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Normal and abnormal puerperium
- 1. Normal and AbnormalPuerperium www.freelivedoctor.com
- 2. Synonyms leiomyoma ofuterus leiomyomas fibromyomas myofibromas fibroids fibromas myomas www.freelivedoctor.com
- 3. Incidence Most commonsolid pelvic tumors Develop in 20 ～ 25% of women during reproductive years 30 ～ 50 years old www.freelivedoctor.com
- 4. Correlative Factors Anestrogenic milieu may be necessary Progesterone function Growth factor and their receptor ： epithelial growth factor （ EGF ） Insulin-like growth factor （ IGF ） platelet-derived growth factor Puberty Menopause Estrogen Progesterone www.freelivedoctor.com
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- 6. Gross Appearance Rareonly a single ， usually many exist Well-circumscribed ， nonencapsulated A pseudocapsule is present. The consistency is usually firm or even hard except when degeneration or hemorrhage has occurred. color ： light gray or pinkish white cut section ： an intertwining pattern or a whorl-like arrangement ； bulgy Pseudocapsule www.freelivedoctor.com
- 7. Smooth muscle tumorsof the uterus are often multiple. Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus. www.freelivedoctor.com
- 8. Microscopic Appearance Composition： smooth muscle connective tissue The nonstriated muscle fibers are arranged in bundles of various sizes that run in multiple directions. www.freelivedoctor.com
- 9. Classification （ 1） According to growth location ： Myomas on the body of uterus （ 90% ） Myomas on the cervix of uterus （ 10% ） www.freelivedoctor.com
- 10. Classification （ 2） According to the relation to uterine muscle ： Submucous （ 10 ～ 15% ） Intramural （ 60 ～ 70% ） Subserosal （ 20% ） Few leiomyomas are actually of a single “pure” type. — hybrids www.freelivedoctor.com
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- 12. Symptoms menorrhagia andprolonged menstrual period ： common Pelvic pain ： occurs in pregnancy if undergoing degeneration or torsion of a pedunculated myoma Pelvic pressure ： urinary frequency bowel difficulty （ constipation ） Spontaneous abortion Infertility 2003-11-3 Menorrhagia Pedunculated spontaneous abortion Infertility www.freelivedoctor.com
- 13. Signs A palpableabdominal tumour Pelvic examination ： uterus — enlarged and irregular ； hard www.freelivedoctor.com
- 14. Degeneration Hyaline degenerationCystic degeneration Red degeneration Sarcomatous change The others ： fat degeneration calcification the secondary infection Result from the diminished vascularity of the connective-tissue element www.freelivedoctor.com
- 15. Red Degeneration Occasionallyseen as a complication of pregnancy （ during pregnancy or immediate postpartum period ） The pathogenesis is unknown ， may be the result of the accumulation of blood in the tumour because of venous obstruction. The cut surface resembles raw meat. Clinical features ： a cause of pain （ acute ） fever rapid growth ， tender www.freelivedoctor.com
- 16. Here is avery large leiomyoma of the uterus that has undergone degenerative change and is red (so-called "red degeneration"). Such an appearance might make you think that it could be malignant. Remember that malignant tumors do not generally arise from benign tumors. www.freelivedoctor.com
- 17. Sarcomatous Change Rare： 0.4% ～ 0.8% More common at 40 ～ 50 years old Usually occur in intramural fiboids grow quickly vaginal bleeding www.freelivedoctor.com
- 18. Diagnosis History Bimanualexamination Ultrasonography （ B–ultrasound examination ） Hysteroscopy Laparoscopy Hysterography Hysteroscopy Laparoscopy www.freelivedoctor.com
- 19. Differential Diagnosis PregnancyOvarian tumour Adenomyosis Malignant tumors of uterus sarcoma of uterus endometrial carcinoma cervical cancer www.freelivedoctor.com
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- 21. Observation and FollowUp Small ， asymptomatic fibroids need not be treated ， especially near menopause. Interval ： 3 ～ 6 months www.freelivedoctor.com
- 22. Medical Treatment Androgenicagents ： testosterone propionate GnRH-a ： induce a hypoestrogenic pseudomenopausal state not recommended for longer than 6 months “ add-back” regimens www.freelivedoctor.com
- 23. Surgery Treatment （1 ） Indications ： greater than 10 weeks’ gestational size menorrhagia ， lead to anemia have pressure symptoms grows rapidly failure of medical treatment www.freelivedoctor.com
- 24. Surgery Treatment （2 ） Method ： Myomectomy—conservative therapy preserve fertility significant risk of recurrence Hysterectomy— radical therapy Subtotal hysterectomy hysterectomy myomectomy Only true “cure” for leiomyomas www.freelivedoctor.com
- 25. Surgery Treatment （3 ） Approach ： trans-abdominal trans-vaginal laparoscopic or hysteroscopic www.freelivedoctor.com
- 26. It is importantto individualize the choice of therapy. www.freelivedoctor.com
- 27. Uterine Leiomyomas ComplicatingPregnancy impact on pregnancy ： abortion impact on delivery ： premature labour fetal malpresentation retained placenta placenta previa need for operative delivery （ birth canal obstruction ） postpartum hemorrhage Conservative treatment 2003-11-3 www.freelivedoctor.com
- 28. Critical Points Maybe related to superabundant estrogen. Well-circumscribed ， nonencapsulated. Have a pseudocapsule. Can be classified into submucosal 、 intramural and subserosal types. Different types have different features. Menorrhagia is common. Four degeneration types Individualized treatment ， include observation 、 medical treatment and surgical treatment. 2003-11-3 www.freelivedoctor.com