Degenerated broad ligament fibroid mimicking ovarian cyst: A case report

The commonest diagnosis of a cystic mass in the pelvis is ovarian cyst, here we report a case of cystic degeneration of broad ligament fibroid mimicking as a ovarian cyst. A 45-year-old lady presented with abdominal discomfort. On evaluation, a pelvic mass of 20 weeks size of varying consistency was noted. Ultra sonogram and Magnetic Resonance Imaging gave a differential diagnosis of right sided broad ligament fibroid and ovarian cyst. Anticipating possible ovarian mass owing to its size, laparotomy was performed and noted a large false broad ligament fibroid which has undergone cystic degeneration. Total abdominal hysterectomy and bilateral salpingo-oopherectomy was performed, however a differential diagnosis of ovarian mass should always be made before surgery.

Efficacy Evaluation of Apparent Diffusion Coefficient in the Treatment of Uterine Fibroid by Magnetic Resonance Guided Focused Ultrasound Surgery / 中山大学学报(医学科学版)

ObjectiveTo assess the value of apparent diffusion coefficient （ADC） in the treatment of uterine fibroid using magnetic resonance guided focused ultrasound surgery （MRgFUS）. MethodsThe MRI and clinical data of 56 patients with uterine fibroid before， at 3 and 6 months after MRgFUS treatment， at Foshan Hospital of Traditional Chinese Medicine from December 2018 to October 2022， were retrospectively analyzed. The correlation between the ADC value and lesion volume， symptoms severity score （SSS） and uterine fibroid symptoms quality of life questionnaire （UFS-QOL） were analyzed. ANOVA was used to compare the differences in related parameters before and after treatment， and Pearson’s method was performed to analyze data correlation. ResultsThere were significant differences in ADC value ［（1.11±0.13）， （1.84±0.09）， （2.12±0.24），×10-3/（mm2/s）］， lesion volume （102±35.30， 56.70±18.88， 46.93±18.99，cm3）， SSS （36.73±11.74， 21.77±10.21， 17.66±9.30） and UFS-QOL score （59.05±17.48， 76.54±16.50， 82.46±12.37） between before treatment and each time point after treatment （F value was 557.837， 73.589， 53.976 and 37.606， respectively， all P<0.05）. The ADC values were negatively correlated with lesion volume and SSS， and positively correlated with UFS-QOL score， with correlation coefficients of -0.586， -0.630 and 0.592， respectively （all P<0.05）. ConclusionThe ADC value has clinical significance for the treatment of uterine fibroid using MRgFUS.

Frequency and pattern of intrauterine hysteroscopic lesions among women coming for IVF in the city of Yaoundé

Background: Hysteroscopy is an essential tool to make intrauterine assessment in infertile patients. Diagnosis and appropriate correction of intrauterine anomalies are considered essential in order to increase chances of conception. Ourobjective was to determine the frequency and pattern of intra uterine anomalies identified among women attending hysteroscopy at the Gynaecological Endoscopic Surgery and Human Reproduction Teaching Hospital Paul et Chantal Biya ­Yaoundé (GESHRTH). Methodsand results.Thiswas a cross sectional retrospective study of 96 women attending diagnostic or operative hysteroscopy at the GESHRTH between January 2020 and December 2021.The mean age was 38.7 ±7.6 years. Fifty-nine (61.5%) of the patients were nulliparous. Primary and secondary infertility were found respectively in fifty-two patients (54.2%) and forty-four patients (45.4%). Eleven patients (11.5%) were post-menopausal. Concerning previous surgery, 29 patients (30.2%) have had a myomectomy, 28 patients (29.1%) curettage,16 patients (16.6%) laparoscopy, eight (8.3%) hysteroscopy and one (1%) caesarean section. In all, 92 patients (95.8%) had abnormal intra uterine findings consisting of endometrial polyps (43.7%), sub-mucosal fibroids (42.7%), uterine cavity adhesions (20.8%), endometrial atrophy (4.1%), foetal bone (2%), uterine septum (1%) and non-absorbable suture thread (1%).Conclusion: Abnormal uterine findings were identified in 95.8% of patients attending hysteroscopy at GESHRTH. Most frequent findings were polypsin 43.7%, sub-mucosal fibroids in 42.7% and synechiae in 20.8%. The overall per operatory complication rate was 6.2%.

