Fibroid Size Research Articles

The characteristics of a fibroid in pregnancy can influence the perinatal outcome.

To determine whether fibroids affect perinatal outcomes and whether women who undergo fibroid surgery before pregnancy have better perinatal outcomes than those who have fibroids during pregnancy. The study also analyzes the optimal time interval between myomectomy and pregnancy and the characteristics of fibroids during pregnancy that affect perinatal outcomes. In both groups, fibroids' size, number, and location were analyzed to determine their influence on perinatal outcomes. The perinatal outcome is determined by gestational age, birth weight, Apgar score, intrauterine growth retardation, placental complications, and delivery method. A study was conducted on the perinatal outcomes of 338 women who had uterine fibroids during pregnancy and those who had undergone fibroid surgery before pregnancy. The medical records of women who gave birth at a tertiary university hospital were analyzed in this retrospective study. Women with submucosal fibroids have a lower gestational age of delivery (P = 0.0371), and those who operated on a higher number of fibroids before pregnancy had newborns with lower birth weights (P < 0.0001). Submucosal fibroids during pregnancy increase the chances of cesarean delivery (P = 0.0354). 14% of newborns have an Apgar score of less than seven within the first minute of birth in fibroids larger than 7cm (P < 0.0001). There is a statistically significant difference in the perinatal outcome of newborns depending on the number, size and placement of uterine fibroids in both observed groups.

High-risk factors for massive haemorrhage in medical abortion patients with missed miscarriage

BackgroundRecently, the incidence of missed miscarriage has gradually increased, and medical abortion is a common method to terminate a pregnancy. In the process of medical abortion, massive vaginal bleeding takes place, leading to emergency surgical haemostasis. Emergency surgery may produce infection and organ damage. Our study aimed to investigate the high-risk factors for massive haemorrhage during a medical abortion.MethodsA total of 1062 missed miscarriage patients who underwent medical abortion participated in this retrospective study. According to the amount of bleeding, the patients were divided into a massive haemorrhage group and a control group. By comparing the general conditions of the two groups, such as fertility history, uterine surgery history, uterine fibroids, etc., the high-risk factors for massive haemorrhage during medical abortion were identified.ResultsRelative to the control group, the massive haemorrhage group exhibited a higher proportion of patients with a previous artificial abortion (51.9% vs. 38.1%, P = 0.001). Additionally, the massive haemorrhage group had a lower percentage of first-time pregnant women (32.1% vs. 40.4%) and a higher proportion of women with shorter pregnancy intervals (44.9% vs. 33.1%, P = 0.03). Furthermore, there were notable differences between the two groups regarding maximum fibroid size, the duration of amenorrhea, and gestational week (P < 0.05).ConclusionIn this study, we determined that a history of artificial abortion and an amenorrhea duration of > 11 weeks represented high-risk factors for massive vaginal bleeding during medical abortion in missed miscarriage patients.

Reduction Of Uterine Fibroid Size Through Integrated Yoga And Naturopathy: A Case Report

This case study investigates the possible efficacy of Yoga and Naturopathy therapies for controlling uterine fibroids. A 51-year-old lady with a big subserous fibroid (64mm x 47mm) and symptoms of excessive bleeding and discomfort underwent a six-month treatment regimen that included Yoga, hydrotherapy, mud therapy, and dietary/lifestyle changes. Ultrasound revealed that the fibroid size (58mm x 40mm) had significantly shrunk following the intervention. This instance implies that Yoga and Naturopathy may have a role in the management of fibroids, presumably through their combined impact on inflammation, oxidative stress, and overall health. Further study with bigger cohorts is required to corroborate these results

Exploring the Efficacy of Homeopathic Medicines in Treating Uterine Fibroids: A Comprehensive Review

