UTERINE

FIBROID
 INVESTIGATIONS
Ultrasound and Color Doppler (TVS)
…
Saline Infusion Sonography (SIS)…
Magnetic Resonance Imaging (MRI)
To minimize blood loss;
•Antiprogesterones (Mifepristone)
•Danazol
•GnRH analogs
-Agonists, Antagonists
•LNG-IUS
•Prostaglandin synthetase inhibitors
 ADVANTAGES OF GnRH ANALOGUE

•Improvement of menorrhagia and may produce

amenorrhea.
•Improvement of anemia.
•Relief of pressure symptoms.
•Reduction in size (50%) when used for a period of 6
months.
•Reduction in vascularity of the tumor.
•Reduction in blood loss during myomectomy.
•May facilitate laparoscopic or hysteroscopic surgery.
 Disadvantages
•Hypoestrogenic side effects
(Vasomotor symptoms, Trabecular
bone loss).
•Cost (high).
•Regrowth of myomas on cessation
of therapy.
•Degeneration (some leiomyomas)-
causing difficulty in myoma
enucleation.
SURGICAL MANAGEMENT OF FIBROID UTERUS

•Myomectomy can done by;

-Laparotomy
- Laparoscopy
-Hysteroscopy

•Embolotherapy
•Myolysis
• Hysterectomy
 Indications Of Myomectomy
•Persistent uterine bleeding despite medical therapy.
•Excessive pain or pressure symptoms.
•Size >2 weeks, woman desirous to have a baby.
•Unexplained infertility with distortion of the uterine
cavity.
•Recurrent pregnancy wastage due to fibroid.
•Rapidly growing myoma during follow-up.
•Subserous pedunculated fibroid.
HYSTERECTOMY
Indications for emergency surgery in a fibroid
•Torsion of the subserous pedunculated fibroid

•Massive intra peritoneal hemorrhage following

rupture of vein over the subserous fibroid

•Uncontrolled infected fibroid

•Uncontrolled bleeding fibroid

 Nursing Diagnosis
 

=Acute Pain related to inflammation due to the addition

of mass in the uterus
=Impaired Urinary Elimination: Retention related to
the suppression by the neoplastic tissue mass in the
surrounding area
= Ineffective individual coping related to emotional
excess.
=Anxiety related to situational crisis (hysterectomy or
chemotherapy), threats to self-concept, changes in
health status, stress
 Indications For Hysterectomy

Benign disease Malignant disease

Abnormal bleeding Cervical intraepithelial
Leiomyoma neoplasm
Adenomyosis Invasive cervical cancer
Endometriosis Atypical endometrial hyperplasia
Pelvic organ prolapse Endometrial cancer ,
Pelvic inflammatory disease Ovarian cancer
Chronic Pelvic pain Fallopian tube cancer
Pregnancy-related Gestational trophoblastic tumors
conditions