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22 Cards in this Set
- Front
- Back
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Leiomyomata are classified into subgroups based on their anatomic relationship to the layers of the uterus. The three most common types are
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intramural (centered in the muscular wall of the uterus), subserosal (just beneath the uterine serosa), and submucosal (just beneath the endometrium). A subset of the subserosal category is the pedunculated leiomyoma, which appears on stump-like structures
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Leiomyomata are classified into subgroups based on their anatomic relationship to the layers of the uterus. The three most common types are
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intramural (centered in the muscular wall of the uterus), subserosal (just beneath the uterine serosa), and submucosal (just beneath the endometrium). A subset of the subserosal category is the pedunculated leiomyoma, which appears on stump-like structures
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Leiomyomata are considered hormonally responsive, benign tumors, because
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estrogen may induce their rapid growth in high-estrogen states, such as pregnancy.
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menorrhagia, defined as
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defined as menstrual blood loss of >80 mL).
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menorrhagia, defined as
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defined as menstrual blood loss of >80 mL).
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Characteristically, the best example of leiomyoma contributing to this bleeding pattern is
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submucous leiomyoma
- Alteration of normal myometrial contractile function in the small artery and arteriolar blood supply underlying the endometrium 2. Inability of the overlying endometrium to respond to the normal estrogen/progesterone menstrual phases, which contributes to efficient sloughing of the endometrium P.390 3. Pressure necrosis of the overlying endometrial bed, which exposes vascular surfaces that bleed in excess of that normally found with endometrial sloughing |
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Characteristically, the best example of leiomyoma contributing to this bleeding pattern is
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submucous leiomyoma
- Alteration of normal myometrial contractile function in the small artery and arteriolar blood supply underlying the endometrium 2. Inability of the overlying endometrium to respond to the normal estrogen/progesterone menstrual phases, which contributes to efficient sloughing of the endometrium P.390 3. Pressure necrosis of the overlying endometrial bed, which exposes vascular surfaces that bleed in excess of that normally found with endometrial sloughing |
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On abdominopelvic examination, uterine leiomyomata usually present as
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large, midline, irregular-contoured mobile pelvic mass with a characteristic “hard feel” or solid quality
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An attempt may be made to minimize uterine bleeding (from fibroids) by using
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intermittent progestin supplementation and/or prostaglandin synthetase inhibitors, which decrease the amount of secondary dysmenorrhea and amount of menstrual flow
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An attempt may be made to minimize uterine bleeding (from fibroids) by using
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intermittent progestin supplementation and/or prostaglandin synthetase inhibitors, which decrease the amount of secondary dysmenorrhea and amount of menstrual flow
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warranted in patients who desire to retain childbearing potential or whose fertility is compromised by the myomas, creating significant intracavitary distortion
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Of the surgical options available, myomectomy
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Indications for a myomectomy include
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a rapidly enlarging pelvic mass, persistent bleeding, pain or pressure, or enlargement of an asymptomatic myoma to more than 8 cm in a woman who has not completed childbearing
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Indications for a myomectomy include
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a rapidly enlarging pelvic mass, persistent bleeding, pain or pressure, or enlargement of an asymptomatic myoma to more than 8 cm in a woman who has not completed childbearing
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Contraindications to myomectomy include
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pregnancy, advanced adnexal disease, malignancy, and the situation where enucleation of the myomas would completely compromise the function of the uterus
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In addition to surgery, pharmacologic inhibition of estrogen secretion has been used to treat fibroids. This is particularly applicable in the
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perimenopausal years when women are more likely anovulatory, with relatively more endogenous estrogen. Pharmacologic removal of the ovarian estrogen source can be achieved by suppression of the hypothalamic-pituitary-ovarian axis through the use of gonadotropin-releasing hormone agonists (GnRH analogs), which can reduce fibroid size by as much as 40% to 60%. This treatment is commonly used before a planned hysterectomy to reduce blood loss as well as the difficulty of the procedure. It can also be used as a temporizing medical therapy until natural menopause occurs. Therapy is generally limited to 6 months of drug treatment.
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In addition to surgery, pharmacologic inhibition of estrogen secretion has been used to treat fibroids. This is particularly applicable in the
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perimenopausal years when women are more likely anovulatory, with relatively more endogenous estrogen. Pharmacologic removal of the ovarian estrogen source can be achieved by suppression of the hypothalamic-pituitary-ovarian axis through the use of gonadotropin-releasing hormone agonists (GnRH analogs), which can reduce fibroid size by as much as 40% to 60%. This treatment is commonly used before a planned hysterectomy to reduce blood loss as well as the difficulty of the procedure. It can also be used as a temporizing medical therapy until natural menopause occurs. Therapy is generally limited to 6 months of drug treatment.
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may have significantly increased rates of preterm labor, placental abruption, pelvic pain, and cesarean delivery
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Pregnancy with small leiomyomata is usually unremarkable, with a normal antepartum course, labor, and delivery. However, women with myomas greater than 3 cm may have significantly increased rates of preterm labor, placental abruption, pelvic pain, and cesarean delivery.
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may have significantly increased rates of preterm labor, placental abruption, pelvic pain, and cesarean delivery
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Pregnancy with small leiomyomata is usually unremarkable, with a normal antepartum course, labor, and delivery. However, women with myomas greater than 3 cm may have significantly increased rates of preterm labor, placental abruption, pelvic pain, and cesarean delivery.
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Myomas may sometimes cause pain, as they can outgrow their blood supply during pregnancy, resulting in
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red or carneous degeneration.
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Myomas may sometimes cause pain, as they can outgrow their blood supply during pregnancy, resulting in
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red or carneous degeneration.
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The risk of abortion or preterm labor following myomectomy during pregnancy is relatively high, so that prophylactic
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β-adrenergic tocolytics are frequently used
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The risk of abortion or preterm labor following myomectomy during pregnancy is relatively high, so that prophylactic
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β-adrenergic tocolytics are frequently used
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