Abstract: Introduction: Uterine fibroids are a common gynaecological condition affecting women worldwide, often leading to significant morbidity and impacting quality of life. While conventional treatment options exist, there is growing interest in alternative therapies such as homeopathy. Objective: The objective of this review paper is to assess the effectiveness of homeopathic medicines in treating uterine fibroids through the analysis of recent clinical trials and observational studies, aiming to provide insights into the potential role of homeopathy as a complementary or alternative therapy for uterine fibroids. Methodology: A thorough search of databases such as PubMed, Google Scholar, Scopus, and pertinent medical journals was undertaken to locate recent studies on the efficacy of homeopathic medicines for uterine fibroids. Only studies meeting predefined inclusion criteria, including randomized controlled trials, prospective observational studies, and systematic reviews, were included in the review process. Result: Recent studies investigating the efficacy of homeopathic medicines in treating uterine fibroids consistently demonstrated positive outcomes, including symptom alleviation, reduction in fibroid size, and improved quality of life. Various remedies showed effectiveness across various potencies. Symptom severity scales, including the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), and Verbal Multidimensional Scoring System (VMSS), were utilized to assess pelvic pain, menstrual bleeding, and discomfort. Quality of life measures like the WHOQOL-BREF scale provided insights into overall well-being. Conclusion: In conclusion, homeopathic medicines show promise as a safe and effective treatment option for uterine fibroids, offering personalized care and improving quality of life. However, more research, including larger trials and long-term studies, is needed to confirm these findings and understand the underlying mechanisms better.

Effect of dienogest treatment on uterine fibroid volume in patients with endometriosis or adenomyosis complicated by uterine fibroids.

Currently, the use of dienogest in clinical practice has increased significantly, and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis; however, the effects of treatment with dienogest on uterine fibroid size in patients with endometriosis or adenomyosis have not been investigated. To explore changes in fibroid size in patients with concomitant uterine fibroids undergoing dienogest treatment for endometriosis or adenomyosis and to evaluate the effectiveness and safety of the drug. The clinical data of patients with uterine fibroids treated with dienogest for endometriosis or adenomyosis at Peking University First Hospital from January 2021 to January 2023 were retrospectively analyzed. The maximum uterine fibroid diameter and volume increased after 3 months, 6 months and 1 year of dienogest treatment compared with those before treatment (P < 0.01). The maximum diameter and volume of the uterine adenomyoma increased after 3 months of dienogest treatment but decreased after 6 months and 1 year of treatment compared with those before treatment, but the difference was not significant (P > 0.05). Endometrial thickness and antigen 125 levels were significantly thinner and decreased, respectively, after dienogest treatment (P < 0.01). Pearson's correlation analysis revealed that the increase in uterine fibroid volume after 3 months of dienogest treatment was positively correlated with the basic uterine fibroid volume (r = 0.792, P < 0.01). Among 64 patients with dysmenorrhea, 63 experienced significant relief of dysmenorrhea after 6 months of treatment with dienogest, and all patients experienced significant relief of dysmenorrhea after 12 months. Patients were able to tolerate the drugs, with an average drug tolerance score of 8.73. The use of dienogest in patients with endometriosis or adenomyosis combined with uterine fibroids can effectively relieve the patient's pain symptoms and significantly reduce the sizes of ovarian endometriotic cysts, but it cannot inhibit uterine fibroid growth.

Comparison of uterine myometrial thickness at the site of myomectomy scar after surgery using laparoscopic and laparotomy methods.

