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10 results

  • Case 18 - A 35-Year-Old with Abdominal Cramping and Pelvic Pain at 24 Weeks’ Gestation

  • from Section 2 - Antepartum (Mid-trimester)
  • Edited by Peter F. Schnatz, The Reading Hospital, Pennsylvania, D. Yvette LaCoursiere, University of California, San Diego, Christopher M. Morosky, University of Connecticut School of Medicine, Jonathan Schaffir, The Ohio State University College of Medicine, Vanessa Torbenson, Mayo Clinic Alix School of Medicine, David Chelmow, Virginia Commonwealth School of Medicine
  • Book:
    Pregnancy Complications
    Published online:
    08 April 2025
    Print publication:
    01 May 2025, pp 54-56

  • Summary

    Leiomyomata are the most common uterine neoplasm, occurring in at least 20–25% of all reproductive-aged patients. The prevalence of uterine myomas among pregnant patients ranges from 0.1 to 3.9% and is likely to increase as more patients delay childbearing until later in life. Pain is the most reported complication of fibroids in pregnancy, with approximately 10–30% of patients with uterine fibroids developing pain during pregnancy. Acute pain episodes can be severe enough to warrant hospitalization and analgesia in certain instances and therefore present a significant complication for pregnant patients with fibroids. Pain from uterine fibroids during pregnancy is thought to be due to red degeneration, which is defined as hemorrhagic infarction of a previously hyalinized myoma caused by ischemic necrosis. Although this was previously thought to be caused by rapid fibroid growth during pregnancy, recent studies suggest that these painful episodes appear to be unrelated to absolute fibroid size. In this case we will explore the pathophysiology of degenerating fibroids in pregnancy including the natural course of uterine fibroids in pregnancy, typical presentation, causes, and treatment options.

  • Chapter 2 - Fibroids in Pregnancy

  • Edited by Swati Jha, Sheffield Teaching Hospital NHS Foundation Trust, Priya Madhuvrata, Sheffield Teaching Hospital NHS Foundation Trust
  • Book:
    Gynaecology for the Obstetrician
    Published online:
    14 July 2023
    Print publication:
    03 August 2023, pp 14-22

  • Summary

    Women with uterine fibroids are more likely to have pregnancies complicated by fetal and maternal complications. Women should be counselled that the risks of obstetrical complications are increased with the presence of fibroids in pregnancy. There are still no adequate data on the optimum management strategy of fibroids in pregnancy. In women with prior myomectomy, a plan for labour and vaginal delivery is reasonable in those who did not have extensive myometrial dissection or entry into the endometrial cavity. Alternately, for those who choose an approach of scheduled Caesarean delivery, timing at 37–38 weeks’ gestation is reasonable.

  • PREOPERATIVE MAGNETIC RESONANCE IMAGING DIAGNOSTIC FEATURES OF UTERINE LEIOMYOSARCOMAS: A SYSTEMATIC REVIEW

  • Helen Kaganov, Alex Ades, David Stuart Fraser
  • Journal:
    International Journal of Technology Assessment in Health Care / Volume 34 / Issue 2 / 2018
    Published online by Cambridge University Press:
    12 April 2018, pp. 172-179

  • Objectives: There are no current established pathognomonic diagnostic features for uterine leiomyosarcomas in the pre- or perioperative setting. Recent inadvertent upstaging of this rare malignancy during laparoscopic morcellation of a presumed fibroid has prompted widespread debate among clinicians regarding the safety of current surgical techniques for management of fibroids. This study aims to conduct a systematic review investigating significant diagnostic features in magnetic resonance imaging (MRI) of uterine leiomyosarcomas.

    Methods: A comprehensive database search was conducted guided by PRISMA recommendations for peer-reviewed publications to November 2017. Parameters available in MRI were compared for reliability and accuracy of diagnosis of leiomyosarcomas. A decision tree algorithm classifier model was constructed to investigate whether T1 and T2 MRI signal intensities are useful indicators.

    Results: Nine eligible studies were identified for analysis. There appears to be a significant relationship between histopathological type and T1 and T2 intensity signals (p < .05). A decision tree model analyzing T1 and T2 signal intensity readings supports this trend, with a diagnostic specificity of 77.78 percent for uterine leiomyosarcomas. The apparent diffusion coefficient (ADC) values were not observed to have a significant relationship with tumor pathology (p = .18).

    Conclusions: Various studies have investigated pre- and perioperative techniques in differentiating uterine leiomyosarcoma from benign fibroids. Given the rarity of the malignancy and lack of pathognomonic diagnostic parameters, there is difficulty in establishing definitive criteria. A decision tree model is proposed to aid diagnosis based on MRI signal intensities.

  • 10 - Delayed menarche

  • Mary Ann Lumsden, University of Glasgow, Margaret Rees, University of Oxford
  • Book:
    Menstrual Problems for the MRCOG and Beyond
    Published online:
    05 June 2014
    Print publication:
    27 February 2014, pp 115-118

  • Summary

    Excessive menstrual bleeding describes the clinical problems of heavy menstrual blood loss together with frequent or irregular menstruation. This chapter addresses endometrial morphology, the mechanism of menstruation and the aetiology and management of menstrual problems. A very common cause relates to ovulatory dysfunction, which typically leads to a combination of irregular bleeding and a variable volume of menstrual flow, which can lead to heavy menstrual bleeding (HMB). Clotting disorders such as von Willebrand's disease are another cause of HMB. Reduced clotting is a known feature at the time of menstruation. Pelvic pathologies such as fibroids are common, affecting between 20 and 25% of women. It is reported that around a third of women with fibroids complain of heavy menstrual blood loss. There are a number of terminologies to describe menstrual complaints such as menorrhagia, polymenorrhoea, oligomenorrhoea, polymenorrhagia and metrorrhagia.

