Clinical features and complications of Fibroids

Clinical features of uterine fibroids include :

Symptoms

-About 50% fibroids are asymptomatic
Menorrhagia, polymenorrhea, metrorrhagia, continuous bleeding. postmenopausal bleeding
infertility

-Pregnancy complications: recurrent abortions, malpresentation, preterm labor, obstructed or prolonged labor, IUGR.
-pain: abdominal pain, backache, spasmodic dysmenorrhea
-abdominal lump, mass protruding at introitus
pressure symptoms: on bladder, ureters, rectum
-vaginal discharge

Signs

Anemia
Abdominal lump
-tumour is mobile from side to side unless fixed by it’s large size or by adhesions
Ascites (rare)

Bimanual examination:
-abdominal lump

-Feel is firm to hard

-Well defined margin,lower border cannot be reached suggesting pelvic origin
cervix moves with swelling

-swelling is felt separate from the uterus if it is pedunculated

-cervical fibroid: uterus is perched on top of the tumour

-broad ligament fibroid :displaces uterus to the opposite side

-myomatous polyp: cervical os is open and lower pole can be felt.

-submucous fibroid: uterus is uniformly enlarged

-intravascular and disseminated fibroids can be diagnosed on laparotomy.

Complications of fibroid

1.Atrophy, hyaline, cystic and fatty degenerations because of decreased vascularity after menopause.

2.Calcareous degeneration : phosphates and carbonates of lime are deposited in the periphery along the vessels

3.Red degeneration :
-mostly seen in 2nd trimester
-due to thrombosis of large veins in the capsule and small veins in the substance of the tumour
-peculiar purple red colour (caused by diffusion of blood pigments from the thrombosed vessels)
-fishy odour
-pain in abdomen (tense and tender myoma)
-aseptic condition but febrile, moderate leucocytosis, raised ESR
-D/D: appendicitis,
twisted ovarian cyst,
pyelitis,
accidental hemorrhage.
-only conservative treatment: antibiotics, analgesics, bed rest.

4.Sarcomatous change
-rare
-seen in postmenopausal women when the tumour grows in size suddenly
-pain and postmenopausal bleeding
-yellowish grey and hemorrhagic
-soft and friable
-hematogenous spread

5.Torsion common in subserous pedunculated fibroids

6.Inversion of uterus

7.Capsular hemorrhage by rupture of veins

8.Infection common in submucous and myomatous polyps if they project into cervical canal or vagina. -blood stained purulent discharge.

9.Associated endometrial carcinoma: because of hyperestrogenism

Mrunali Gondane

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