Introduction. Le recours à l'hystéroscopie constitue une étape indispensable au bilan cavitaire des patientes infertiles. Le diagnostic et la prise en charge adéquate des lésions intra cavitaires permettent d'améliorer les chances de conception.L'objectif de cette étude était de déterminer la fréquence et les caractéristiques des anomalies intra cavitaires chez les patientes opérées d'une hystéroscopie au Centre Hospitalier de Recherche et d'Application en Chirurgie Endoscopique et Reproduction Humaine Paul et Chantal Biya ­Yaoundé (CHRACERH).Méthodes et résultats. Nous avons mené une étude descriptive transversale de Janvier 2020 à Décembre 2021 et recruté 96 patientes. L'âge moyen était de38,7 ±7,6 ans. Soixante-neuf patientes (61,5%) étaient nullipares. Cinquante-deux (54,2%) et quarante-quatre (45,5%) présentaient une infertilité primaire et secondaire respectivement. Onze patientes (11,5%) étaient ménopausées. Concernant les antécédents chirurgicaux,nous avons identifié une myomectomie chez 29 patientes (30,2%), un curetage utérin chez 28 (29,1%), une cœlioscopie chez 16 (16,6%), une hystéroscopie chez huit (8,3%) et une césarienne chez une (1%). Au total, 92 (95,8%) des patientes avaient des anomalies cavitaires objectivées. Il s'agissait de polypes endométriaux (43,7%), fibromes sous-muqueux (42,7%), synéchies utérines (20,8%), atrophie de l'endomètre (4,1%), métaplasie osseuse (2%), cloison utérine (1%) et corps étranger à type de fil de suture nonrésorbable (1%).Conclusion.Les anomalies intra-cavitaires étaient retrouvées chez 95,8% des patientes réalisant une hystéroscopie au CHRACERH. Les anomalies les plus représentées étaient les polypes endométriaux (43,7%), les fibromes sous-muqueux (42,7%) et les synéchies utérines (20,8%). Le taux global de complications opératoires était de 6,2%.

Surgeon experience, robotic perioperative outcomes, and complications in gynecology

SUMMARY OBJECTIVE: Robotic surgery is currently on the rise and has been widely applied all over the world. Gynecology offers great opportunities for the development of innovative techniques due to the magnitude of surgical needs. The aim of this study was to correlate perioperative complications, surgical time, and length of hospital stay with surgical diagnosis, procedure performed, and surgeon experience in robot-assisted gynecological surgeries in a 10-year period. METHODS: This was a retrospective, transversal, cross-sectional study involving 632 patients who underwent robotic gynecological surgery from January 2008 to December 2017 in a community hospital in Sao Paulo, Brazil. Medical records of robot-assisted gynecological operations were searched for perioperative complications, operative time, and length of hospital stay, correlating these outcomes with surgical diagnosis, procedure performed, and surgeon experience, considering those with 20 or less robotic procedures and surgeons with more than 20 cases in their career as in-training or qualified surgeons, respectively. RESULTS: Endometriosis (381 cases) was the most common surgical indication, followed by uterine myoma (171 patients). Qualified surgeons had 64% less complications than in-training surgeons (p=0.03) and achieved 20% lower surgical time and 15% shorter length of hospital stay. CONCLUSION: In this study, qualified surgeons with more than 20 robotic procedures had better perioperative outcomes and less complications than in-training surgeons during their first 20 robotic surgeries.

