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.

Broad Ligament Fibroid: A Case Series.

Fibroids are most common benign tumors of the uterus, mostly situated in the body of the uterus. Rarely, they arise from extra-uterine sites with broad ligament fibroids being uncommon. Although by clinical examination and newer imaging modalities, we can easily know about size, number, and origin of these tumors and any anatomical distortion of surrounding vital organs, but some time it is very difficult to differentiate pre-operatively between large broad ligament leiomyomas and ovarian/adnexal pathology specially if cystic degeneration or necrosis is present in leiomyoma. We report four patients with broad ligament fibroids to emphasize the importance of their location, the diagnostic difficulties, and surgical complications they can pose.

Lower Uterine Segment Fibroid Complicating Pregnancy: A Case Report.

Th e uterine fi broids are very common in the reproductive age group. During pregnancy, it may undergo rapid growth and red degeneration. It may get infected during puerperium. Most of the fi broids are asymptomatic. Women with fi broids may have infertility, a tendency for miscarriage, pre-term labor, placental abruption, placenta previa, fetal growth restrictions, fetal anomalies, postpartum hemorrhage, uterine dystocia, malpresentations and increased risk of caesarean. Here, we present 26-year-old primigravida who was admitted with 9 months of amenorrhea and anterior lower uterine segment intramural fi broid of size 7.2 cm × 7.1 cm on the right side. She conceived immediately after marriage. All Investigations were normal. She was delivered by a cesarean section. An alive female baby of 2.5 kg with good Apgar score. Th e indication was lower uterine segment fi broid. Th e liquor was meconium stained. Th ere was no sign of intrauterine growth restriction of the baby. Th e Doppler study, cardio-topography was normal before section. Th e post-operative period was uneventful. Th e patient was discharged and came for follow-up after a month and was found to be alright.

Vaginal Removal of Non Prolapsed Uterus with Benign Pathology.

Vaginal hysterectomy was the first minimally invasive surgical approach for benign gynecologic conditions, a number of other approaches for hysterectomy have been introduced, yet when compared with vaginal hysterectomy these approaches do not offer significant benefits for similar indications. Objectives : (1) To know the benign gynecological conditions that can be treated by vaginal hysterectomy. (2) To find out the operative difficulties of vaginal hysterectomy done in non-prolapsed uterus. (3) To know the morbidity and mortality of vaginal hysterectomy. Methodology : This is a prospective study conducted at our Hospital from 1st December 2010 to 30th Nov. 2011. Hundred consecutive cases of non-descent vaginal hysterectomy for benign pathology of uterus were studied. Results : In our study maximum hysterectomies were done in the age group 41-50 (49%) followed by 31- 40 (40%) least were in age more than 50 years. Mean parity of the cases undergoing hysterectomy were 2.47. In 77% patients, complaints were menorrhagia. The maximum hysterectomies, 41% for fibroid uterus were done, followed by 39% for DUB. One patient had intraoperative bladder injury. Mean operating time for the hysterectomies was 53.21 minutes. No mortality was seen, 12% post-operative complications were present. The mean post-operative stay in the hospital was 5.95 days. Conclusion : Vaginal hysterectomy is both feasible and optimal for many patients who long have been considered inappropriate candidates for vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic approach for benign conditions of the uterus.

Does life-course socioeconomic position influence racial inequalities in the occurrence of uterine leiomyoma? Evidence from the Pro-Saude Study / A posicao socioeconomica influencia as desigualdades raciais na ocorrencia de miomas uterinos? Evidencias do Estudo Pro-Saude / El nivel socioeconomico influye en las desigualdades raciales en cuanto a la incidencia de miomas uterinos? Evidencia del Estudio Pro-Saude

We aimed to investigate whether life-course socioeconomic position mediates the association between skin color/race and occurrence of uterine leiomyomas. We analyzed 1,475 female civil servants with baseline data (1999-2001) of the Pró-Saúde Study in Rio de Janeiro State, Brazil. Life-course socioeconomic position was determined by parental education (early life socioeconomic position), participant education (socioeconomic position in early adulthood) and their combination (cumulative socioeconomic position). Gynecological/breast exams and health insurance status were considered markers of access to health care. Hazard ratios (HR) and 95% confidence intervals (95%CI) were estimated using Cox proportional hazards models. Compared with white women, black and parda (“brown”) women had higher risk of reporting uterine leiomyomas, respectively HR: 1.6, 95%CI: 1.2-2.1; HR: 1.4, 95%CI: 0.8-2.5. Estimates were virtually identical in models including different variables related to life-course socioeconomic position. This study corroborated previous evidence of higher uterine leiomyomas risk in women with darker skin color, and further suggest that life-course socioeconomic position adversity does not influence this association.