Fibroids are the most common benign tumours of the uterus, often requiring surgery when symptomatic. This study aims to investigate the impact of surgery using two methods, laparoscopy and laparotomy, on the thickness and vascularity of the uterine myometrium at the site of myomectomy scar (comparing sonographic features at the surgical scar site, including thickness, vascularity, and the extent of fibrotic tissue, in both open and laparoscopic surgical approaches). In this clinical trial, 100 women with type 2-5 fibroids and clinical symptoms, seeking surgery et al. Zahra Hospital, were enrolled in two groups: laparoscopy and laparotomy. Inclusion criteria were a maximum fibroid size of 8cm and, in the case of multiple fibroids, a maximum of three, with the largest being 8cm. 6 months post-surgery, sonographic assessments of the myomectomy scar site were compared between both groups. Participants showed no significant differences in demographic and obstetric factors. The most common clinical symptom (87%) in both groups was abnormal uterine bleeding (AUB). The mean hospital stay duration was statistically significantly lower in the laparoscopy group at 1.64 (SD 0.56) compared to 1.89 (SD 0.58) in the laparotomy group (p = 0.028). Additionally, the decrease in haemoglobin levels was 0.89 (SD 0.92) and 1.87 (SD 2.24) units, respectively, which showed a statistically significant difference (p = 0.003). The duration of surgery was significantly shorter in the laparotomy group (p = 0.001). Abdominal pressure was not observed in the laparoscopy group, while 12% of the laparotomy group reported complaints (p = 0.013). Based on the results obtained in this study, it can be concluded that there was no difference between these two methods in terms of improving uterine thickness and associated complications. However, the decrease in haemoglobin levels and the length of hospital stay were lower in patients undergoing laparoscopy.

Risk Factors Are Not Very Risky Once a Normal Embryonic Heart Rate is Seen in Early Pregnancy.

To assess first-trimester prognosis when an early pregnancy sonogram demonstrates a normal embryonic heart rate and to determine how a number of risk factors affect prognosis. Our study population consisted of 6597 first-trimester scans with gestational age (GA) ≤ 7.0 weeks (all with crown-rump length [CRL] <10 mm), normal embryonic heart, and known first-trimester outcome. We recorded GA; CRL; heart rate; first-trimester outcome; maternal age; presence, absence, and size of subchorionic hematoma; presence or absence of vaginal bleeding; and presence, absence, and size of uterine fibroids. We assessed first-trimester outcome in the study population and subsets based on the above data. First-trimester outcome was successful in 6030 of the 6597 cases (91.4%). The prognosis was somewhat worse with each of the following risk factors: maternal age ≥35 years, large subchorionic hematoma, and large or multiple uterine fibroids (P < .02, chi-squared or Cochran's test for trend, for all of these items). The rate of successful outcome was in the range of 83-88% with each of these risk factors and 93.8% in the absence of any of these factors. The presence of a normal embryonic heart rate on an early first-trimester sonogram is a reassuring finding, indicating a likelihood of good first-trimester outcome of at least 83% even in the presence of risk factors, and of over 90% in the absence of such factors.

The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis

ObjectiveThe objective of the meta-analysis was to determine the influence of uterine fibroids on adverse outcomes, with specific emphasis on multiple or large (≥ 5 cm in diameter) fibroids.Materials and methodsWe searched PubMed, Embase, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and SinoMed databases for eligible studies that investigated the influence of uterine fibroids on adverse outcomes in pregnancy. The pooled risk ratio (RR) of the variables was estimated with fixed effect or random effect models.ResultsTwenty-four studies with 237 509 participants were included. The pooled results showed that fibroids elevated the risk of adverse outcomes, including preterm birth, cesarean delivery, placenta previa, miscarriage, preterm premature rupture of membranes (PPROM), placental abruption, postpartum hemorrhage (PPH), fetal distress, malposition, intrauterine fetal death, low birth weight, breech presentation, and preeclampsia. However, after adjusting for the potential factors, negative effects were only seen for preterm birth, cesarean delivery, placenta previa, placental abruption, PPH, intrauterine fetal death, breech presentation, and preeclampsia. Subgroup analysis showed an association between larger fibroids and significantly elevated risks of breech presentation, PPH, and placenta previa in comparison with small fibroids. Multiple fibroids did not increase the risk of breech presentation, placental abruption, cesarean delivery, PPH, placenta previa, PPROM, preterm birth, and intrauterine growth restriction. Meta-regression analyses indicated that maternal age only affected the relationship between uterine fibroids and preterm birth, and BMI influenced the relationship between uterine fibroids and intrauterine fetal death. Other potential confounding factors had no impact on malposition, fetal distress, PPROM, miscarriage, placenta previa, placental abruption, and PPH.ConclusionThe presence of uterine fibroids poses increased risks of adverse pregnancy and obstetric outcomes. Fibroid size influenced the risk of breech presentation, PPH, and placenta previa, while fibroid numbers had no impact on the risk of these outcomes.