Opciones terapéuticas para una joven nulípara con mioma uterino intramural gigante / Therapeutic options for a nulliparous young woman with a giant intramural uterine myoma

RESUMEN Introducción: Los leiomiomas uterinos son los tumores ginecológicos benignos más comunes; son causa de anemia, infertilidad, alteración en la implantación embrionaria, pérdida gestacional recurrente, parto prematuro e incontinencia urinaria. Su transformación maligna es excepcional. La afectación a la fertilidad, se asocia con miomas entre el 3 % y el 31 % y depende de su ubicación y tamaño, sobre todo en los que distorsionan la cavidad uterina. Objetivo: Describir las opciones terapéuticas para una joven nulípara con un mioma uterino intramural gigante. Caso Clínico: Paciente de 30 años de edad, con antecedentes de mioma uterino intramural, de 5 años de evolución, además anemia ferripriva. Aqueja menstruaciones abundantes y dolorosas, incontinencia urinaria y constipación. El tratamiento fue escalonado, mediante el uso de acetato de goserelina, embolización selectiva de las arterias uterinas y posterior miomectomía. Conclusiones: El tratamiento del mioma uterino en la mujer joven, nulípara, depende del tamaño, localización, sintomatología asociada, edad de la paciente y deseo de engendrar descendencia.

ABSTRACT Introduction: Uterine leiomyomas are the most common benign gynecological tumors; they are a cause of anemia, infertility, altered embryo implantation, recurrent gestational loss, premature delivery and urinary incontinence. Their malignant transformation is exceptional. Fertility impairment is associated with myomas in between 3 % and 31 % and depends on their location and size, especially in those that distort the uterine cavity. Objective: To describe the therapeutic options for a nulliparous girl with a giant intramural uterine fibroid. Clinical Case: A 30-year-old patient with a 5-year history of intramural uterine fibroid, in addition to iron deficiency anemia. She complains of heavy and painful periods, urinary incontinence and constipation. Treatment was staggered, using goserelin acetate, selective embolization of the uterine arteries, and subsequent myomectomy. Conclusions: The treatment of uterine fibroid in young, nulliparous women depends on the size, location, associated symptoms, age of the patient and desire to have offspring.

The clinical curative effect analysis of interventional therapy for fibroid / 中国辐射卫生

Objective To explore the clinical curative effect of interventional treatment of fibroids, evaluate its clinical application effect and provide a reference for future clinical treatment. Methods This study retrospectively analyzed the clinical data of 29 fibroid cases who admitted in our hospital from March 2016 to March 2019. All patients were performed X-ray guided uterine artery embolization (UAE). The study observed and recorded the volume of uterine and fibroid, menstruation, hormone levels, the post-operative complications etc. before and after the treatment. Results Patients were reexamined once every three months after the treatment, three times in a row. It was found that the patients’ postoperative uterine volume and fibroid volume were significantly smaller than preoperative volume (P < 0.05), and the difference was statistically significant. The postoperative menstrual cycle, menstruation, menstruation time were significantly improved (P < 0.05), and the difference was statistically significant. The postoperative LH, E2, FSH levels had no significant change (P > 0.05), and the difference was not statistically significant. There were two abdominal pain cases, one hematoma case and one vomite case during the postoperative observation period. These symptoms disappeared after the symptomatic treatment, and no serious symptoms such as high fever and pelvic infection occurred. Conclusion Interventional therapy of fibroids can effectively reduce the size of fibroids, significantly improve the quality of life of patients, with small damage, rapid recovery, preservation of the uterus and other advantages, which is worthy of further clinical application and promotion.

Use of GnRH analogues in the reduction of submucous fibroid for surgical hysteroscopy: A systematic review and meta-analysis / Uso de análogo de GnRH na redução de mioma submucoso na histeroscopia cirúrgica: Revisão sistemática e meta-análise

