Intramural Uterine Fibroids Research Articles

A Study of Fibroid Vascularization and Vascular Indices With Three-Dimensional Power Doppler and Superb Microvascular Imaging and the Correlation With Heavy Menstrual Bleeding.

Objective The objective of the study was to evaluate fibroid vascularization and vascular indices with three-dimensional (3D) power Doppler and superb microvascular imaging (SMI) and its correlation with heavy menstrual bleeding (HMB). Material and methods A total of 75 women with intramural uterine fibroid: 50 with HMB (Group A) and 25 without HMB (Group B)were recruited for the study. All participants were subjected to transabdominal and transvaginal color Doppler ultrasound. A 3D Power Doppler was used to measure Doppler Indices and flow rate in uterine arteries and the dominant vessel of fibroid. SMI was also used to determine vascularity in the dominant fibroid and to grade the vascularity. Results A significant association was observed between Doppler indices in the dominant feeding vessel of fibroid and HMB. Flow rates, namely peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly higher. Contrarily, resistance measured as Resistive Index (RI) and Pulsatility Index (PI) was lower in Group A than in Group B. The mean PSV of the dominant feeding vessel in group A was 26.42 ± 4.57and in group B was 14.56 ± 3.17, with p-value < 0.0001. For EDV, the median value (25th-75th percentile) in women with HMB was 6.76 (6.152-8.74) vs 3.99 (3.2-5.95)in womenwithout HMB (p < 0.0001). A significant association was observed between uterine artery Doppler indices (specifically, PSVand EDV) and HMB. However, no significant association was found between RI and PI of the uterine artery and HMB. In the study of the vascular pattern on SMI, the percentage of women exhibiting both central and peripheral vascularity in Group A and Group B were 72% and 4%, respectively (p< 0.0001). Women in Group A showed a significantly higher proportion of grade 2 and grade 3 vascularity (76% and 20%, respectively), whereas only 4% showed grade 1 vascularity. Conversely, in Group B, all the women showed grade 1 vascularity (p <0.001). Conclusion Doppler indices in the dominant feeding vessel of fibroid show a positive correlation with HMB. In the study of the vascular pattern on SMI, a significant proportion of women with HMB exhibited both peripheral and central vascularity and a higher grade. Most women with symptomatic fibroids are of childbearing age and fertility preservation is at times their prime concern. Fibroid vascularization assessed with 3D power Doppler ultrasound and the new advanced SMU tool may prove to be useful in the prediction of response to various non-surgical management options of uterine leiomyoma and thus aid in counseling and appropriate patient selection.

Management of Intramural Uterine Fibroid by Ayurveda - A case study

Too many female gynaecological issues are a result of shifting food habits and lifestyles. One of the main concerns for women who are of reproductive age is uterine fibroids. The symptoms of uterine fibroids have a detrimental effect on women's well-being, their ability to engage in social and physical activities, and their productivity at work. A 25-year-old married female patient arrived at the outpatient clinic complaining of lower abdominal pain, heavy menstrual flow, burning during micturition, and white discharge coming from her vagina six months ago . An intrauterine fibroid measuring 24 x 10 mm size with an ET of 10.5 mm was seen during the ultrasound examination. The ovaries' B/L measurements were normal, and the wall of the gallbladder was slightly enlarged. Surgery was recommended for the same condition, but the patient refused to have it done and preferred non-hormonal treatment. The patient refused to take any allopathic medication. The patient sought Ayurvedic treatment at the OPD. She received treatment in accordance with the Ayurvedic regimen prescribed by Kanchanar Guggulu, Kuberaksha vati, Raktavardhak vati, Ashoka-arishta, Hingwashtak churna, Chandraprabha vati, Kumaryaasawa.After three months of treatment and a follow-up every 15 days, a repeat scan showed normal results and symptom alleviation.

