Facteurs limitant la prise en charge du leiomyome remanie au CHU Mel de Cotonou : à propos d'un cas et revue de litterature

Les léiomyomes sont des pathologies courantes. Cependant ils peuvent présenter parfois des aspects inhabituels ce qui engendre des difficultés de prise en charge. La reconstitution du parcours thérapeu-tique d'une patiente de 36 ans, infertile porteuse d'un utérus polymyomateux et son suivi postopératoire ont permis d'identifier de nombreux facteurs limitant la précocité de la prise en charge. Malgré une prise en charge chirurgicale effective le pronostic fonctionnel reste réservé

Embolisation des fibromyomes utérins (EFU): premières expériences en Côte d'Ivoire à propos de 81 patientes

Objectifs. Rapporter les résultats des premières procédures d'embolisation des fibromyomes (EFU) utérins en Côte d'Ivoire et en préciser les particularités africaines Matériels et méthodes. Etude prospective à visée descriptive réalisée sur unepériode de 25 mois, portant sur des patientes, non ménopausées, présentant un utérus fibromateux symptomatique et n'ayant pas de grossesse et d'infection pelvienne.Elles ont été retenues à l'issue d'une concertation collégiale entre les médecins radiologue interventionnel, gynécologue et anesthésiste.Résultats. L'âge moyen des patientes était de 40,5 ans et 28,3% d'entre elles étaient dans la période de pré-ménopause. Les motifs de consultation étaient dominés par les saignements anormaux avec 89,41% qui disparaissaient dans 92% des cas en post-EFU. Le volume utérin moyen et la taille des myomes dominants étaient respectivement de 849,5 cm3 et 67,7cm passant à 584 cm3 et 45,4cm soit un taux de réduction de 31,3% et 33% après l'embolisation. Le nombre moyen de fibromes était de 12 avec une dévascularisation quasi-totale après l'EFU. Les myomes étaient à 89% intra muraux et de volume très important. L'endométriose représentait la lésion associée majoritaire avec 31% des cas. Le cathétérisme était bilatéral dans 92,6% des cas. Les suites post-EFU étaient marquées par des complications mineures à type de troubles digestifs et aménorrhée définitive dans 4,93% des cas.Conclusion. L'embolisation des artères utérines pour les fibromyomes symptomatiques est une méthode efficace, dont le taux de réussite est de 92,59% dans notre étude, comparable au taux préconisé par la SIR

Outcome of pregnancy with clinically visible/palpable myoma among women who undergo caesarian section in three teaching hospitals, Addis Ababa, Ethiopia: a cross sectional study

Introduction: Myoma is the most common pelvic tumor and an enormous healthcare concern in women. Complications occur in approximately 10-40% of pregnancies with myomatous uterus. This study is conducted to determine the prevalence and obstetric outcome of grossly visible and/or palpable myoma among women who gave birth by caesarean section.Methods: A cross sectional study conducted in three teaching hospitals in Addis Ababa, Ethiopia. Data was collected using a pre-tested questioner.Results: A total of 404 cases were included in the study. The prevalence of myoma was 15.3% (62/404). Only 9.7% (6/62) of the myoma cases were diagnosed preoperatively with ultrasound. The number of myoma per case ranged from 1-to-14 with mean number of 3 ±2.7. The mean diameter of largest single myoma per case was 5.2cm ± 3.4. The commonest location of myoma was subserous being the location in 58.1% (36/62). There was significant association between presence of myoma and age of the woman (P<0.05). The adjusted prevalence of myoma increases as women's age increases, and gestational age and birth weight decreases. In addition, the prevalence of myoma was about two times higher in low (≤6) first and fifth minute APGAR score groups with adjusted prevalences of 22.2% (Vs 14.1% in ≥7 group) and 31.8% (Vs 14.4% in ≥7 group) respectively.Conclusions: The prevalence of myoma during pregnancy in this study is higher than prior reports from similar setups. But, no statistically significant association was observed between the presence of myoma and maternal out come