Abstract Objective Gonadotropin-releasing hormone analogues (GnRH-a) have been used preoperatively before hysteroscopic myomectomy to decrease the size and vascularization of the myomas, but evidence to support this practice is weak. Our objective was to analyze the use of GnRH-a in the reduction of submucous fibroid as a facilitator for surgical hysteroscopy from published clinical trials. Data sources Studies from electronic databases (Pubmed, Scielo, EMBASE, Scopus, PROSPERO), published between 1980 and December 2018. The keywords used were fibroid, GnRH analogue, submucous, histeroscopy, histeroscopic resection and their correspondents in Portuguese. Study selection The inclusion criteria were controlled trials that evaluated the GnRH-a treatment before hysteroscopic resection of submucous myomas. Four clinical trials were included in the meta-analysis. Data collection Two review authors extracted the data without modification of the original data, using the agreed form. We resolved discrepancies through discussion or, if required, we consulted a third person. Data synthesis The present meta-analysis included a total of 213 women and showed no statistically significant differences in the use of GnRH-a compared with the control group for complete resection of submucous myoma (relative risk [RR]: 0.94; 95%; confidence interval [CI]: 0.80-1.11); operative time (mean difference [MD]: - 3.81; 95%;CI : - 3.81-2.13); fluid absorption (MD: - 65.90; 95%;CI: - 9.75-2.13); or complications (RR 0.92; 95%;CI: 0.18-4.82). Conclusion The present review did not support the routine preoperative use of GnRH-a prior to hysteroscopic myomectomy. However, it is not possible to determine its inferiority when compared with the other methods due to the heterogeneity of existing studies and the small sample size.

Resumo Objetivo Análogos de hormônio liberador de gonadotrofina (GnRH-a) têm sido usados no pré-operatório de miomectomia histeroscópica para reduzir o tamanho e vascularização dos miomas, mas a evidência que suporta essa prática é fraca. Nosso objetivo foi analisar o uso de GnRH-a na redução do mioma submucoso como um facilitador de histeroscopia cirúrgica em ensaios clínicos publicados. Fonte de dados Estudos de bases de dados eletrônicas (Pubmed, Scielo, EMBASE, Scopus, PROSPERO), publicados entre 1980 e dezembro de 2018. As palavras-chave usadas foram fibroid, GnRH analogue, submucous, histeroscopy, histeroscopic resection e seus correspondentes em português. Seleção dos estudos Os critérios de inclusão foram ensaios clínicos controlados que avaliaram o tratamento com GnRH-a antes da ressecção histeroscópica de miomas submucosos. Quatro ensaios clínicos foram incluídos na meta-análise Coleta de dados Dois autores revisores extraíram os dados, sem modificarem os dados originais, usando a forma acordada. Nós resolvemos as discrepâncias através de discussão ou, se necessário, consultando um terceiro autor. Síntese dos dados A meta-análise incluiu um total de 213 mulheres e não demonstrou diferença estatisticamente significativa no uso de GnRH-a comparado com o grupo controle para ressecção completa de mioma submucoso (risco relativo [RR]: 0.94. índice de confiança [IC] 95%;: 0.80-1.11); tempo cirúrgico (diferença de média [MD]: - 3.81; IC95%;: -3.81-2.13); absorção de fluidos (MD: - 65.90; IC95%;: - 9.75-2.13); ou complicações (RR 0.92; IC95%;: 0.18-4.82). Conclusão A presente revisão sistemática não suporta o uso pré-operatório rotineiro de GnRH-a antes de miomectomia histeroscópica. No entanto, não é possível determinar sua inferioridade quando comparado aos outros métodos devido à heterogeneidade dos estudos existentes e ao pequeno tamanho da amostra.

The effect of small size uterine fibroids on pregnancy outcomes in high-risk pregnancies

Abstract Objective To evaluate the obstetric outcomes of singleton high-risk pregnancies with a small size uterine fibroid. Methods This retrospective cohort study was conducted among 172 high-risk pregnant women who were followed-up by a single surgeon between 2016 and 2019. Pregnant women with preconceptionally diagnosed small size (< 5 cm) single uterine fibroids (n = 25) were compared with pregnant women without uterine fibroids (n = 147) in terms of obstetric outcomes. Results There was no statistically significant difference between the groups in terms of adverse pregnancy outcomes. The size of the fibroids was increased in 60% of the cases, and the growth percentage of the fibroids was 25% during pregnancy. Intrapartum and short-term complication was not observed in women who underwent cesarean myomectomy. Conclusion Small size uterine fibroids seem to have no adverse effect on pregnancy outcomes even in high-risk pregnancies, and cesarean myomectomy may be safelyperformed in properly selected cases.