Enhancing surgical performance: the role of robotic surgery in myomectomies, a systematic review and metanalysis.

Examine the role, benefits, and limitations of robotic surgery in myomectomies compared to laparoscopic and open surgical approaches. This review sourced data from CENTRAL, Pubmed, Medline, and Embase up until May 1, 2023. Full articles comparing clinical outcomes of robotic myomectomy with open or laparoscopic procedures were included without language restriction. Initially, 2150 records were found. 24 studies were finally included for both qualitative and quantitative analyses. Two investigators independently assessed all reports following PRISMA guidelines. Meta-analysis was conducted using the software "Review Manager Version 5.4". Risk-of-bias was assessed using the Newcastle-Ottawa scale. Sensitivity analysis was conducted, when feasible. In a comparison between robotic and laparoscopic myomectomies, no significant difference was observed in fibroid weights and the size of the largest fibroid. Robotic myomectomy resulted in less blood loss, but transfusion rates were comparable. Both methods had similar complication rates and operative times, although some robotic studies showed longer durations. Conversion rates favored robotics. Hospital stays varied widely, with no overall significant difference, and pregnancy rates were similar between the two methods. When comparing robotic to open myomectomies, open procedures treated heavier and larger fibroids. They also had greater blood loss, but the robotic approach required fewer transfusions. The complication rate was slightly higher in open procedures. Open surgeries were generally faster, postoperative pain scores were similar, but hospital stays were longer for open procedures. Pregnancy rates were comparable for both robotic and open methods. Robotic surgery offers advancement in myomectomy procedures by offering enhanced exposure and dexterity, leading to reduced blood loss and improved patient outcomes. PROSPERO registration: CRD42023462348.

Surgical Outcomes and Complications of Myomectomy: A Prospective Cohort Study

Study objectiveTo investigate postoperative surgical and non-surgical complications that occur within 30 days following myomectomy procedures, whether laparoscopic or via open surgery. DesignProspective cohort study SettingDel Ponte Women's and Children's Hospital, Varese, Italy PatientsWomen undergoing myomectomy either with laparoscopic or open surgery from July 2020 to June 2023 InterventionsData of consecutive patients who underwent abdominal myomectomy procedures, either via laparoscopy or open abdominal surgery were collected. The study examined patient characteristics, size and location of fibroids, surgical data, and complications. Univariate and multivariable analyses were employed to identify factors contributing to postoperative Clavien-Dindo grade ≥ II complications. Measurements and main resultsOverall 383 patients were included in the study. The univariate analysis showed intramural fibroid type (p = 0.0009), large fibroid size (p = 0.03), and extended operative times (p = 0.05) were associated with postoperative complications. Open surgical approach (p<0.001) and uterine cavity opening (p = 0.02) also contributed to complications. Postoperative anemia emerged as the most prevalent complication. In the multivariable analysis, the open surgical approach emerged as the only independent factor associated with an increased risk of grade ≥ II complications (odds ratio 7.37; p < 0.0001). ConclusionIn this study we found an increased likelihood of complications in case of open myomectomy. While the presence of potential selection bias may have impacted this finding, it could provide valuable insights for clinicians and surgical teams in the strategic planning of myomectomy procedures.

