Introduction:

• Uterine tumors either benign or malignant.
• Benign tumors includes (uterine fibroid, endometrial polyps & cervical polyps).
• Malignant tumors includes (cervical ca., endometrial ca.)

0.1. Uterine fibroid:

• It is benign tumor of uterine muscles (myometrium).
• Commonest tumor in females (20% in women above 35yrs).
• It is estrogen dependant therefore the woman with age more than 35yrs more prone to develop fibroid because of high exposure to estrogen.
• It is more common in nulliparous & woman with low fertility index.
• It is either single or multiple (up to 50 in number).
• It's size range (water melons-grape fruits-orange-pea nuts).

0.2. Sites:

1. Intramural fibroid: located inside the uterine muscles.
2. Sub-serous fibroid: may transforms to polyp or may cause erosion & inter-menstrual bleeding.
3. Pedunculated fibroid: bulge outside the uterus.
4. Wandering fibroid: that attach to the omentum.
5. Sub-mucous fibroid: very important type because it may interfere with implantation (infertility) or may cause abortion in the 1^st trimester or it may ulcerates & causes intra-menstrual bleeding.
6. Broad ligament (ligamental) fibroid.
7. Lower segment fibroid: most difficult & serious type because it is:
   1. Very close to uterus.
   2. Near to uterine artery.

0.3. Complications OR changes:

1. Red degeneration (painful & tender) which may confused with acute abd.
2. Hyaline degeneration → liquefaction.
3. Cystic degeneration → infection.
4. Calcification also known as (womb stones.
5. Atrophy (occur toward menopause).
6. During pregnancy become flat & difficult to diagnosed.
7. Malignant changes mainly sarcoma (leiomyosarcoma) which is very rare.

0.4. Clinical presentation:

• May be symptom less.
• Usual presentation is menstrual disturbance (inter-menstrual, post-coital bleeding & secondary dysmenorrhea).
• Abdomino-pelvic mass.
• Frequency of micturition due to pressure.
• Backache.
• Infertility due to compressing on fallopian tube.

0.5. D. Dx.:

1. Pregnancy.
2. Ovarian cyst.

0.6. Diagnosis:

Confirmed by pelvic Ultrasound.

0.7. Management:

• Treatment depend on:
  • Age of pt.
  • Parity (fibroid that thought to be a cause of infertility should be treated).
  • Size of fibroid (in case of small one just reassure the pt. & see here every 6moths).

• Indications of surgery:
  • Size of fibroid more than 14-16wks (5cm & above).
  • Proved to be the cause of infertility or abortion.
  • There is doubt about diagnosis.
  • If there is no response to medical treatment.

• Definitive surgical treatment include:
  • Myomectomy: which is removal of fibroid with preservation of the uterus. It's complications include:

• • • Hemorrhage.
    • Hysterectomy (rarely).
    • Adhesions which impair future fertility especially for post. wall fibroid.
    • Fibroid re-growth (40%).
  • Hysterectomy: which is removal of the uterus, it is the choice of women who have complete their family.

0.8. UTERINE FIBROID & PREGNANCY:

Uterine fibroids are associated with

• Infertility.
• Abortion.
• Preterm labour.
• Uterus bigger than date.
• Malpresentation & obstructed labour (with lower segment fibroid).
• PPH (most serious complication).