Comparative study between vaginal natural progesterone and oral dydrogesterone in prevention of red degeneration of uterine fibroid in pregnancy

Background: Uterine leiomyomas are highly prevalent benign monoclonal tumors, arising from the smooth muscle of the myometrium; they occur in up to 50-60% of reproductive age women, causing significant morbidity in up to 30% of women. The most serious complication of uterine fibroids; is red degeneration that causes severe pain, and may lead to preterm labour, miscarriage, fetal and maternal morbidity and mortality. Objective of this study was designed to compare between the effect of vaginal natural MP and oral dydrogesterone in prevention of red degeneration of uterine fibroid during pregnancy.Methods: Patients were recruited from El-Shatby Maternity University Hospital. They were 50 pregnant females, diagnosed having a uterine fibroid more than 3 cm in size then there were divided into two groups, Group A: twenty-five treated by vaginal natural progesterone, Group B: twenty-five treated by oral dydrogesterone. All patients at 14-15 weeks of gestational age underwent complete history taking, clinical examination and ultrasound examination for mean gestational age and assessment of the type and uterine fibroid.Results: Results showed that there were no statistically significant differences as regards age, obstetric history (gravidity and parity), number, Site, grade and size of the fibroid. There was a significant difference between the two studied groups, regarding the acute abdominal pain, it occurred to only 3 cases (12%) in Group A, versus to 16 cases (64%) in Group B. Regarding occurrence of red degeneration, it occurred only to 3 cases (12%) in Group A, while in Group B it occurred to 15 cases (60%).Conclusions: Vaginal natural micronized progesterone is more effective than oral dydrogesterone in prevention of red degeneration of uterine fibroid in pregnancy with fewer complications. Vaginal natural progesterone daily dose of 200 mg is recommended to all pregnant females with uterine fibroids.

Non-descent vaginal hysterectomy in previous cesarean section: a retrospective study

Background: Non-descent vaginal hysterectomy (NDVH) is removal of uterus through vagina in non-prolapsed uterus. As there is an increase in caesarean section, hysterectomy in women with previous caesarean section is also increasing. The objective of this study is to assess the feasibility and safety of non-descent vaginal hysterectomy in patients with previous caesarean section.Methods: This is a retrospective study conducted in the department of obstetrics and gynecology, Government Medical College, Thrissur from January 2017 to December 2018. Non-descent vaginal hysterectomy in 24women with previous caesarean section was studied. Details regarding age, parity, number of caesarean sections, indication of surgery, intraoperative and postoperative complications were evaluated.Results: All 24 women underwent non-descent vaginal hysterectomy successfully. 10 women (41.7%) were between 46-49 years. Commonest indication of hysterectomy was fibroid uterus (41.7%) and most common complaint was heavy menstrual bleeding (79%). There was bladder injury in one woman with history of previous 2 caesarean section. 3 women developed UTI in postoperative period.Conclusions: Vaginal hysterectomy is associated with lower complications and more rapid recovery. A successful NDVH in previous caesarean section depends on the expertise and experience of the surgeon. NDVH in previous caesarean is safe in expert hands.