Fertility Following Myomectomy at Aba; Southeastern Nigeria

Background: While hysterectomy remains the gold standard treatment for fibroids; it is an unacceptable treatment option for women who wish to conserve their fertility. The actual effects of myomectomy on fertility remain uncertain though. Objective: The objective was to ascertain pregnancy and live birth rates among a small group of women undergoing abdominal myomectomy. Methods: The study population consisted of women of reproductive age intending to conceive soon after undergoing abdominal myomectomy. A total of 40 women who met the inclusion criteria were recruited for the study and followed-up for 4 years. Women who achieved pregnancy within the study period were analyzed in terms of their demographics and intra-operative findings. Results: The mean age of the women was 28 years (range 24-35) married for about 3 years. Majority of the women (50%) had more than 11 fibroid nodules; and the largest nodule was bigger than 5 cm in 35 women (87.5%). Cumulative pregnancy rate was 60% (24/40) while live birth rate was 22/40 (55%) following myomectomy and majority 19/22 achieved this within 2 years of myomectomy. Conclusion: Myomectomy for fibroid-associated infertility increase pregnancy rates such that approximately 60% of women undergoing the procedure subsequently conceive

Clinical Presentation of Uterine Fibroids in Nnewi; Nigeria: A 5-Year Review

Background: Uterine leiomyomas are the commonest benign tumors in women; with a higher preponderance amongst Africans. Several etiological factors have been suggested; with subtle variations in clinical presentation being reported in different studies. This may constitute a determinant for the management measures undertaken. Aim: To review the clinical presentation and management measures undertaken for uterine leiomyoma. Subjects and Methods: A retrospective study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH); Nnewi; from January 2002 to December 2006. A review of case records of patients with a diagnosis of uterine leiomyoma was done. The data were analyzed and presented in tables using comparative percentages. Results: Uterine leiomyoma constituted 117 of the 1094 gynecological admissions during this study period (10.7;117/1094). The mean (SD) age of presentation was 35.7 (6.1) years. Most of the patients were nulliparous (76.7;79/103) and 51.5 (53/103) were married. The commonest mode of presentation was lower abdominal mass (66.9;67/103) and the least was recurrent abortion (1;1/103). Surgery was employed in all cases; with myomectomy being the commonest modality used in 90.3 (93/103) of cases. The common postoperative complications were prolonged pain (49.5;51/103) and postoperative pyrexia (34.9;36/103). Conclusion: The symptom of lower abdominal mass correlates with late presentations in our setting. This makes the application of newer therapies like laparoscopic myomectomy difficult even when they are available. Other therapies which are independent of fibroid size (like uterine artery embolization) are not readily available in our environment. This further emphasizes the importance of myomectomy as the most important treatment modality in our environment

Clinical Presentation of Uterine Fibroids in Nnewi; Nigeria: A 5-year review

Uterine leiomyomas are the commonest benign tumors in women; with a higher preponderance amongst Africans. Several etiological factors have been suggested; with subtle variations in clinical presentation being reported in different studies. This may constitute a determinant for the management measures undertaken. Aim: To review the clinical presentation and management measures undertaken for uterine leiomyoma. Subjects and Methods: A retrospective study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH); Nnewi; from January 2002 to December 2006. A review of case records of patients with a diagnosis of uterine leiomyoma was done. The data were analyzed and presented in tables using comparative percentages. Results: Uterine leiomyoma constituted 117 of the 1094 gynecological admissions during this study period (10.7; 117/1094). The mean (SD) age of presentation was 35.7 (6.1) years. Most of the patients were nulliparous (76.7; 79/103) and 51.5 (53/103) were married. The commonest mode of presentation was lower abdominal mass (66.9; 67/103) and the least was recurrent abortion (1; 1/103). Surgery was employed in all cases; with myomectomy being the commonest modality used in 90.3 (93/103) of cases. The common postoperative complications were prolonged pain (49.5; 51/103) and postoperative pyrexia (34.9; 36/103). Conclusion: The symptom of lower abdominal mass correlates with late presentations in our setting. This makes the application of newer therapies like laparoscopic myomectomy difficult even when they are available. Other therapies which are independent of fibroid size (like uterine artery embolization) are not readily available in our environment. This further emphasizes the importance of myomectomy as the most important treatment modality in our environment

Laparoscopic Myomectomy for Infertile Patients with Intramural Fibroids: a Retrospective Study at a Tertiary Endoscopic Centre

