Chapter 13 Benign Disorders of the Lower Genital Tract Flashcards
(45 cards)
21 hydroxylase deficiency leads to
congenital adrenal hyperplasia. phenotypically demonstrated in the neonate with ambiguous genitalia, hyperandrogenism with salt wasting, hypotension, hyperkalemia, and hypoglycemia.dx is made by elevated 17alpha-hydroxyprogesterone. (1/40,000-50,000) pregnancies
25% of women with uterine septa may suffer from recurrent 1st trimester pregnancy loss. a bicornuate uterus is more commonly complicated by the limited size of the uterine horn rather than by blood supply.
true
bicornuate and unicornuate uteri associated with
- second trimester pregnancy loss
- malpresentation
- preterm labor and delivery.
many uterine anomalies require no treatment, however, when defect causes significant symptoms such as pain, menstrual irregularities, or infertility, treatment options should be explored.
uterine septa can be excised with operative hysteroscopy once bicornuate uterus has been ruled out.
bicornuate uterus are able to carry pregnancy to fruition although
- preterm labor
- delivery
is a significant risk.
uterine leiomyomas / fibroids/ uterine myomas are
benign proliferations of smooth muscle cells of myometrium. Fibroids occur in women of childbearing age then REGRESS during menopause.
fibroids become problematic only when their location results in heavy/irregular bleeding or reproductive difficulties.
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submucosal
beneigh the endometrium. commonly associated with heavy/prolonged bleeding.
intramural
in the muscular wall of the uterus. (most common)
subserosal
beneath the uterine serosa.
fibroids are surrounded by
pseudocapsule , contains very few blood vessels and lymphatic vessels. As leiomyomas enlarge, they can outgrow their blood supply, infarct, and degenerate, causing pain.
most women with fibroids have no clinical symptoms. of those who do, they complain about
abnormal uterine bleeding, which is due most commonly to submucosal fibroids impinging on the endometrial cavity.
submucosal fibroids can impact implantation, placentation, and ongoing pregnancy. Resection of submucosal fibroids in patients diagnosed with infertility does lead to increased conception rates. Intramural and subserosal fibroids are unlikely to affect conception / pregnancy loss except when multiple fibroids are present.
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clinical symptoms of uterine leiomyomas mnemonic: FIBROIDS
F: Frequency and retention of urine, hydronephrosis
I: Iron deficiency anemia
B: bleeding abnormalities (menorrhagia, metrorrhagia, menometrorrhagia, postcoital spotting), bloating
R: reproductive difficulties. (dysfunctional labor, premature labor/delivery, fetal mal presentation, increased need for c/s)
O: obstipation and rectal pressure
I: Infertility failed implantation, spontaneous abortion
D: dysmenorrhea, dyspareunia
S: symptomless (most common)
when fibroids multiple, large (5-10cm), or located behind the placenta, they may
contribute to increased rates of preterm labor and delivery, fetal malpresentation, dysfunctional labor, c/s.
diagnostic evaluation:
pelvic us, HSG hysterosalpingogram, saline infusion sonogram (sonohysterogram) and hysteroscopy . MRI especially helpful in distinguishing fibroids from adenomyosis.
patient with actively growing fibroids should be followed every 6 months to monitor size and growth.
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medical therapies for leiomyomas. MNEOMINC: GO PAN AM
go pan am
G: Gnrh agonists (nafarelin acetate, leuprolide acetate depot, and goserelin acetate)
O: Oral contraceptive pills
P: Progestins (medroxyprogesterone acetate, Mirena IUD, norethindrone acetate)
A: Antifibrinolytics (tranexamic acid)
N: Nonsteroidal antiinflammatory drugs
A: androgenic steroids (danazol and gestrinone)
M: mifeprixtone.
indications for surgical intervention for uterine leiomyomas
- abnormal uterine bleeding, causing anemia
- severe pelvic PAIN or 2ndary amenorrhea
- uterine size (>12wk)obscuring evaluation of adnexa
- Urinary frequency, retention/ hydronephrosis
- growth after menopause
- recurrent miscarriage / infertility
- rapid increase in size
disadvantage of myomectomy
fibroids recur in more than 60% of pts in 5 years. adhesions frequently form that may further complicate pain and infertility.
endometrial polyps account for __ of all cases of postmenopausal bleeding
25%
best evaluation of polyps
ultrasound, sonohysterogram, hysteroscopy. as with any other etiology for abnormal bleeding, women 45 and older with abnormal bleeding from endometrial polyps should be evaluated with endometrial bx prior to removal.
continuous endogenous or exogenous estrogen stimulation in the ABSENCE of progesterone , simple endometrial proliferation can advance to
endometrial hyperplasia.
most common exogenous source is estrogen hormone replacement without progesterone. in obese women, excess adipose tissue results in increased
peripheral conversion of androgens to estrogens. this excess endogenous estrogen stimulation can then stimulate overgrowth of endometrium resulting in endometrial hyperplasia and even cancer.