A rare case of symplastic leiomyoma: case report

Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. Atypical and bizarre leiomyoma synonymous with symplastic leiomyoma are rare smooth muscle tumors that contain cells with moderate to severe cytological atypia, still cell necrosis is absent and mitotic index is fewer than 10/10 HPF. A 42-year P1L1A3 with no comorbidities came with complaints of lower abdominal pain for one year and heavy menstrual bleeding for eight months, LMP- 15/2/19, regular cycles, changes 4-5 pads/day, clots (+) (+), dysmenorrhoea (+). Parity score of P1L1A3, LCB-24 years, not sterilized. On examination - moderately built and nourished, pallor (+). Per abdomen examination - uterus - 22 weeks size, irregular mass, arising from pelvis - no tenderness, lower border not made out. Per speculum examination - cervix and vagina healthy. Per vagina examination - cervix firm, posterior, left fornix: mass felt, non-tender. The patient underwent Abdominal hysterectomy and B/L salpingo-oophorectomy under CSEA. Intraoperative findings - uterus - 20 weeks size, enlarged, a posterior wall subserosal fibroid with degeneration of 6×8 cm. Microscopic appearance - uterus - myometrium shows changes in adenomyosis. Sections of smaller mass reveal structure of leiomyoma. Nuclei are large, hyperchromatic, and show coarse chromatin clumps. Many giant-sized cells with multiple large nuclei were seen. It showed large chromatin clumps. Stroma showed myxoid change. Diagnosis - symplastic leiomyoma, adenomyosis. Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. The regularity of the tumor margins, low mitotic activity, and absence of nuclear atypia or necrosis should be made for the exclusion of malignancy.

Role of selective progesterone receptor modulators in the treatment of symptomatic uterine fibroids

Background: Uterine leiomyomas are benign tumours of smooth muscle cells and fibrous tissue that develop within the wall of the uterus. Objective of this study was to compare efficacy and safety of Mifepristone and Ulipristal acetate in the treatment of symptomatic uterine fibroids.Methods: The present randomized comparative prospective study was conducted among 120 non-pregnant and non-lactating females of age 25-50 years with symptomatic fibroids reported in the department of obstetrics and gynecology, Chhatrapati Shivaji Subharti Hospital, Meerut, Uttar Pradesh for a duration of 2 years from September 2017 to July 2019.The selected subjects were divided into two treatment arms i.e. Group 1: ulipristal acetate: 5 mg OD for 3 months and Group 2: mifepristone: 25 mg OD for 3 months. Detailed history of the patient, general physical examination and systemic examination was done followed by per abdomen examination, per speculum and per vaginal examination. A blood examination, USG (pelvis), Pap smear and endometrial biopsy was done. Subjects visited the hospital at visit 1, visit 2, visit 3, visit 4, visit 5 and visit 6 for 6 months.Results: In both the groups, maximum subjects were in the age group of 36-40 years, followed by 41-50 years. When mean PBAC score at first, second, third, fourth and fifth visit was compared statistically among ulipristal acetate and mifepristone group, it was found to be statistically significant. Uterine pain was reduced more in mifepristone group as compared to ulipristal acetate group at all the different intervals. Size was reduced more in mifepristone group as compared to ulipristal acetate group at all the different intervals.Conclusions: Authors conclude from this study that mifepristone should be preferred over ulipristal acetate for treatment of symptomatic fibroids.

A study on the correlation of clinical and ultrasonography diagnosis with histopathological outcome in cases of hysterectomy

Background: Hysterectomy is the most commonly performed gynaecological operation throughout the world due to different causes of pelvic pathology. Fewer studies have been performed describing the relationship between preoperative clinical, ultrasonological diagnosis and histopathological outcome.Methods: Authors report 100 cases with benign gynecological disorders who underwent hysterectomy. Authors excluded malignant cases from the study. A preoperative diagnosis was formed based on clinical and ultrasound examination and it was compared with the histopathological report of the hysterectomy specimen.Results: In this study the most common preoperative diagnosis for hysterectomy was fibroid uterus (39%) among which 94.87% showed positive correlation with HPE. Correlation for adenomyosis was 100% between preoperative diagnosis and HPE outcome. Correlation for DUB was poor. 57.14% of the preoperatively diagnosed DUB cases showed adenomyosis on HPE. One case of fibroid showed adenocarcinoma of endometrium on HPE.Conclusions: The study fulfills the aim of finding the efficacy of clinical and USG findings in diagnosing gynecological disorders accurately. Clinical examination is not always adequate. USG is the most important, simple and easily accessible investigation. There is one missed malignant case in this study which is a major shortcoming of clinical evaluation.