Determination of Whole Blood Loss From Minimally Invasive Myomectomy Using a Standardized Formula: A Pilot Study

Study ObjectiveTo determine the median perioperative blood loss (PBL) during minimally invasive surgical (MIS) myomectomy. DesignProspective pilot study. SettingLarge academic teaching hospital. PatientsThirty-one patients underwent laparoscopic or robotic myomectomy and completed a postoperative complete blood count (CBC) from November 2020 to August 2022. Patients had to have at least one fibroid greater than or equal to 3 cm on preoperative imaging. InterventionsA CBC was collected preoperatively within 7 days of surgery. Estimated blood loss (EBL) was determined by the surgeon intraoperatively. A repeat CBC was drawn between postoperative days 2 through 4. PBL was calculated using the equation PBL = (patient weight in kg × 65 cc/kg) × (preoperative hematocrit − postoperative hematocrit)/preoperative hematocrit. Measurements and Main ResultsMedian PBL (536.3 cc [270.0, 909.3]) was greater than median EBL (200.0 cc [75.0, 500.0]). PBL ranged from a net gain of 191.5 cc to net loss of 2362.5 cc. Median size of the largest fibroid on preoperative imaging was 8.8 cm (6.6, 11.5), and median weight of fibroids removed was 321 g (115, 519). About half of patients (51.6%) had one fibroid removed, and 48.4% had 2 or more fibroids removed. Five patients were converted to laparotomy, 4 from robotic approaches. Two patients required a blood transfusion. ConclusionCalculated PBL was greater than intraoperative EBL. This suggests there is continued blood loss post myometrial bed closure. Blood loss should be evaluated both during and after myomectomy, as intraoperative EBL underestimates total PBL.

A CLINICAL STUDY IN THE MANAGEMENT OF GARBHASHAYA GRANTHI WITH SARJADI LEPA WITH SPECIAL REFERENCE TO FIBROID UTERUS

Background: Uterine fibroids are the most common gynaecological disorder, and as such, it should not be surprising that, over the countries. It is also a well-known fact that fibroid is one of the lifestyle disorders that have risen to numbers that never existed before. Uterine fibroid, considered as Garbhashaya Granthi in this study, is one of the forms of current lifestyle disorder. When the fibroid size is small, it may or may not show symptoms. In the presence of symptoms, the patient may suffer from menorrhagia, dysmenorrhea, anaemia, etc. Fibroid is dependent on oestrogen, and therefore, a hyperestrogenic state will be there. It will grow potentially in the childbearing period. An attempt is made to reverse this pathogenesis and reduce the fibroid growth. Aim: To analyse the efficacy of Sarjadi lepa along with oral Chitraka moola churna in the management of Garbhashaya Granthi with special reference to fibroid uterus. Method: A randomised open-labelled controlled clinical study of two groups of 15 patients, the control and trial groups, in each group. Results: Size of fibroid reduction was seen in both the groups, but Group B patients had a little more size reduction compared to Group A. Conclusion: Combined Chitraka moola churna orally along with Sarjadi lepa and alone Chitraka moola churna orally is equally effective in Garbhashaya Granthi with special reference to fibroid uterus.

ОСОБЕННОСТИ ТАКТИКИ ВЕДЕНИЯ ПАЦИЕНТКИ С МНОЖЕСТВЕННОЙ МИОМОЙ МАТКИ И ДИВЕРТИКУЛЕЗОМ КИШЕЧНИКА

The purpose of this study is to study the features of management tactics for a patient with multiple uterine fibroids and intestinal diverticulosis. When analyzing this clinical case, it was revealed that surgical intervention was indicated in this case. A complication, intraoperative injury to the ileum, occurred due to severe inflammation and adhesions of the abdominal cavity caused by diverticulosis of the large intestine. The presence of pronounced inflammatory changes in the ileum with the formation of diverticular disease, followed by the development of a massive adhesive process in the intestine, was not diagnosed before surgery. Late diagnosis may be due to the patient having a mild, asymptomatic clinical picture of the disease and the absence of pronounced clinical manifestations. The patient's nagging pain in the lower abdomen could be due to either the large size of uterine fibroids or be a manifestation of the clinical picture of diverticular disease. The ileal injury was detected in a timely manner, during a planned operation, and repaired in a timely manner. The management tactics in the postoperative period were correct; all diagnostic and therapeutic appointments were carried out in full, which allowed the woman to be discharged on the 14th day of the postoperative period in satisfactory condition. The patient was given recommendations in connection with the diagnosis of diverticular disease, aimed at preventing its progression and development of complications. It is necessary, if a patient has diverticulosis, even with minor manifestations and an asymptomatic course, to assume the possibility of developing pelvic adhesive disease and to prevent the development of possible complications.