  • 18 - Emergency contraception

  • Edited by Paula Briggs, Gabor Kovacs, Monash University, Victoria
  • Edited in consultation with John Guillebaud, University College London
  • Book:
    Contraception
    Published online:
    05 August 2013
    Print publication:
    11 July 2013, pp 159-169

  • Summary

    This chapter focuses on the non-oral combined hormonal contraceptive options, including the patch and more specifically the vaginal ring, which are underused in the UK and Australia. The clinical effectiveness unit of the faculty of sexual and reproductive healthcare developed a guideline to facilitate appropriate investigation of women presenting with unscheduled bleeding. For women with breakthrough bleeding in association with the use of hormonal contraception, lasting longer than three months, it is important to view the cervix. A pelvic examination should be undertaken to exclude pelvic pathology including ovarian cysts, fibroids and gynaecological cancers. In clinical trials, most users have been satisfied with the combined hormonal ring. The greatest barrier to this method is promoting the vagina as an ideal organ in which to place hormonal contraception and this remains a challenge to all providers of contraception.

  • Prenatal exposure to diethylstilbestrol and long-term impact on the breast and reproductive tract in humans and mice

  • R. R. Newbold
  • Journal:
    Journal of Developmental Origins of Health and Disease / Volume 3 / Issue 2 / April 2012
    Published online by Cambridge University Press:
    19 December 2011, pp. 73-82

  • The term ‘developmental origins of health and disease’ (DOHaD) originally referred to delayed effects of altered maternal factors (e.g. smoking or poor nutrition) on the developing offspring, but it now also encompasses early life exposure to environmental chemicals, which can cause an unhealthy prenatal environment that endangers the fetus and increases its susceptibility to disease later in life. Prenatal exposure to the pharmaceutical diethylstilbestrol (DES) is a well-known DOHaD example as it was associated in the 1970s with vaginal cancer in daughters who were exposed to this potent synthetic estrogen before birth. Subsequently, numerous long-term effects have been described in breast and reproductive tissues of DES-exposed humans and experimental animals. Data reviewed suggest that the prenatal DES-exposed population should continue to be monitored for potential-increased disease risks as they age. Knowledge of sensitive developmental periods, and the mechanisms of DES-induced toxicities, provides useful information in predicting potential adverse effects of other environmental estrogens.

  • 15 - Tubal ectopic pregnancy

  • Edited by Davor Jurkovic, Lil Valentin, Sanjay Vyas
  • Book:
    Gynaecological Ultrasound in Clinical Practice
    Published online:
    05 February 2014
    Print publication:
    01 June 2009, pp 179-192

  • Summary

    Tubal ectopic pregnancy is an important cause of maternal morbidity and mortality worldwide. Clinical presentation of ectopic pregnancy varies from mild vaginal bleeding to sudden rupture and massive intra-abdominal haemorrhage. The diagnosis of the ectopic pregnancy was made at surgery and then confirmed on histological examination following salpingectomy. At laparoscopy, an unruptured ectopic pregnancy typically presents as a well-defined swelling in the fallopian tube. The diagnosis of intrauterine pregnancy becomes more difficult if the uterus is enlarged by fibroids. Fibroids often distort the shape of the endometrial cavity and prevent the operator from visualising in a single plane the continuity between the gestation sac and the cervical canal. Surgery remains the main therapeutic option for the treatment of tubal ectopic pregnancy. Medical management of ectopic pregnancy has grown in popularity following observational studies which reported success rates greater than 90% with single-dose systemic methotrexate.

  • 13 - Controversial issues in assisted reproduction

    • By Caroline Overton, St. Michael's Hospital and the Bristol Royal Infirmary, Bristol, UK, Colin Davis, Fertility Unit, St Bart's and the London Hospitals, London, UK
  • Edited by Paul Serhal, Caroline Overton
  • Book:
    Good Clinical Practice in Assisted Reproduction
    Published online:
    22 October 2009
    Print publication:
    01 July 2004, pp 226-255

  • Summary

    Fibroids are a frequent finding in women with infertility. Gonadotrophin releasing hormone agonists (GnRH-agonist) will cause both uterine and fibroid shrinkage and a reduction or elimination of menstrual flow. Uterine artery embolization offers an alternative method of treatment that allows conservation of the uterus. Under local anaesthesia and sedation, an 18-gauge needle can deliver heat to a fibroid with localized ablation of a fibroid. Hysteroscopic myomectomy may be considered for women with submucous fibroids less than 3 cm. Uterine septum is the most common congenital abnormality of the female reproductive tract with an incidence of 2-3% in the general population. This chapter discusses hydrosalpinx, endometriosis and ovulation induction, endometriosis and intrauterine insemination, endometriosis and in vitro fertilization, and management of ovarian cyst. It also explains elevated follicle stimulating hormone (FSH), thin endometrium, assisted reproductive techniques, and embryo transfer.