Uterine fibroid

Benign growths in the uterus that can develop during a woman's childbearing years.Highest incidence was seen in Pakistani women 78%, then rural Indian women 37.65%, urban India 24% and Nigerian women 30%. Arobosoba from Nigeria has reported prevalence of uterine fibroids in black women was more (26%), in comparison to Caucasian women (17.9%).

1. Fibroid uterus Sr. Susmita Halder Sister tutor School of nursing, asia heart foundation

2. Introduction Uterine fibroids are benign smooth muscle tumors that occur within the uterus. These are most common benign tumors of female genital tract. It is also known as uterine leiomyoma ,myoma or fibromyoma.

3. Incidence It has been estimated that at least 20% of women at the age of 30 have got fibroid in their wombs. Fortunately 50% of them remain asymptomatic. The incidence of symptomatic fibroid in the hospital outpatient is about 3% A high incidence of 10% prevails in England. The incidence is even higher in black women

4. Types of of uterine fibroid Uterine fibroids can be classified according to anatomical location. Corporal /body ( the fibroids are mostly located in the body of the uterus and are usually multiple) Cervical ( The fibroids are mostly located in the cervix of uterus. This can be supravaginal or vaginal)

5. Corporeal fibroids of uterus Interstitial or intramural: (75%) : fibroidss are initially in intramural position but subsequently some are pushed outwards or inwards. Subperitoneal or subserous(15%) : In this condition the intramural fibroid is pushed outwards towards the peritoneal cavity. The fibroids are either personally or completely covered by peritoneum.

6. When it is completely covered by peritoneum it attains a pedicle – penductulated subserous fibroid. in some cases the pedicle may be turn through and the fibroid gets its nourishment from the omental for mesenteric additions and is called – wandering or parasitic fibroid. Sometimes the intramural fibroid may be pushed out in between the layers of broad ligament and is called- broad ligament fibroid. 3. Submucous (5%) : the intramuralfibroid when pushed towards the uterine cavity and is lying underneath the endometrium it is called submucous fibroid. Submucous fibroid can make the uterine cavity irregular and distorted. Penductulated mucous fibroid may come out through cervix it may be infected or ulcerated to cause metrorrhagia. The type is very least common but it produces maximum symptoms

7. Cervical fibroids Cervical fibroids are rare. In the supravaginal part of cervix it may be interstitial or subperitoneal variety and rarely polypoidal. Depending upon the position it may be anterior-posterior lateral or central. Interstitial growths mein displays the cervix or expanded so much that the external cost is difficult to recognise it also affects ureter In the vaginal cervix the fibroid is usually penductulated. A fibroid polyp arising from the uterine body when occupies and distance from the cervical canal is called pseudo cervical fibroid

8. Etiology Histogenesis Origin The etiology still remains unclear. the prevailing hypothesis is that it arises from new plastics in the smooth muscle cell of myometrium The stimulus for initial neoplastic transformation is not known.

9. Chromosomal abnormality: in about 40% of cases there is a wearing type of chromosomal abnormality particularly in chromosome 6 or 7 rearrangements and deletion takes place. Somatic mutations in mitral cells may also be the cause for uncontrolled cell proliferation. Role of peptide growth factors: epidermal growth factor EGF, insulin like growth factor 1 IGF1 , transforming growth factor TGF, simulate the growth of leiomyoma either directly or via oestrogen. A positive family history is often present.

10. Growth it is predominantly and oestrogen dependent tumor. Oestrogen and progesterone is incriminated as the cause. Oestrogen dependency is evidence by Growth potential ATI is limited during childbearing period Increase growth during pregnancy They do not occur before menarche Following menopause there is cessationof growth and they undergo atrophy after menopause

11. It seems to contain more oestrogen receptors than adjacent myometrium. Association of anovulation The growth potentiality varies. As a whole the rate of growth is slow and takes about three to five years for the five to grow sufficiently to be felt per abdomen (Evidence shows Ovarian tumors grow in months. However fibroid grows rapidly during pregnancy or OCP users. Rapid growth also may be due to degeneration or due to malignant change

12. Risk factors Increased risk Nulliparity Obesity Hyper oestrogenic state Black women Reduce risk Multiparity

13. Clinical features of corporeal fibroid PATIENT PROFILE Patients are usually nari Paris or having a long period of secondary infertility Early marriage and frequent childbirth makes it even higher amongst the multiparous women The incidence is at its peak in 35 to 45 years There is a tendency of delayed menopause.