Молекулярные паттерны, связанные с повреждением, при интрамуральной миоме матки и бесплодии

Молекулярные паттерны, связанные с повреждением, при интрамуральной миоме матки и бесплодии

Robotic-assisted uterine transposition followed by anatomic pelvic repositioning for a patient with intramural fibroids and rectal cancer

To report the first described case of robotic-assisted utero-ovarian transposition followed by anatomic repositioning in the pelvis and cervicovaginal anastomosis in a woman with uterine fibroids, which was performed for fertility preservation in the context of pelvic radiation for rectal cancer. Description of technique and live-action narrated surgical footage showing uterine transposition and repositioning. University hospital. A 36-year-old woman with a new diagnosis of cT3N2M0 rectal adenocarcinoma planned for neoadjuvant chemotherapy and pelvic radiation and desired fertility preservation permissive of future pregnancy. A transvaginal ultrasound revealed a 5-cm posterior leiomyoma and a normal endometrial cavity. The patient elected for utero-ovarian transposition before chemoradiation. The patient included in this video gave consent for publication and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites. Per institutional guidelines, an Institutional Review Board review was not required. Robotic-assisted utero-ovarian transposition was performed in an inpatient setting 2 weeks after ovarian stimulation and oocyte retrieval. She was given a gonadotropin-releasing hormone agonist for menstrual suppression after oocyte retrieval. The uterus and adnexa were transposed en bloc to the upper abdomen, with perfusion via retroflected infundibulopelvic ligaments. Intravenous indocyanine green was administered intraoperatively to visualize uterine perfusion. Three weeks postoperatively, the patient underwent surgical management of small bowel obstruction, which was successfully managed with laparoscopic adhesiolysis. The patient subsequently completed chemoradiation and had a complete response to the rectal tumor. She therefore elected for surveillance. Seven months after transposition and 2 months after completion of treatment, the patient underwent uncomplicated robotic-assisted utero-ovarian anatomic repositioning in the pelvis with cervicovaginal anastomosis. Chromopertubation confirmed tubal patency. Restoration of normal pelvic anatomy and resumption of reproductive physiology. At her 4-month postoperative visit, the cervix and vagina were normal in appearance. The patient reported the return of spontaneous menses and sexual activity without complications. This case is unique because of the presence of bulky intramural uterine fibroids. The described technique may be useful for selected cancer patients who desire to carry a pregnancy after pelvic radiation for cancer treatment, and demonstrates that patients considering utero-ovarian transposition need not be excluded solely on the basis of the presence of uterine fibroids.

Endometrial blood flow evaluation in women with uterine fibroids during in vitro fertilization treatment

BACKGROUND: Sufficient endometrial blood supply in the mid-secretory phase of the menstrual cycle is a key to a successful pregnancy achievement, and a decreased spiral artery blood flow resistance determined by the Doppler is known to be positively associated with successful in vitrofertilization outcome. Particular aspects of endometrial blood flow in women with uterine fibroids might affect the efficiency ofin vitrofertilization and intra cytoplasmic sperm injection cycles.&#x0D; AIM:The aim of this study was Doppler-based determination of the uterine and spiral artery blood flow resistance in women with uterine fibroids throughout controlled ovarian stimulation inin vitrofertilization cycles, depending on the clinical pregnancy rate.&#x0D; MATERIALS AND METHODS:Doppler ultrasound spiral artery blood flow evaluation was performed in 83 women throughout thein vitrofertilization cycle. Intramural uterine fibroids were detected in 44 women, and 39 women with no uterine fibroids comprised the comparison group. All women underwent a Doppler study of spiral artery blood flow on the second or third day of the menstrual cycle (at the start of thein vitrofertilization protocol) and on the day of embryo transfer. Thein vitrofertilization efficiency was determined by the onset of clinical pregnancy after visualizing the gestational sac in the uterine cavity during ultrasound examination on the 2025th day after embryo transfer.&#x0D; RESULTS:The values of the uterine and spiral artery blood flow resistance in the uterine fibroids group were determined to be significantly lower than those in the comparison group. Considering the identified influence of decreased spiral artery blood flow resistance on the results ofin vitrofertilization cycles in the comparison group, we have analyzed the dependence of the efficiency of the cycles based on the rate of the spiral artery blood flow resistance decline. Thus, a significantly more reliable decline in the pulsatility index was revealed in pregnant women from the comparison group throughout thein vitrofertilization cycle compared to women with negative results. In women with uterine fibroids, the pulsatility index decline did not differ depending on the onset of pregnancy, and the decline rate differed significantly from that in the comparison group.&#x0D; CONCLUSIONS:Uterine fibroids are associated with a stable decline in the uterine and spiral artery blood flow resistance. This leads in turn to increased endometrial vascularization throughout the stimulation cycle inin vitrofertilization programs and negatively affects the blastocyst implantation ability.

High-Intensity Focused Ultrasound Ablation of Uterine Fibroids: A Review.

