Download Uterine fibroid

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It is benign uterine tumour consist of smooth
muscles ,it can present anywhere in the
uterine wall.it could be intrmural,subserosal,
Submucosal,cervical or pedunculated fibroid.
Incidence about 20_30% of reproductive age
women.
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Asymptomatic.
Menorrhagia.
Dysmenorrhea and backache.
Urinary frequency.
Infertility.
Iiregular uterine mass.
Pregnancy
complication:abortion,AP.,malpresentation,ob
structed labour and PPH.
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History and clinical examination.
Ultrasound.
MRI.
HSG ,Hycosy for pedunculated fibroid.
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1_Just follow up if asymptomatic.
2_Medical treatment:
*NSAID.
*progesterone.
*combined contraceptive pills.
*danazole.
*GNRH analouge.
3_surgical treatment:
*myomectomy:involve incleation of fibroid
through the uterine wall.
Advantage:conservation of fertility and
avoidance of hysterectomy.
disadvantage:risk of bleeding ,reccurance of
fibroid,adhesion formation.
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To decrease the risk of bleeding during
myomectomy the patient can be given GnRH
three months before myomectomy this also
can improve the Hb level before operation
and decrease the size of fibroid, but this has
many disadvantages:
*leads to loss the line of cleavage between
the fibroid and the uterine wall which make
the operation more difficult.
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*osteoporosis :so any woman use it should
take calcium supplementation.
*menopausal side effects like hot flushes and
sweating due to the hypoesrogenic state
created by this drug.
*expensive.
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*hysterectomy:
Advantage:no risk of recurrence and solving
the problem completly.
Disadvantage:loss of fertility ,it is major
operation associated with many complication
Such as bleeding,blood transfusion,internal
organ injury ,thromboembolism ,wound
infection and anaesthetic complication.
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Involve injection of radio opaque substance
through the femoral artery under ultrasound
guidance that cause obstruction of blood
supply to the artery and shrinkage of the
uterine fibroid.
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Allergic reaction.
Failure of procedure.
Wrong embolization involving the ovary or
intestines.
Premature ovarian failure.
Vaginal discharge.
Re enlargement of fibroid.
Death.