14. SYMPTOMS 75% of fibroids remain asymptomatic. They are accidentally discovered by physician during routine examination or at leopard to me or laparoscopy. The symptoms are related to an atomic type and size of tumor. The site is more important than the size. A small submucous fibroid may produce more symptoms than a big subserous fibroid.

15. MENSTRUAL ABNORMALITIES A . In 30% of cases mineral is the classic symptom of symptomatic fibroid. Menstrual loss is progressively increased with successive cycles due to Increase surface area of endometrium Interference with normal uterine contractility due to interposition of fibroid Condition and dilation of adjacent endometerial venous plexus is caused by obstruction of tumor. Endometrial hyperplasia due to hyper oestrogenic state. Pelvic congestion Imbalance of thromboxane A2 and prostacyclin with deficiency of thromboxane A2.

16. B. Metrorrhagia or irregular bleeding may be due to Ulceration of submucous fibroid polyp Torn vessels from slugging base of a polyp Associated endometrial carcinoma. C. dysmenorrhea. : the congestive variety may be due to associated pelvic congestion or endometriosis. Spasmodic type is associated with extrusion of polyp and its aspiration from uterine cavity Subserous or broad ligament fibroids are usually on associated with menstrual abnormalities.

17. D.Infertility – infertility may be a major complaint the probable known attributing factors are UTERINE Distortion and or elongation of uterine cavity which leads to difficult sperm ascent Preventing kramak contraction due to fibroids during intercourse leads to impaired sparm transport Congestion and dilatation of endometrial venous plexus Atrophy an ulceration of endometrium Menorrhagia and dyspareunia TUBAL – cornua block duty position of fibroid. OVARIAN – anovulation PERITONEUM- endometriosis

18. OTHER SYMPTOMS ARE Pregnancy related problems like abortion preterm labour and intrauterine growth restriction. The reasons are defective implantation of class inter poly developed endometrium reduce space of for growing foetus and placenta. Shoulder dystocia postpartum hemorrhage are also common. Pain per abdomen: usually painless ,pain may be due to associated pelvic pathology such as tumor, endometriosis , pelvic inflammatory disease etc Patient may have a sense of heaviness in lower abdomen she may feel a lump in the lower abdomen even without any other symptoms

19. Clinical features of cervical fibroid In non pregnant state the symptoms are predominantly due to pressure effects on the surrounding structures Anterior cervical: bladder symptoms like frequency or even retention of urine are species the retention is more due to pressure then elongation of urethra. Posterior cervical: rectal symptom is the form of constipation Lateral cervical: vascular obstruction may lead to hemorrhoids and edema of legs the ureter is post laterally and below the tumor Central cervical: Is producers predominant bladder symptoms. It is mainly asymptomatic during pregnancy but produces obstruction during labour.

20. Signs General examination reveals varying degrees of pallor depending upon the magnitude and duration of menstrual loss Abdominal examination reveals tumor may not be sufficiently enlarge to be felt per abdomen. Bath is enlarged to 14 weeks or more of the following features are noted. Upon palpation It fields farm more hard may be due to cystic degeneration Margins are well defined accept the pole which cannot be reached suggestive of pelvic in origin Surface is nodular and mobility is restricted

21. 4. This swelling is dull on percussion. 5. Pelvic examination reveals the uterus is regularly enlarged by the swelling per abdomen. Uterus isnot well separated from swelling such as groove is not filled between the uterus and the mass Movement of cervix along with the tumor is felt per abdomen

22. Fate of a fibroid! ( COMPLICATIONS) Surface necrosis Polypoid change following pedicle formation Infection Degeneration including sarcomatous change Sarcomatous change are rare Hemorrhage due to rupture of surface vein of subserous fibroid Polycythemia due to erythropoietic function by the tumor Torsion of subserous penductulated fibroid.

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24. Questions ✍️ What is uterine fibroid? 1 What are the signs and symptoms of uterine fibroid? 5 Explain treatment modalities of fibroid uterus. 9 1+5+9=15

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