INEVITABLE MYOMECTOMY OF EXTRUDING INTRAMURAL FIBROID DURING CAESAREAN SECTION- A CASE REPORT

Myomectomy during caesarean sections have been avoided routinely in the past in the fear of massive hemorrhagewhich may lead to obstetric hysterectomy. However in the recent times with adequate facilities and expertise, caesarean myomectomies are being performed with good outcomes. Case Presentation: A35-year-oldprimi gravida was diagnosed to have intramural fibroid - anterior 4.6*4.3cm and posterior 1.8cm*2.8cm at 8 weeks of gestation.By 13 weeks, during her NT scan there was increase in the size of anterior wall fibroid 7.0*6.6cm, the rest of NT scan and first trimester screening was normal. She developed early onset intrauterine growth restriction in her anomaly scan. She was conservatively managed as the doppler flow was normal. Her scan at 36 weeks showed estimated fetal weight at 2nd centile with normal doppler flow in breech presentation and an anterior intramural fibroid of size 9.5*8.2cm.Hence an elective caesarean section was planned at 37 weeks.Baby was delivered by breech extraction. Manual removal of placenta was done. As the uterus started contracting, the intramural fibroid started extruding, became submucosal and bulging into uterine edges. Hence planned for myomectomy. Injection vasopressin was injected into the surface of myoma,enucleation of the myoma done and myoma bed closed in 2 layers followed by the closure of uterine edges. Intra operative blood loss was around 800ml. No primary or secondary PPH noted. Patient was discharged on 5th post operative day without any complaints. Conclusions: Routine myomectomy at the time of cesarean section is not a standard procedure worldwide. However, it may be considered in carefully selected patients in centers with good facilities to tackle complications by the experienced obstetricians.

The Effect of Uterine Artery Embolization on Heavy Menstrual Bleeding in Patients with Leiomyomata

Objective: To compare the effect of uterine artery embolization and medical management on heavy menstrual bleeding in patients managed for uterine fibroids. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: The study was conducted at the Department of Gynecology and Obstetrics, Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan fromAugust 2021 to March 2023.Methods: Women between the ages of 35 and 50 years who presented with heavy menstrual bleeding and were diagnosed with leiomyomata were included in this study. They were divided into two groups via block randomization. Group-I underwent uterine artery embolization while group-II received medical treatment (gonadotropin-releasing hormone (GnRH) antagonist). Clinical factors like shrinkage in the size of fibroids, rise in hemoglobin levels, and pelvic pain scores were compared in both groups at the end of three months. Results: Out of 160 women recruited in the study, 52 (32.5%) were pre-menopausal, while 108 (67.5%) were peri menopausal. The mean age of patients who presented with heavy menstrual bleeding due to leiomyomata was 45.23 ±12.70 years. The mean rise in hemoglobin (p-value-0.007) and mean shrinkage size (p-value&lt;0.001) were statistically significantly found more in patients who underwent uterine artery embolization as compared to those who took medical treatment. The mean pain score (p-value-0.01) was also found to be more in a group of patients who underwent uterine artery embolization.Conclusion: Uterine artery embolization emerged as an effective procedure for women managed for heavy menstrual bleeding due to uterine fibroids. Medical management via gonadotropin-releasing hormone (GnRH) antagonist was inferior in efficacy in terms of mean rise in hemoglobin and fibroid shrinkage.How to cite this: Khan S, Ahmad M, Mirza ZA, Sheraz A, Tariq M. The Effect of Uterine Artery Embolization on Heavy Menstrual Bleeding in Patients with Leiomyomata. Life and Science. 2024; 5(1): 27-32. doi: http://doi.org/10.37185/LnS.1.1.475

Application of transabdominal ultrasound- and laparoscopy-guided percutaneous microwave ablation for treating uterine fibroids: 24-month follow-up outcomes.

