Uterine fibroids introduction and Management

Uterine fibroids introduction and Management

1. Uterine fibroids Anamika Ramawat M.Sc. Nursing prev. Batch 2017-18 Gcon , jodhpur

2. Introduction Uterine fibroid is a leiomyoma (benign (non- cancerous) tumor form from smooth muscle tissue) that originates from the smooth muscle layer (myometrium) of the uterus. Synonyms: Myoma, Fibromyoma. Most common benign neoplasm in the female. Incidence: 20 to 40% of reproductive age women.

3. Definition “Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years.” Uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

4. ETIOLOGY

5. Other factors- Onset of menstruation at an early age Diet low levels of vitamin D Drinking alcohol Obesity Nulliparity

6. TYPES/ Classification

7. CLINICAL FEATUREs Asymptomatic  Fibroid size<4cm Abnormal uterine bleeding  menorrhagia > 64% woman present with heavy blood loss. Metro menorrhagia present in cases of infected / ulcerated fibroid polyp. Infertility Pain lower abdomen Abdominal swelling (lump) Pressure symptoms

8. DIAGNOSIS History Collection Physical Examination

9. FIBROID SIGNS G/E - Pallor P/A - If >12 weeks size, firm, nodular, arising from pelvis, lower limit can’t be reached, relatively well defined, mobile from side to side, nontender, dull on percussion, no free fluid in abdomen. P/S - Cervix pulled higher up. P/V - Uterus enlarged, nodular, uterus not separately felt, transmitted movement present, notch not felt.

10. FIBROID USG : Well defined hypoechoic lesions. Peripheral calcification with distal shadowing in old fibroids

11. TAS & TVS - Size, site and number of fibroids Differentiates the tumor from other swelling as ovarian tumor.

12. HYSTEROSCOPY - To visualize a sub mucous fibroid or a small fibroid polyp.

13. MRI - Most accurate imaging modality for diagnosis of fibroid. It does precise fibroid mapping & characterization. Detects all fibroids accurately. Ovaries are easily seen Detects small myomas (0.5 cm)

14. Laparoscopy - It is helpful, if the uterine size is less than 12 CMS and associated with pelvic pain and infertility.

15. Endometrial biopsy - Tissue sample is taken to send it for biopsy procedure to find out the type of fibroid malignancy.

16. COMPLICATIONs Menorrhagia Abdominal pain Premature birth, labor problems, miscarriage Infertility Twisting of the fibroid Anemia Urinary tract infections Some pregnant women with fibroids have heavy bleeding immediately after giving birth.

17. Management Medical/ Pharmacological

18. Surgical

19. Uterine artery embolization/ Embolotherapy

20. Uterine artery ligation

21. Laparoscopic or robotic myomectomy

22. Hysteroscopic myomectomy

23. Endometrial ablation and resection of submucosal fibroids

24. Abdominal myomectomy

25. Hysterectomy a surgical operation to remove all or part of the uterus in case of life threatening condition of the women i.e., menorrhagia, post-menopausal period. Most common surgical treatment done in India.

26. TECHNIQUES of Hysterectomy Abdominal hysterectomy Vaginal hysterectomy Laparoscopic-assisted vaginal hysterectomy Laparoscopic-assisted supracervical hysterectomy Total laparoscopic hysterectomy

27. NURSING INTERVENTIONS The nurse determines what the experience means to the patient and encourages her to verbalize her concerns. Explanations are given about physical preparations and procedures that are performed. The patient needs reassurance that she will still have a vagina and that she can experience sexual intercourse after temporary postoperative abstinence while tissues heal. The nurse needs to approach and evaluate each patient individually in light of these factors. A nurse who exhibits interest, concern, and willingness to listen to the patient’s fears will help the patient progress through the surgical experience.

28. Cont … The nurse assesses the intensity of the patient’s pain and assists the patient with analgesia as prescribed. The nurse counts the perineal pads used, assesses the extent of saturation with blood, and monitors vital signs. Abdominal dressing is monitored for drainage if an abdominal surgical technique was used. Nurse should instruct to contact the nurse or surgeon if bleeding is excessive. The patient is encouraged and assisted to change positions frequently. Nurse helps the patient to ambulate early in the postoperative period.

29. Cont … Intake and output chart is monitored. Explain the patient about follow up visits. Administer iron and BT as prescribed. Encourage verbalization of feelings Monitor active fluid loss from wound drainage, bleeding. Encourage patient to drink prescribed fluid amounts

30. Cont … Monitor serum electrolytes. Encourage clients to increase fluid intake Observations of changes in mental status, behavior or level of consciousness. Note the catheter patency was settled (when using catheter) Assess nutritional status, including weight, history of weight loss and serum albumin. Encourage intake of protein and calorie-rich foods. Help in developing effective coping strategies.

31. Summary…

32. THANK YOU!