Nós investigamos se posição socioeconômica ao longo da vida medeia a associação entre cor/raça e ocorrência de mioma uterino. Analisamos 1.475 funcionárias públicas com dados na linha de base (1999-2001) do Estudo Pró-Saúde no Rio de Janeiro, Brasil. A posição socioeconômica ao longo da vida foi determinada pela escolaridade dos pais (posição socioeconômica precoce), escolaridade da participante (posição socioecônomica no inicio da vida adulta) e suas combinações (posição socioeconômica acumulada). Exames ginecológicos/mama e plano de saúde foram considerados marcadores de acesso à saúde. Razão de hazards (RH) e intervalos de 95% de confiança (IC95%) foram estimados por modelos de riscos proporcionais de Cox. Comparadas às mulheres brancas, as de cor preta e parda tiveram maior risco de relatarem mioma uterino (RH: 1,6, IC95%: 1,2-2,1; RH: 1,4, IC95%: 0,8-2,5, respectivamente). As estimativas foram praticamente idênticas nos modelos que incluíram as diferentes variáveis de posição socioeconômica ao longo da vida. Este estudo corrobora evidências prévias de maior risco de mioma uterino entre mulheres de cor da pele mais escura e também sugere que a posição socioeconômica ao longo da vida não influencia esta associação.

Hemos investigado si es estatus socioeconómico durante toda la vida influye en la asociación entre raza y presencia de mioma uterino. Se analizaron a 1.475 funcionarias, con datos provenientes de la cohorte Pró-Saúde (1999-2001) en Río de Janeiro, Brasil. La posición socioeconómica durante toda la vida se determinó por la educación de los padres (posición socioeconómica temprana), educación de la participante (posición socioeconómica principio de la edad adulta) y combinaciones de los mismos (posición socioeconómica acumulada). Exámenes ginecológicos/mama y el plan de salud se consideran marcadores de acceso a la salud. La razón de riesgo (hazards ratio, HR) y el intervalo de un 95% de confianza (IC95%) se calcularon utilizando modelos de riesgos proporcionales. La comparación entre mujeres blancas, negras y mulatas/mestizas concluyó que tenían un riesgo más elevado de mioma uterino, en los siguientes porcentajes respectivamente HR: 1,6 IC95%: 1,2-2,1; HR: 1,4 IC95%: 0,8-2,5. Las estimaciones fueron prácticamente idénticas en los modelos que incluyen diferentes variables de posición socioeconómica para toda la vida. Este estudio apoya la evidencia de mayor riesgo de mioma uterino entre mujeres de color de piel más oscuro y también sugiere que la posición socioeconómica para toda la vida no influye en esta asociación.

Prevalência de diagnóstico médico auto-relatado de miomas uterinos em população brasileira: Padrões demográficos e socioeconômicos no Estudo Pró-Saúde / Prevalence of self-reported medical diagnosis of uterine leiomyomas in a Brazilian population: Demographic and socioeconomic patterns in the Pro-Saúde Study

Introdução: Os miomas uterinos (MU) são considerados os tumores mais comuns do sistema reprodutor feminino; no entanto, existem poucos estudos epidemiológicos sobre essa condição no Brasil. Objetivo: Estimar as prevalências de história auto-relatada de MU segundo características demográficas, socioeconômicas e de acesso a serviços de saúde. Métodos: Foram analisados dados de 1.733 trabalhadoras de universidade no Rio de Janeiro, participantes da linha de base do Estudo Pró-Saúde (1999-2001), em relação a três desfechos: (1) diagnóstico médico de MU, (2) MU com sintomas prévios ao diagnóstico e (3) casos que realizaram histerectomia pelo tumor. As prevalências e seus intervalos de 95% de confiança (IC 95%) foram estimadas em relação a estratos de variáveis demográficas (idade, cor/raça), socioeconômicas (escolaridade, renda) e marcadoras de acesso a serviços de saúde (teste Papanicolaou , exame de mama, plano de saúde). Resultados: A prevalência de diagnóstico médico de MU foi de 23,3% (IC 95% - 21,3; 25,2); a de MU com sintomas prévios ao diagnóstico, de 13,3% (IC 95% - 11,7; 15,0) e a de histerectomia pelo tumor, de 8,4% (IC 95% - 7,5; 10,3). Entre participantes abaixo de 45 anos de idade, foram observadas prevalências mais elevadas nos estratos de piores condições socioeconômicas e de cor/raça preta. Entre aquelas com 45 anos ou mais, foram encontradas maiores prevalências entre mulheres com melhor acesso a serviços de saúde. Conclusão: Entre as mulheres brasileiras investigadas, os MU constituem problema relevante de saúde, com prevalências ...

