Fibroid MCQs

Absolute Contraindications for ECV: Placenta previa Uterine abnormalities (e.g., fibroids or structural anomalies) Contracted Pelvis, CPD Maternal medical conditions (e.g., severe hypertension, cardiac disease) Fetal distress or non-reassuring fetal heart rate patterns IUGR Multiple pregnancies Rupture of membranes, Oligohydramnios ECV is performed with caution and without force in patients with lower uterine scar. Its a relative contraindication Reference : Fernando Arias 4/e, p 374

Let us see each option one by one. Red degeneration of fibroid commonly occurs during pregnancy. (Option “a” is correct) The pathogenesis of fibroid is obscure but the initial change appears to be one of subacute necrosis which is presumably due to an interference with its blood supply. Some say that arterial or venous thrombosis is the basis of this and the lesion is the result of infarction. (Option “c” is thus correct). Red degeneration should be managed conservatively with bed rest and analgesics to relieve the pain. (option “d” is thus correct) There is no need for surgical intervention. Reference: Shaw 15th/ed p 355.

Measures to control blood loss during myomectomy Preoperative GnRH analogs Moderate degree of edelberg position to enhance venous return Timing the surgery in the immediate postmenstrual phase. Hypotensive anaesthesia (using sodium nitro pruside) Use of vasoconstrictive agents mainly vasopressin intraoperatively Use of victor Bonney’s myomectomy clamp around blood vessels and round ligament Use of tourniquets around blood vessels Uterine artery embolisation (UAE) Reference: Dutta Gynae 6th/ed p 604.

The M/C investigation done to diagnose/detect fibroids is USG Three-dimensional ultrasonography can locate fibroids accurately. Although MRI is better (more accurate) than USG but is not routinely used as it is expensive and not widely available. -CT scan has a limited contrast resolution than MRI. For submucous fibroid hysteroscopy on saline infusion semiography can be done. Reference: Dutta Gynae 6th/ed p 278-279.

Management of Red degeneration of fibroid. Patient is managed conservatively Patient is put to bed rest and given analgesics (to relieve the pain), sedatives and, if required antibiotics If because of mistaken diagnosis laparotomy is done, abdomen is closed without doing anything Myomectomy should never be contemplated during caesarean section as vascularity of fibroid is increased during pregnancy (due to increased estrogen) leading to increased blood loss during cesarean section. Reference : Shaw 14/e, pg 326; Dutta Obs. 6/e, pg 309; Jeffcoate 7/e, pg 502

"Calcareous degeneration usually involves the subserous fibroids with small peduncle or myomas of postmenopausal women. It is usually preceded by fatty degeneration. There is precipitation of calcium carbonate or calcium phosphate within the tumor, when whole of the tumor is converted into a calcified mass it is termed as 'womb stone' " Complications : Torsion Hemorrhage Infection Ascites; pseudo-Meigs syndrome (Produced by pedunculated subserous fibroid) Malignant change (rarest) Degenerations: Atrophy Red degeneration Hyaline degeneration (MC) Fatty degeneration or calcification Myxomatous degeneration Cystic degeneration Reference: Dutta Gynae 5th/ed p 265.

Laparoscopy is not the best method for detecting submucosal fibroids as it is primarily used for other types of fibroids and other pelvic issues. Hysteroscopy -This method directly visualizes the uterine cavity and is very effective for detecting and treating submucosal fibroids. Hysterosalpingography -This radiologic technique can reveal filling defects in the uterine cavity caused by submucosal fibroids. USG (Transabdominal) -While it is less specific for detecting submucosal fibroids compared to other methods, it can still help in identifying fibroids and their locations. Laparoscopy (D)-This method is useful for detecting subserous fibroids or differentiating pedunculated fibroids from other pelvic masses but is not ideal for detecting submucosal fibroids directly. Reference : William's Gynae 1st/ed p 203; Dutta Gynae 6th/ed p 278.

Placental implantation at the fundus, Uterine atony, Cord traction applied before placental separation, Abnormally adherent placentation seen with placenta accreta spectrum disorders Other risk factors are a short cord, uterine wall weakening at the implantation site, uterine tumors, and excessive fundal pressure. Reference: Williams obstetrics 26 th edition, chapter 42