Background: The safety of laparoscopic myomectomy has been questioned especially in the case of intramural fibroids. Objectives: To assess the safety of a laparoscopic myomectomy for intramural fibroids and study the subsequent effect on fertility Methods and Settings: A retrospective study of a tertiary endoscopic centre specialising in laparoscopic myomectomy. Results: 87 Patients were studied and there were no major complications. The conversion rate from laparoscopy to laparotomy was 3/87 (3.4) due to multiple fibroids. There was one case of uterine perforation during hysteroscopy. The overall pregnancy rate was 29/64 (45) with a spontaneous pregnancy rate of 18/29 (62). Conclusions: Laparoscopic myomectomy can be regarded as a safe alternative to abdominal myomectomy in the hands of the experienced surgeon resulting in good subsequent pregnancy rates

A Five-year review of uterine fibroids at the University of Uyo Teaching Hospital, Nigeria

Background: Uterine fibroids are benign tumours that arise from myometrial smooth muscle cells. They are the most common tumours found in humans and are particularly common in Negros. We determined the prevalence modes of presentation and treatment modalities of uterine fibroid at the University of Uyo Teaching Hospital; Uyo; Nigeria. Methods: The case notes of all patients with uterine fibroids over a 4-year period were studied. Results: Uterine fibroids accounted for 7.1of gynaecological admissions and 21.2of major gynaecological surgeries. The patients' age ranged from 21 to 55 years with modal age group being 31-40 years (38.8). Majority of the patients were of low parity (75.4). The most common presenting complaints were abdominal swelling (25.5) and infertility (21.4). Myomectomy was the most common surgical procedure performed (77.6) and the most common post operative omplications were anaemia (21.4) and pyrexia (18.4). Conclusion: Uterine fibroids are common in our environment. The patients are predominantly of low parity and myomectomy is the most common surgical procedure performed

Inevitable Caesarean Myomectomy

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place.We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion; and skillful surgery ensured minimal intra operative and post operative blood loss

Presentation and Management of Uterine Leiomyoma at Imo State University Teaching Hospital; Orlu; Nigeria

Background: Uterine myomas are benign growths primarily involving the smooth muscles of the uterus; the myometrium with varying quantities of connective tissue interspersing. It is the most common tumour of the female genital organs with more than three quarters of the tumours being asymptomatic Aim: To determine the mode of presentation; factors influencing the occurrence and the management options of uterine leiomyoma; the commonest tumour of the female pelvic organs at the Imo State University Teaching Hospital; Orlu. Methods: A descriptive study of all cases of uterine leiomyoma managed at the Department of Obstetrics and Gynaecology of the Imo State University Teaching Hospital; Orlu; from June 1; 2004 to June 30th 2007. Results: The prevalence of uterine leiomyoma at the Imo State University Teaching was 32.0. Majority of the patients (86.4) were in their 3rd and 4th decades of life. Seventy-two point one percent of the patients were nulliparous. The Commonest reasons given for late presentation were poverty (92) and aversion to surgery (86). Uterine leiomyoma affected women across all socioeconomic strata. Majority of the patients (73.5) presented with uterine mass of between 14-22 week gravid uterine size. The common modes of presentation were lower abdominal swelling (73.9); menstrual abnormalities (52.3) and infertility (26.1). The commonest site of the myomas was intramural. Treatment was essentially surgical mainly myoectomy (62.5). About 25.6of those who had myomectomy subsequently had live births. Conclusion: Uterine leiomyomas tend to grow to large sizes in our environment. Mass enlightenment campaigns; women empowerment; reduction of the cost of health care delivery in our country and routine ultrasound screening of all women of reproductive age will all help in early detection and treatment

Attitude therapeutique face a une myomatose uterine chez la femme jeune

A Kinshasa; la fibromyomatose uterine est une pathologie qui se rencontre frequemment chez la femme jeune en age de reproduction. Vu ce jeune age; le traitement de la fibromyomatose uterine souleve quelques problemes. Il sera fonction de nombreux facteurs. Le traitement du myome non complique sera fait principalement de progestatifs dans la deuxieme partie du cycle. La chirurgie plus particulierement la myomectomie sera l'operation de choix pour tout fibrome volumineux ou complique chez la jeune femme