Introduction: Uterine leiomyomas (UL) are considered the most common tumors of the female reproductive system. However, there are few epidemiological studies about this condition in Brazil. Aim: To estimate the prevalence of self-reported history of UL according to demographic and socioeconomic characteristics, and to markers of access to health care. Methods: We analyzed data from 1,733 university employees who participated at the baseline waves of the Pro-Saude Study (1999-2001), in relation to three outcomes: (1) self-reported medical diagnosis of UL, (2) UL with symptoms prior to diagnosis, and (3) cases with hysterectomy due to UL. Prevalence and 95% confidence intervals (95% CI) were estimated in relation to strata of variables related to demographic (age, color/race) and socioeconomic characteristics (education, income) and of markers of access to health care (Pap smear, breast clinical exam and private health insurance status). Results: The prevalence of medically-diagnosed UL was 23.3% (95% CI - 21.3, 25.2), the UL with symptoms prior to diagnosis of 13.3% (95% CI - 11.7, 15.0) and hysterectomy due to UL, 8.4% (95% CI - 7.5, 10.3). Among participants younger than 45 years old, higher prevalence was observed among women with worse socioeconomic conditions and of black color/race. Among those with 45 years or more, there was higher prevalence among women with better access to health care. Conclusion: In this study population of Brazilian women, UL is a relevant health problem, and its prevalence and associated socio-demographic gradients are similar to those observed in other countries. .

Leiomiomatose uterina: revisão / Uterine leiomyomatosis: review

Os leiomiomas uterinos são tumores monoclonais que se originam de uma mutação somática em um miócito progenitor. Representam a neoplasia benigna mais comum do útero. A causa precisa relacionada ao seu desenvolvimento ainda não foi totalmente esclarecida. As apresentações clínicas mais frequentes são o sangramento anormal, a dor e pressão pélvicas, massa pélvica não diagnosticada anteriormente e infertilidade. O diagnóstico baseia-se na história clínica, no exame físico, que pode ser completamente normal em alguns casos, e nos achados de exames complementares, como a ultrassonografia endovaginal, a histerossonografia e a ressonância magnética. O tratamento varia de acordo com a apresentação clínica e pode ser expectante, clínico ou cirúrgico.

The uterine leiomyomas are monoclonal tumors that originate from a somatic mutation in a myocyte progenitor and are the most common benign tumor of the uterus. The precise cause related to its development has not been fully clarified. The most common clinical presentations are abnormal vaginal bleeding, pelvic pain and pressure, previously undiagnosed pelvic mass, and infertility. The diagnosis is based on clinical history, physical examination, which may be completely normal in some cases, and the findings of laboratory tests such as transvaginal ultrasound, the sonohysterography, MRI. Treatment varies according to clinical presentation and may be expectant, medical or surgical.

Síndrome de Rokitansky y Fibroma Pélvico / Rokitansky syndrome and pelvic fibroma

Se presenta una paciente de 39 años de edad con síndrome de Rokitansky diagnosticada desde el año 1984, la cual es valorada en el INOR por la presencia de una lesión tumoral pélvica que resultó ser un fibroleioma de la pared

This is the case of a female patient presenting with Rokitansky syndrome diagnosed from 1984, evaluated in the National Institute of Oncology and Radiobiology (NIOR) by presence of pelvic tumor lesion became a wall fibroleiomyoma.

Polymorphic [CAG]n repeats in the androgen' receptor gene: a risk marker for endometriosis and uterine leiomyomas

