[Midwife's Corner]: Uterine Leiomyomas (Fibroids)

Uterine leiomyomas or fibroids are benign tumors of the uterus composed of smooth muscle and varying amounts of connective tissues.
It is the commonest formation of new, abnormal growth of tissue in the uterus. About 20-50% of women over 40years have fibroids of various sizes.

AETIOLOGY

The exact cause of initial development is unknown, but it is hypothesized that fibroids originate from somatic mutation in the myometrial cells(cells of the inner lining of the uterus).

There is progressive loss of growth regulation, the tumours grow as genetically abnormal clones of cells derived from a single progenitor cell( in which the original mutation took place).

Each Myoma or fibroid is monoclonal and results from a single muscle cell , multiple fibroids within the same uterus are not clonally related , each arises independently.
Genetic predisposition for myoma formation is associated with estrogen and progesterone hormones. This is common during hormonal active years and regress after menopause.

RISK FACTORS

Onset of menstruation before12 years, that is prolong exposure to estrogen.
It is prevalent in black women compared to white women, as a result  of their diet or environment. Also, being
Overweight may also  raises estrogen levels. Nevertheless, women who have never been pregnant are at higher risk than women who have had children. In addition,
increasing age at last term birth is also a risk factor.

SIGNS AND SYMPTOMS

The signs and symptoms include:
✅Menorrhagia that is enlargement of the surface area of the uterine cavity.
✅Congestion and dilatation of endometrial venous plexus ( group of nerves).
✅Imbalance of uterine prostaglandin production.
✅Disturbances in normal myometrial vasodilator.
✅Intramenstrual bleeding.
✅Chronic pelvic pains
✅Flank pains
✅Dysmenorrhea (difficult painful menstruation).
✅Dyspareunia(difficulty or painful coitus).
✅Pelvic pressure.
✅Acute pain from degeneration, infarction (pains from dieing cells).
✅Frequent urination
Pressure on bladder depending on the size.
✅Urethral compression
Constipation or intestinal obstruction.

GENERAL CHARACTERISTICS AND PATHOLOGY

✅Size is variable, from tiny to huge sizes.
✅Have pseudo capsule of connective tissues.
✅There is on major vessel supplying tumour.
✅Only a small percentage of fibroids develops in the cervix because of the relative scarcity of smooth muscles cells to the cervix.

CLASSIFICATIONS

✅Submucosal: the fibroid is situated in the uterine cavity and distorts the uterine cavity.
✅Intramural: it is embedded in the uterine muscle and does not distort the uterine cavity, less than 50% of it protrudes into the serosal  surface.
✅ Subsetosal: greater than 50% of the fibroids nodule protrudes our of the serosal surface which maybe sessile or pedunculated.
✅Intraligamentary: the fibroids grows at the side in the fold of the broad ligament.

DIAGNOSIS

✅Pelvic examination
✅Ultrasound
✅Magnetic resonance imaging (MRI)
✅Sonohysterography
✅Hysterocopy.

TREATMENT
NONSURGICAL
Uterine artery, embolization, cut of estrogen

TREATMENTS
SURGICAL
Hysterectomy
Myomectomy( laparoscopy, hysteroscopy)
 
REFERENCES

MIDWIFES DICTIONARY
www.medscape.com
Comprehensive Gynaecology by Doreen Muller et al 4/e

By: Stephanie Abena Serwaa Ampofo
(School of Nursing and Midwifery, UHAS)