Podcast
Questions and Answers
What is a common clinical presentation of red degeneration in fibroids during pregnancy?
What is a common clinical presentation of red degeneration in fibroids during pregnancy?
- Pain abdomen, nausea/vomiting, and fever (correct)
- Difficulty breathing
- Severe headaches
- Increased appetite
Which finding on histopathological examination is indicative of a fibroid undergoing degeneration?
Which finding on histopathological examination is indicative of a fibroid undergoing degeneration?
- Loose pseudocapsule and soft texture (correct)
- Increased cell density
- Increased vascularity
- Presence of necrosis without inflammation
Which factor is primarily responsible for the pathogenesis of red degeneration in fibroids?
Which factor is primarily responsible for the pathogenesis of red degeneration in fibroids?
- Hormonal fluctuations
- Thrombosis of blood vessels supplying the fibroid (correct)
- Infection of the fibroid
- Genetic mutations in fibroid tissue
What laboratory findings would likely be seen in a patient with red degeneration of a fibroid?
What laboratory findings would likely be seen in a patient with red degeneration of a fibroid?
Which of the following is NOT a recommended management option for red degeneration of fibroids during pregnancy?
Which of the following is NOT a recommended management option for red degeneration of fibroids during pregnancy?
Which of the following is a characteristic of Pseudo Meig's syndrome?
Which of the following is a characteristic of Pseudo Meig's syndrome?
What is the most common type of degeneration observed in fibroids?
What is the most common type of degeneration observed in fibroids?
Which complication is not associated with pregnancy in the presence of fibroids?
Which complication is not associated with pregnancy in the presence of fibroids?
What type of degeneration is characterized by 'popcorn calcification' on an X-Ray?
What type of degeneration is characterized by 'popcorn calcification' on an X-Ray?
Which part of a fibroid is the least vascular and where degeneration begins?
Which part of a fibroid is the least vascular and where degeneration begins?
Which type of fibroid is classified as Type 0 in the FIGO classification?
Which type of fibroid is classified as Type 0 in the FIGO classification?
What symptoms are associated with anterior cervical fibroids?
What symptoms are associated with anterior cervical fibroids?
How are Type 0 and Type 1 submucosal fibroids typically removed?
How are Type 0 and Type 1 submucosal fibroids typically removed?
What is the primary investigation for submucous fibroids when considering them along with infertility?
What is the primary investigation for submucous fibroids when considering them along with infertility?
Which of the following is NOT a type of extra-uterine fibroid?
Which of the following is NOT a type of extra-uterine fibroid?
Which management approach is indicated for a patient with submucous fibroids type 0 or 1 and presenting with infertility?
Which management approach is indicated for a patient with submucous fibroids type 0 or 1 and presenting with infertility?
Which type of fibroid is the most common according to the provided classification?
Which type of fibroid is the most common according to the provided classification?
What is the management for bilateral cornual intramural fibroids when associated with infertility?
What is the management for bilateral cornual intramural fibroids when associated with infertility?
Which of the following statements about the management of symptomatic fibroids is NOT true?
Which of the following statements about the management of symptomatic fibroids is NOT true?
In general management of fibroids, which condition is regarded as an exception requiring surgical management?
In general management of fibroids, which condition is regarded as an exception requiring surgical management?
What is the most common cause of heavy menstrual bleeding (HMB)?
What is the most common cause of heavy menstrual bleeding (HMB)?
Which of the following can lead to subfertility due to impaired gamete transport?
Which of the following can lead to subfertility due to impaired gamete transport?
What is the primary symptom associated with submucosal fibroids?
What is the primary symptom associated with submucosal fibroids?
Which of the following options is considered an endocrine symptom related to fibroids?
Which of the following options is considered an endocrine symptom related to fibroids?
What type of fibroid is most commonly associated with painful symptoms?
What type of fibroid is most commonly associated with painful symptoms?
Which of the following symptoms is least likely to be associated with fibroids?
Which of the following symptoms is least likely to be associated with fibroids?
What is a recommended step to reduce blood loss during surgery (Sx)?
What is a recommended step to reduce blood loss during surgery (Sx)?
What is the purpose of clamping the bilateral uterine artery during myomectomy?
What is the purpose of clamping the bilateral uterine artery during myomectomy?
What percentage range represents the recurrence rate of fibroids post-myomectomy?
What percentage range represents the recurrence rate of fibroids post-myomectomy?
Which instrument is specifically mentioned for holding fibroids during surgery?
Which instrument is specifically mentioned for holding fibroids during surgery?
What is a potential complication following myomectomy concerning menstrual symptoms?
What is a potential complication following myomectomy concerning menstrual symptoms?
What type of fibroid is most commonly observed in females?
What type of fibroid is most commonly observed in females?
Which hormones are directly associated with the development of fibroids?
Which hormones are directly associated with the development of fibroids?
What effect does menopause have on fibroids?
What effect does menopause have on fibroids?
Which of the following chromosomal anomalies is associated with fibroids?
Which of the following chromosomal anomalies is associated with fibroids?
Which statement regarding the effect of oral contraceptive pills (OCP) on fibroids is true?
Which statement regarding the effect of oral contraceptive pills (OCP) on fibroids is true?
What is the primary surgical option for a patient with a completed family who has fibroids?
What is the primary surgical option for a patient with a completed family who has fibroids?
Which type of fibroid is most commonly associated with infertility?