Prevalence of uterine lesions associated with leiomyomas and role of endometrial biopsy in management

Background: Present study highlights association between symptomatic patients of fibroids and its coexistence with pathologies like endometriosis, adenomyosis, polyp, endometrial hyperplasia and carcinoma. The aim was evaluating role of endometrial biopsy before surgery.Methods: The study was observational cohort, conducted on women operated for fibroid or recently diagnosed with fibroid. 150 women were included. Histopathology reports of already operated were analysed for association between uterine pathology and fibroid. In prospective cases ultrasonography findings was noted and patients having leiomyoma underwent biopsy and reports studied for association. Chi-square test done to find association between qualitative variable and p value <0.05 considered significant.Results: Out of 150, 24.6% had adenomyosis, 14% had endometrial hyperplasia in which 2% had atypia and 12% without atypia, 8.6% had cervical polyp, 5.33% had endometrial polyp, 4% had endometriosis while 42.7% had no association.Conclusions: This study revealed increasing trend of coexistence of leiomyomas with uterine pathologies. Early identification of endometrial pathologies on clinical history and imaging helps in selection of high-risk patients who need biopsy to rule out malignancy thus avoiding routine D and C which is done for every case.

Fertility outcomes following myomectomy in infertile patients at our centre: a retrospective analysis

Background: Fibroids have been known to cause infertility due to multiple factors. However, the role of myomectomy in patients with intramural and subserosal fibroids has been a topic of debate. This study evaluates outcomes following myomectomy in patients seeking treatment for infertility at study centre.Methods: This was hospital based retrospective study which evaluated 92 infertile patients who took treatment for infertility.Results: A total 41.3% patients conceived within one year of myomectomy. Pregnancy rates were better in patients with intramural combined with submucous fibroids, age between 30 and 35 years, size of largest fibroid between 3 and 6 cm and when number of fibroids were between 3 and 6 and conception was maximum after ovulation induction.Conclusions: Pregnancy rates after myomectomy are better in young patients with large fibroids. Active management for infertility needs to be done after myomectomy.

Incidence of fibroid and its effects on fertility in Eleme local government area of Rivers State

Background: Fibroid is a gynaecological problem that affects women of reproductive age across the globe especially among the black race. This study was done to evaluate the incidence of fibroid and its effects on fertility in Eleme Local Government Area.Methods: It is a cross-sectional study with 60 participants aged 18-28 years, 29-39 years, 40-49 years, 50-59 years and >60 years.Results: The study revealed that 90% of the respondents have fibroid and 10% do not have fibroid. The effects range from painful menstruation, heavy menses, irregular menstruation and infertility at the values of 63.3%, 48.3%, 51.7% and 86.8% respectively.Conclusions: Though the effects of fibroids are universal, our study population seems to show some effects more common to them.

A study to correlate association between vitamin D with fibroid and its supplementation in the progression of the disease

Background: Uterine fibroids, or leiomyomas are the most common benign tumors of the female reproductive tract, affecting up to 60% of Indian women with only 25% of women who are symptomatic. Symptoms do not always correlate with the size, number, or location of the fibroids. Recent studies suggest that hypovitaminosis D is associated with an increased risk of uterine fibroids.Methods: Total 110 women diagnosed with fibroid in USG were included in the study. Inclusion and exclusion criteria were applied and size of the fibroid noted. 60 women were included in the study group who took Vitamin D supplementation and 50 women in the control group who didn’t perform the study properly.Results: The growth pattern of fibroids with study group under supplementation with 25-OH-D3 seems to be stable, with no increases or decreases in size or number of identified lesions. Instead, women in control group, who did not perform appropriate vitamin D supplementation seem to have a slight but significant increase in size of the lesions.Conclusions: It was seen that hypovitaminosis D was associated with fibroid and thus supplementation with Vitamin D helped in the shrinkage of fibroid or slower the progression of the disease.

