise accompanied by

a stress free lifestyle reduces
uterine fibroid incidence

 Supplements such as iron, and

magnesium aid in its prevention

MANAGEMENT OF
UTERINE FIBROID:

MEDICAL TREATMENT

 Non steroidal anti-inflammatory

drugs (NSAIDs) such as
ibuprofen and antifibrinolytics
such as tranexamic acid can be
given to treat uterine fibroid
symptoms effectively.
Nevertheless, the NSAIDs can’t
be given to decrease the size of
the fibroid.

 Gonadotropin releasing hormone

agonists (GnRHa) medications
can be given as an implant, nasal
spray, or injection to shrink the
uterine fibroid. These drugs work
by stopping the production of
oestrogen and progesterone.

 Vitamin and iron supplements

may be prescribed by your doctor
 to treat heavy menstrual bleeding
(Menorrhagia) and anaemia.

 Progestin-releasing intrauterine
device (IUD): An IUD that
releases progesterone can stop
excessive bleeding brought on by
uterine fibroids. A progestin-
releasing IUD merely relieves
symptoms; it does not reduce or
eliminate fibroids. It also avoids
getting pregnant.

SURGICAL TREATMENT:

 Depending on the diagnosis and

severity, there are uterine fibroids
surgery options available which
can be suggested for the uterine
fibroid treatment.

 Traditional surgeries, such as

Abdominal Myomectomy and
Hysterectomy were performed for
 very large fibroid, multiple
fibroid, very deep fibroid, or
permanent solution for uterine
fibroid have been outdated and
replaced by minimally invasive
techniques that use laparoscopy or
robotic surgical system to perform
uterine fibroid removal surgery,
such as:

1. RADIOFREQUENCY
ABLATION:

Radio frequency ablation is a safe,

dependable, and effective procedure.
It is minimally invasive treatment
option which is effective for women
with recently developed fibroids, apart
from preserving the uterus. High
temperatures are used in
radiofrequency ablation to kill tissue.
In the case of large fibroid.

2. UTERINE FIBROID
 EMBOLIZATION(UFE):

The procedure includes administration

of drugs which cut off the blood
supply are injected into one or both
uterine arteries during an
interventional radiologic treatment to
stop the blood circulation to the uterus
and fibroids. Although uterine artery
embolization has a considerably
shorter hospital stay than
hysterectomy and myomectomy, and a
lower chance of needing a blood
transfusion, it is contraindicated in
pregnancy, uterine infections.

3. LAPROSCOPIC
MYOMECTOMY:

It is an option, especially for women

who plan to have children in the
future. In this surgery, the uterus is left
intact after the removal of the fibroids.
However, it's not feasible in all the
cases. In between 80-90% of the cases,
myomectomy patients have either
symptom alleviation or symptom
reduction.

4. ROBOTIC MYOMECTOMY:

It is a kind of laparoscopic
myomectomy. In comparison to open
surgery, a robotic myomectomy may
result in less blood loss, fewer
problems, a shorter hospital stay, and a
quicker return to normal activities.
Traditional laparoscopy and robotic
surgery may take longer and cost
more, but overall outcomes are
typically similar.

5. MYOLYSIS:

With the help of a focused energy

delivery system, such as heat, laser, or
more recently, magnetic resonance-
guided focused ultrasound surgery
(MRgFUS), fibroids can be destroyed
in a minimally invasive treatment
called myolysis.

6. ENDOMETRIAL ABLATION:

In endometrial ablation, the inner

lining of the uterus is removed through
a variety of techniques, such as
microwave heating, laser radiation, or
a heated wire loop. This surgery is
typically advised for fibroids that are
near to the uterus' inner lining.

7. HYSTEROSCOPIC
MYOMECTOMY:

This procedure is best suited for the

surgical treatment of intracavitary
fibroid. Hysteroscopy allows
surgeons to selectively remove
intrauterine pathological conditions,
and hysteroscopic myomectomy, a
single surgical operation, has steadily
evolved into a safe and efficient
treatment over the years.

8. ABDOMINAL
MYOMECTOMY OR
LAPAROTOMY:

An abdominal myomectomy, also

referred to as an "open" myomectomy,
is a significant surgical treatment. It
entails removing the fibroids from the
uterine wall using a "bikini cut"
incision made through the skin on the
lower abdomen. After that, multiple
layers of stitches are used to
reconstruct the uterine muscle.

9. TOTAL LAPAROSCOPIC
HYSTERECTOMY AND
 TOTAL ROBOTIC
HYSTERECTOMY:

The most conventional and frequent

therapy for fibroids is total
laparoscopic hysterectomy or total
robotic hysterectomy or total
abdominal hysterectomy where the
entire uterus is taken out during the
surgery and so it is usually done in
patients who had children.

In comparison to laparoscopic
hysterectomy, a robotic hysterectomy
may result in less blood loss, a shorter
hospital stay, and a quicker return to
normal activities.

SUMMARY:
So far we discussed about the definition of uterine fibroid, prevention of uterine fibroid, types of uterine fibroid, causes and risk
factors of uterine fibroid, complication of risk factors, diagnosis of uterine fibroid, prevention of uterine fibroid and management of
uterine fibroid
CONCLUSION:

Uterine fibroid is a common concern in women at fertile age causing multiple bleeding and pain symptoms which can have a
negative impact on different aspects in women's life.

BIBLIOGRAPHY:

 DC Duttas Textbook of obstetric and gynecological nursing 9TH edition published by Jay Pee brothers
 Myles Textbook of midwives 15th edition published by British Library cataloguing

 Reeder and Mortin Textbook of maternity nursing 19th edition publised by wolter kluwer

NET REFERENCE:

http://www.decline.com

http://www.mayoclinic.com

http://www.mediplus.com

http://www.journals.com

JOURNALS:

ABSTRACT:

Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical
presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.
Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve
surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid ‘radical’ surgery
such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other
surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine
artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine
fibroids.

There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack
of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic
impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to
surgical intervention.