To determine the ablation efficacy of transabdominal ultrasound- and laparoscopy-guided percutaneous microwave ablation (PMWA), to investigate whether the risk of damage to adjacent organs and endometrium due to this technique can be reduced or even avoided. We also evaluated the clinical efficacy of this technique in the treatment of uterine fibroids of different sizes and at different locations over a 24-month follow-up period. This study included 50 patients with uterine fibroids who underwent transabdominal ultrasound- and laparoscopy-guided PMWA from August 2018 to July 2020. Lesions were confirmed by pathology. The technical efficacy and complications of PMWA were assessed. The lesion diameter, lesion volume, lesion location, and contrast-enhanced ultrasound (CEUS) features before PMWA and within 24h after PMWA were recorded. Magnetic resonance imaging (MRI) was used for follow-up at 3 and 6months after PMWA. Transvaginal ultrasound was used for follow-up at 24months after PMWA. A total of 50 patients with uterine fibroids received treatment. The median ablation rate of uterine fibroids was 97.21%. The mean lesion volume reduction rates were 32.63%, 57.26%, and 92.64% at 3, 6, and 24months after treatment, respectively. The size and location of uterine fibroids did not significantly affect the ablation rate and the rate of lesion volume reduction. No major complication was found during and after the procedure. Transabdominal ultrasound- and laparoscopy-guided PMWA can be utilized to safely enhance the ablation rate while minimizing ablation time and avoiding harm to adjacent organs and the endometrium. This technique is applicable for treating uterine fibroids of different sizes and at varying locations. ChiCTR-IPR-17011910, and date of trial registration: 08/07/2017.

Giant "Hydra Headed" Uterine Fibroid in a Nullipara: A Case Report.

Uterine fibroids, or Leiomyoma is a type of Smooth Muscle Tumors of the uterus (SMTs) and are common in the black race. Giant uterine fibroids, on the other hand, are uncommon and may occur during patient dissimulation. Dissimulation may occur because of a dread of surgery and hospitals visits, fear of surgical death, chronic intake of herbal concussion, and a religio-traditional strong belief system on instant healing following prayers, among others. Myths like belief of defecating the uterine fibroids, some herbs that can melt them away, and the belief that such illness may follow ancestral curses can fuel dissimulation. The surgical approach can be a source of challenge, careful case selection considering the size and number of tumors can be helpful. We present a 35-year-old nulligravida who presented to the clinic with a 14-year history of progressive abdominal swelling. Examination revealed a firm mass with a symphysio-fundal height of 55 cm. She subsequently had an open abdominal myomectomy with all the myoma nodules weighing 12.9 kg in total! Histology confirmed uterine fibroid. It is possible to offer open myomectomy in patients with giant uterine fibroid following careful patient selection with a consent for possible hysterectomy. Dissimulation can be minimized with repetitive counseling of patients. The choice of surgery depends on the size and number of uterine fibroids, but surgical approach does not necessarily influence fecundity.

1012 The association between uterine fibroid size and number and risk of preterm birth

1012 The association between uterine fibroid size and number and risk of preterm birth

Fibroids and unexplained infertility treatment with epigallocatechin gallate: a natural compound in green tea (FRIEND) – protocol for a randomised placebo-controlled US multicentre clinical trial of EGCG to improve fertility in women with uterine fibroids

IntroductionUterine fibroids affect 30%–77% of reproductive-age women and are a significant cause of infertility. Surgical myomectomies can restore fertility, but they often have limited and temporary benefits, with postoperative complications...

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches.

Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient's age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as "myomectomy laparoscopic and open", "myomectomy open and minimally invasive", "myomectomy open and laparoscopic", and "myomectomy open vs. laparoscopic." The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.