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UTERINE FIBROIDS

BY

DR. JAMES ENIMI OMIETIMI


Department of Obstetrics & Gynaecology
University of Port Harcourt Teaching
Hospital
PORT HARCOURT
UTERINE FIBROIDS
A fibroid is a benign tumour of uterine smooth
muscle.
 It is also termed a leiomyoma.

It is the commonest gynaecological tumor in


women.
It is present in 20-25% of women in the reproductive
age group.
Systematic histology studies of autopsies of the
uterus show a prevalence of up to 50%.
It accounted for 82 (45.3%) out of 181 all
gynaecological tumours in U.P.T.H in the year 2003.
(Annual report.)
It was the 3rd commonest cause for admission into
AETIOLOGY-unknown
ASSOCIATED RISK FACTORS
 Age

 Parity- “fibroids are the reward


of virtue, babies the fruit of sin”
 Race

 Family history

 Obesity
AETIO-PATHOLOGY
 Ovarian Hormones;
Estrogen stimulation of EGF receptors
Progesterone stimulation of EGF &
stimulation of AIP
 Ovarian suppression;
↓Metalloproteinase inhibitory activity
↑Metalloproteinase matrix
 Reduced expression of growth Inhibitory
Factors;
Monocyte chemotatic protein-1
 Monoclonal expansion
 Single or multiple
 Spherical in shape, lobulated cut surface with a
TYPES/SITES
 Submucous
 Intramural
 Subserosal
 Pedunculated submucosal
 Pedunculated abdominal
 Parasitic
 Cervical
 Intraligamentous
CLINICAL FEATURES
SYMPTOMS
2. Asymptomatic
3. Abnormal uterine bleeding
4. Abdomino-pelvic mass
5. Pain
6. Pressure effects; bladder, ureter,
GIT, veins, nerves, pancreas,
deep dyspareunia
7. Subfertility
EXAMINATIONS

PHYSICAL SIGNS
 GENERAL EXAM

 ABDOMINAL EXAM

 BIMANUAL EXAM
COMPLICATIONS OF
FIBROIDS
 Torsion
 Haemorrhage
 Ascitis; Pseudo-Meigs’ syndrome
 Infection
 Degeneration;
Hyaline
Cystic
Red degeneration
Calcification
 Malignant change
FIROIDS AND
PREGNANCY
 Abortions
 Premature labour
 Malpresentation
 Malpositions
 Obstructed labour
 Abnormal uterine action
 Post partum Haemorrhage
DIFFERENTIAL
DIAGNOSIS
 PREGNANCY
 OVARIAN TUMORS
 TUBO-OVARIAN ABSCESS/NEOPLASIA
 LEIOMYOSARCOMA
 ADENOMYOSIS
 ENDOMETRIOSIS
 ENDOMETRIAL CARCINOMA
 CONGENITAL ABNORMALITIES
INVESTIGATIONS
 FBC
 URINALYSIS & URINE M/C/S
 INTRACERVICAL SWAB M/C/S
 S/E/U/Cr
 U.S.S.
 ABD. X-RAY
 INTRAVENOUS UROGRAPHY
 HYSTEROSALPINGOGRAPHY
 SALINE SONOHYSTEROGRAPHY
 EUA & ENDOMETRIAL BIOPSY
 MAGNETIC RESONANCE IMAGING
 HYSTEROSCOPY
 LAPAROSCOPY