Chronic non puerperal uterine inversion due to submucosal fibroid: a rare case report

Chronic uterine inversion is a very rare and often difficult to distinguish between uterovaginal prolapse, submucous fibroid and cervical fibroid. Its diagnosis is based on high index of suspicion. A 50-year-old Para-3Live-3 tubectomised postmenopausal women with k/c/o psychiatric illness, resident R/0 Jambhrun, Mudhkhed came to our hospital with a complaint of irreducible mass protruding per vaginum since 2-3 months duration Subsequently vaginal hysterectomy has been done. The certainty of diagnosis of inverted uterus reached intraoperatively. Gross examination of cut uterus showed fundally located sub-mucous fibroid and specimen sent for histo-pathological report. Non puerperal chronic inversion of uterus is rare condition occurring in approximately 17% of all uterine inversions and most uterine inversions are acute and puerperal. Its incidence is 1/30,000 deliveries and is considered a serious complication of child birth. Most common factor causing inversion -> prolapse and extrusion of fibroids1 especially submucous myoma of fundus (80-85%). Its diagnosis should be considered at any age in post-menopausal period. Superinfection of the infected part should be suspected and treated with appropriate broad-spectrum antibiotics before the surgery.

Ultrasound Evaluation of Uterine Leiomyoma in Perimenopausal Females with Histopathological Correlation.

Abnormal uterine bleeding remains an important health issue in perimenopausal females, often a cause of high morbidity and mortality. Uterine leiomyoma is the major cause of abnormal or irregular bleeding. We wanted to evaluate the role of ultrasound in assessing uterine leiomyomas and determine its sensitivity, specificity and diagnostic accuracy in comparison to histopathological studies.METHODSThis is a cross sectional, observational and analytical study conducted in the Department of Radiodiagnosis at AVBRH, (Sawangi Meghe), a rural tertiary care hospital in central India. The study was carried out over a period of 6 months from January 2019 to June 2019. 50 patients in perimenopausal age group of 40-50 years were selected on the basis of predetermined inclusion and exclusion criteria. All included patients were counselled and asked for informed consent before entry into the study. Statistical analysis was done using descriptive and inferential statistics using sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.RESULTSMost of the uterine leiomyomas were intramural in location and hypoechoic in echotexture. Intramural fibroid was the most common fibroid detected constituting 88%. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and diagnostic accuracy of ultrasound in correlation to histopathology was found to be 93.75%, 91.67%, 97.83%, 78.57% and 93.33% respectively.CONCLUSIONSUltrasound has high sensitivity and specificity in diagnosing the uterine leiomyomas. It should be used as primary investigative modality for work up of abnormal uterine bleeding in perimenopausal age group

Management of single submucosal fibroid in unmarried females with uterine artery embolization

Background: Uterine fibroids (leiomyomas) are the most common benign neoplasm of the female pelvis. The location of fibroids, whether submucosal, subserosal, pedunculated subserosal, intramural, or endocavitary, is important because signs and symptoms may be determined by location. Uterine artery embolization (UAE) for many patients is an effective alternative treatment to surgical therapy for fibroid tumors. It is a minimally invasive procedure, which allows for rapid recovery and return to normal activities. Objective of this study was to know the efficacy of minimally invasive technique UAE for reducing symptoms in sub-mucous uterine leiomyoma in unmarried females.Methods: This retrospective analysis was performed on 9 unmarried females with symptomatic single submucosal fibroid diagnosed on MRI with size range of 3.5 cms to 6.5 cms. They presented at Dayanand Medical College and Hospital, Ludhiana, Punjab in a period of 3 years from January 2016-December 2019. Inclusion criteria were unmarried females, single submucosal fibroid diagnosed on USG/MRI. Exclusion criteria was active infection, more than one fibroid in uterus, prior GnRH analogues treatment during the previous 3 months.Results: All patients presented with heavy menstrual bleeding (HMB) and dysmenorrhea, lower abdomen pain was encountered in 3 patients and 2 patients had inter-menstrual bleeding. Recurrent, UTI was there in 1 patient and 1 patient had vaginal discharge. All fibroids belonged to stage 1 FIGO classification. UAE was done and patients were followed for 6 months. Symptomatic success was seen in 100% patients and 77.77% patients expelled the fibroid per vaginally.Conclusions: UAE is alternative method of treatment for submucosal fibroids in unmarried females who do not want to undergo surgery. Proper case selection can give us good results and symptomatic relief.