Which type of fibroid is most commonly associated with infertility?
For a Type 0/1 submucosal fibroid, what is the recommended surgical management?
For a Type 0/1 submucosal fibroid, what is the recommended surgical management?
What is a non-surgical management option for decreasing the size of fibroids?
What is a non-surgical management option for decreasing the size of fibroids?
In which situation is Laparoscopic myomectomy indicated?
In which situation is Laparoscopic myomectomy indicated?
Which of the following is NOT a first-line medication for managing intramural/subserosal fibroids?
Which of the following is NOT a first-line medication for managing intramural/subserosal fibroids?
What is the preferred approach for myomectomy of a type 2 submucous fibroid measuring 5 cm or larger?
What is the preferred approach for myomectomy of a type 2 submucous fibroid measuring 5 cm or larger?
Which medication is associated with a side effect of hirsutism?
Which medication is associated with a side effect of hirsutism?
Under which condition would uterine artery embolization (UAE) be contraindicated?
Under which condition would uterine artery embolization (UAE) be contraindicated?
What is the principle behind magnetic resonance guided focused ultrasound (MRGFUS)?
What is the principle behind magnetic resonance guided focused ultrasound (MRGFUS)?
Which of the following statements about second-line treatments for fibroids is correct?
Which of the following statements about second-line treatments for fibroids is correct?
Study Notes
General Gynaecology
- Peri/postmenopausal women may experience a sudden increase in fibroid size, leading to pain.
Histopathological Examination (HPE)
- Fibroids can present as soft and loose with a pseudocapsule.
- High mitotic activity is indicated with ≥10 mitoses per high-power field (HPF).
Red Degeneration
- Occurs during pregnancy, typically in the second trimester.
- Caused by thrombosis in supplying blood vessels, leading to necrosis and peritoneal irritation.
- Common symptoms include abdominal pain, nausea/vomiting, and fever.
- Laboratory findings show elevated white blood cell count and erythrocyte sedimentation rate.
Management of Red Degeneration
- Conservative treatment includes analgesics, antiemetics, and intravenous fluids.
- Antibiotics, termination of pregnancy, and myomectomy are contraindicated.
- "Red" degeneration characterized by salmon pink appearance and fishy odor due to blood pigments.
Types of Extra-Uterine Fibroids
- Cervical Fibroid:
- Anterior: irritates bladder; posterior: affects urethra, causing urinary frequency or retention.
- Broad Ligament Fibroid:
- True and pseudo types, may affect ureters depending on their location.
FIGO Classification of Fibroids
- Submucosal Fibroid Types:
- Type 0: completely within the cavity, usually pedunculated
- Type 1: at least 50% in cavity
- Type a: less than 50% in cavity
- Types 0 and 1 can be surgically removed hysteroscopically; others may require laparoscopic approaches.
Clinical Presentation of Fibroids
- Most common: Asymptomatic; if symptomatic, heavy menstrual bleeding is prevalent.
- Additional symptoms may include dysmenorrhea, subfertility, and pressure symptoms.
Causes of Heavy Menstrual Bleeding (HMB)
- Increased endometrial surface area and vascularity due to elevated estrogen levels.
- Submucosal fibroids are the most common cause.
Causes of Subfertility
- Distortion of uterine cavity impairs implantation and gamete transport.
- Submucosal fibroids are a leading cause of subfertility.
Pain Related to Fibroids
- Usually asymptomatic; acute symptoms may arise from torsion or red degeneration.
Endocrine Effects
- Potential symptoms include polycythemia, hypercalcemia, and increased prolactin levels.
Pseudo Meigs' Syndrome
- Associated with pedunculated fibroids, featuring right-sided pleural effusion and ascites.
Pregnancy Complications
- Increased risk of preterm labor, intrauterine growth restriction (IUGR), and abruptio placentae.
Degeneration of Fibroids
- Most common degeneration is hyaline degeneration, characterized by a homogeneous appearance.
- Calcareous degeneration typically affects subserosal fibroids and gives a distinctive "popcorn" calcification appearance on X-ray.
Investigations for Fibroids
- Transvaginal sonography (TVS) is the investigation of choice for uterine fibroids.
- Saline infusion sonography (SIS) is more effective for submucous fibroids.
Management Strategies for Fibroids
- Asymptomatic fibroids may be managed with observation.
- Submucosal fibroids causing infertility typically require surgical intervention.
- Medical management includes tranexamic acid and hormonal treatments; surgical options depend on the type and size of the fibroid.
Surgical Options
- Hysterectomy is indicated if family planning is complete; otherwise, myomectomy is performed to preserve fertility.
- Various techniques are employed based on fibroid type and symptoms.
Special Techniques
- Uterine artery embolization is contraindicated in women wanting to conceive.
- High-intensity focused ultrasound (HIFU) and magnetic resonance-guided focused ultrasound (MRGFUS) are non-invasive treatments.
Overview of Fibroids
- Benign tumors composed mainly of smooth muscle cells, often estrogen and progesterone dependent.
- Most common pelvic tumors in females, and they regress post-menopause.
- Intramural fibroids are the most common initial form.
Classification of Fibroids
- Anatomical classification includes intramural, submucosal, and subserosal types.
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Description
Test your knowledge on general gynaecology with a focus on fibroid complications, especially during peri/post-menopausal stages and pregnancy. This quiz covers histopathological findings, pathogenesis, and clinical presentations associated with red degeneration of fibroids.