Endometriosis and uterine leiomyomas are leading hormone responsive, benign uterine disordders responsible for high morbidity in women of reproductive age group. A polymorphic [CAG]n repeat length located in exon 1 of the androgen receptor [AR] gene has been proposed as a risk marker for both endometriosis and leiomyomas in some ethnic groups. The present study was carried out to assess the frequency of AR [CAG]n repeat polymorphism as a risk marker for endometriosis and uterine leiomyomas in Asian Indian women. DNA was isolated from peripheral blood samples of 331 subjects, which include 90 endometriosis cases, 140 cases of leiomyomas and 101 healthy age- and sex-matched controls. PCR was carried out to amplify exon 1 of the AR gene. All the PCR amplicons were analysed initially on 2% agarose gel electrophoresis, folllowed by bidirectional sequencing to calculate the number CAG repeats in individuals. The CAG repeat ranges detected in endometriosis cases were 4-33 [Mode-19] and in leiomyomas cases 5-34 [Mode-20], whereas in controls it was 5-34 [Mode-22]. A distinct variation was observed in the three groups at 14, 18, 19, 20 and 22 [CAG]n repeats, which were statistically analyzed using chi-square and odds ratio tests. 19 CAG repeats were found to be higher in endometriosis cases [19.09%] when compared with conttrols [9.04%], while 20 CAG repeats were higher in leiomyomas cases [14.02%] compared to controls [6.14%]. A statistically significant [P < 0.05] association was observed in 19 and 20 CAG repeats in endometriosis and leiomyomas, respectively. This is the first report from an Asian Indian population proposing that 19 and 20 CAG repeats of the AR gene are associated with endometriosis and leiomyoma and can be regarded as high-risk markers

Clinicopathologic study of pelvic lesions managed by surgeons in a medical college in Kolkata in the last 2 years.

The pelvic cavity is a basin-like space in the lowermost part of the abdomen where various neoplastic and non neoplastic lesions can occur involving its contents. When the nature of lesions are not clearly gynecological, patients are managed by surgeons. Our study aims to asses the clinicopathologic analysis of neoplastic lesions of the pelvic cavity managed by surgeons particularly over a period of 2 years. Out of 162 total lesions, 102 cases were non neoplastic, such as appendicular lump, Tubo-ovarian (TO) mass, hematoma and 60 cases were neoplastic. Among the 60 cases of neoplastic lesions, 40 cases were benign comprised of twisted ovarian cyst, broad-ligament fibroid, and neurofibroma and 20 cases were malignant comprised of colorectal carcinoma, ovarian carcinoma, liposarcoma, Primitive nurectodermal tumor (PNET), seminoma, and lymphnode metastasis. The lesions in such closed, difficult to approach areas throws clinicians into a diagnostic dilemma during both the preoperative and intraoperative period. Even pathologists cannot ascertain some diagnosis without the help of immunohistochemistry. So, to adopt early and concise management protocol, there should be more such studies in different institutions that are currently lacking in world literature.

Ureteral endometriosis and coexistent urethral leiomyoma in a postmenopausal woman

We report the case of a postmenopausal woman with a synchronous obstructing intrinsic endometrioma of the left ureter and a coexistent periurethral leiomyoma. Endometriosis in postmenopausal women is a rare clinical entity usually associated with exogenous estrogen use. Urethral leiomyomas are also rare, with only 40 cases reported in the literature. Ovarian hormones are believed to influence the growth of leiomyomas. We report the genitourinary presentation of 2 separate disease entities with known hormonal influence in a postmenopausal woman receiving estrogen replacement therapy. We believe the patient's hormonal milieu affected the development of her concurrent pathology.

Endometrial abnormalities in postmenopausal breast cancer patients.

OBJECTIVE: To determine the prevalence of endometrial thickening and pelvic pathologies in postmenopausal breast cancer patients. MATERIAL AND METHOD: A total of 66 postmenopausal breast cancer patients receiving treatment at Srinagarind Hospital from 1 July 1999 to 31 August 2000 were included in the study. Patients who had been treated with hormones such as tamoxifen or progestins were not eligible for this study. Thorough history taking and physical examination as well as transvaginal ultrasonography were conducted in all study patients. Fractional curettage was carried out and the specimens obtained were sent for pathological examination in all patients whose endometrial thickness was found to be greater than 5 mm on the ultrasound scan. RESULTS: Among the 66 patients included in this study, the mean age was 54.97 years. The majority of patients (75.76%) had stage II disease. The mean +/- SD of endometrial thickness found in this study was 3.55 +/- 1.72 mm. The prevalence of thickened endometrium (defined as ET > 5 mm from TVS) was 10.60% (7 from 66 cases). Other pelvic pathologies detected by ultrasonography were myoma uteri (4.55%) and ovarian mass (1.52%). Among the seven patients whose endometrial thickness was found to be greater than 5 mm, results of curettage specimens revealed inadequate tissue obtained (42.85%), atrophic endometrium (28.57%), active endometrial gland (14.29%), and scanty stromal cell (14.29%). CONCLUSION: The prevalence of thickened endometrium in postmenopausal breast cancer patients found in this study was interestingly high. The pathological results of such cases, however, turned out to be negative for neoplastic changes in all cases. Further study, thus, is needed before precise recommendation could be made regarding the value of TVS screening in breast cancer patients not taking tamoxifen.

Frequency, presentation and management of fibroid uterus

The study was carried-out in Unit - I, Department of Obstetrics and Gynaecology Lady Willingdon Hospital, Lahore from January 2001 to December 2002. A total of 164 women with fibroid uterus were managed during this period. The objective of this study is to find out frequency and presentation of fibroids and to evaluate surgical treatment of women with fibroid uterus. Out of 164 cases, 47 had diagnostic D and C and were managed medically. Out of the rest 117 patients, 23 patients underwent myomectomy after diagnostic D and C. Ninety-three patients had abdominal hysterectomy while only one had vaginal hysterectomy. During operation, haemorrhage was the only complication which occurred in nine cases of myomectomy and intra-operative blood transfusion was done. Patients were followed- up for a period of six weeks to six months. There was no delayed complication or mortality in our study

Dados epidemiologicos do leiomioma uterino / Epidemiologycal data on uterine leiomyoma

Foram estudados retrospectivamente 559 prontuarios medicos de mulheres atendidas na Clinica Ginecologica do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. Avaliaram-se parametros clinicos, ultrassonograficos, terapeuticos e anatomo-patologicos. Conclui-se que a faixa etaria mais acometida e de...

Cáncer de esófago y estómago: una evaluación de tres años / Cancer of the esophagus and stomach: a three years evolution

El cáncer de esófago es una patología de muy mal pronóstico. Son considerados factores de riesgo: alcohol, tabaco, deficiencia en vitaminas A y C. etc. La mortalidad por cáncer de estómago varía notablemente de acuerdo a la región geográfica. Los factores genéticos, étnicos, el tabaquismo y socioeconómicos son algunas de las causas involucradas en el desarrollo del cáncer de estómago. Se estudiaron 646 pacientes sintomáticos que concurrían a la sección de gastroenterología del Hospital J.M. Cullen. Se diagnosticó Histopatológicamente, 22 (3,3 por ciento) cánceres de esófago y 13 (2 por ciento) cánceres de estómago. Todos los cánceres de esófago eran epidermoideo. 82 por ciento eran varones y un 18 por ciento mujeres. Un 50 por ciento tenían ubicación en el tercio medio. El 92,3 por ciento de los cánceres de estómago eran adenocarcinomas. 83 por ciento eran masculinos y 17 por ciento femininos. El 50,8 por ciento estaban localizados en la región corporo-fúndica. Todos los cánceres tanto el de esófago como el de estómago estaban en estadio avanzado. El cáncer de esófago se presentó con mayor frecuencia dentro de los cánceres del tracto digestivo en nuestro hospital, diferencia significativa con los registros provinciales y nacionales.

Mioma uterino y embarazo / Uterine myomas and pregnancy

Se analizan los principales aspectos del embarazo asociado a mioma uterino: incidencia, diagnóstico, evolución, complicaciones más frecuentes y sus alternativas terapéuticas, en base a una revisión bibliográfica del tema. Se comunican, además, dos casos clínicos atendidos en el Servicio de Ginecología y Obstetricia del Hospital San Juan de Dios en 1997 y se señala la frecuencia de esta patología en los último dos años

Leiomioma uterino: patología y epidemiología / Uterine leiomyoma: pathology and epidemiology

Se revisan 200 informes de biopsias con diagnóstico histopatológico de mioma uterino. El 67,3 por ciento de los casos estaba en el rango entre 41-50 años de edad. Las pacientes premenopáusicas presentaron un promedio de número de miomas casi 3 veces mayor que las postmenopáusicas. El mioma más frecuente resultó ser el intramural, con tamaño menor de 2 cm. La cervicitis crónica inespecífica del cuello uterino, fue el hallazgo más frecuente de patología cervical, con un 58,5 por ciento de los casos. Se encontró neoplasia intraepitelial en el 1,5 por ciento En 2 casos 1 por ciento , se encontró adenocarcinoma del endometrio. En el 66,5 por ciento no se evidenciaron alteraciones endometriales. En el 60,5 por ciento se extirparon uno o ambos anexos, en ningún caso se encontraron alteraciones neoplásicas malignas. En 51 casos 25,2 por ciento el mioma presentó algún tipo de degeneración, siendo la más frecuente la celular, 16 de 200, 8 por ciento considerada como presarcomatosa. Se discute la conducta clínica preoperatoria frente al análisis de estas cifras y los alcances hacia el tratamiento conservador con el uso de nuevas técnicas no ablativas