Leiomyomas, or uterine fibroids, are growths consisting of muscle and tissue that develop in or on the uterine wall. The most frequent benign uterine tumours in women of reproductive age are thought to be fibroids. Dysmenorrhea, spotting, hypermenorrhoea, abdominal pain, pressure on surrounding organs, and issues with micturition and defecation are among the symptoms that are often present. Fibroids can form as a single nodule or as a cluster. Uterine fibroids, especially large submucosal and intramural uterine fibroids, can cause obstacles to implantation and lead to pregnancy loss. Uterine fibroids can be treated without surgery and with little downtime using focused ultrasound. There is published research showing that women can conceive and have healthy children after therapy, thus protecting fertility. The ablation of uterine fibroids by high-intensity focused ultrasound (HIFU) is successful since the volume of the fibroids is significantly reduced.

Ayurvedic Intervention of Garbhashyagata Granthi (Uterine Fibroid) - A Case Report

Uterine fibroid is most common solid benign tumors in women of reproductive age. The symptoms of uterine fibroid adversely affect social and recreational activities, women's quality of life, and productivity at work. Uterine fibroid occur in 50–60% of women, rising to 70% by the age of 50 and in 30% of cases cause morbidity. A 40-year-old married woman consulted in the outpatient department (OPD) of P.G. department of Prasutitanta and Striroga with a complaint of heavy and prolong menstrual bleeding with painful menstruation since 5 years. It is associated with lower back pain, lower abdominal pain, frequent urination, mild constipation and pain in both lower extremities. Her Ultrasonography report shows bulky uterus and intramural uterine fibroid size of 19x17x25 mm. Patient was treated according to Ayurvedic management of Granthi. So the drug having properties Raktstambhak, Lekhana, Raktshodhak, Shothahara, etc. are used with advice of Pathya Aahar-Vihara.Treatment was continued for one years with a follow up once in 15days and a repeat scan revealed shrinking size of the fibroid and relief in all symptoms.

Sonographic Evaluation of Pelvic Pain in Gravid and Non-Gravid Uterus

Aim: To evaluate sonographically pelvic pain and contribution of pelvic ultrasound in diagnosing pelvic pathologies in females with gravid and non-gravid uterus. Study Design: Cross-sectional analytical study Place and Duration: Sami Diagnostic and Waraich Ultrasound center Jauharabad (Khushab). Duration of study was 9 months. Methodology: Convenient sampling technique was used and 100 patients were enrolled. Toshiba Xario and Hitachi Aloka ultrasound machines were used. Study included females with gravid uterus, nongravid uterus, and those with pelvic pain present and also with absent pain. It excluded females with non-gynecological complaints. Both transabdominal and transvaginal ultrasound modalities were used. Longitudinal, transverse and oblique views were taken. Based on sonographic findings, diagnosis was made and image recorded. SPSS version 22.0 was used for data analysis. Results: In patients with gravid uterus pelvic pain was present in 23 (67.6%) and absent in 11 patients (32.4%). In non-gravid uterus pelvic pain was present in 64 (97.0%) and absent in 2 (3.0%). Most common finding was Intramural uterine fibroid (12%) with pain present in 8 and absent in 4 patients followed by hemorrhagic ovarian cyst HOC (10%) with pelvic pain present in 9 and absent in 1, simple ovarian cysts (7%) caused pelvic pain in 7 patients and in subserosal fibroid (6%) pelvic pain was present in 4 patients and absent in 2 patients. 10% females were presented with pelvic pain but showed normal ultrasound findings. Conclusion: Ultrasound is modality of choice to determine the pelvic pathologies in females. Pelvic pain was present more in non-gravid females. Most incident etiology causing pelvic pain was intramural fibroids. Age factor is one of the most effecting factors for the pelvic pain in gravid uterus. Keywords: Ultrasound, Pelvic pain, Fibroids, Hemorrhagic ovarian cyst, Ovarian cyst

Efficacy of Oxytocin in Reducing Blood Loss During Abdominal Myomectomy

Introduction: The drug of choice for preventing postpartum uterine atony and bleeding is oxytocin. Myomectomy is a procedure that may result in substantial bleeding. In about 20% women, transfusion of blood may be required during abdominal myomectomy. The objective was to compare the frequency of patients who needed blood transfusions with and without oxytocin during abdominal myomectomy. Place and duration of study: This was a randomized controlled trial carried out at the Department of Obstetrics and Gynecology of Sharif Medical Complex Lahore from 10th May 2018 to 10th November 2018. Material &amp; Methods: 108 patients having intramural uterine fibroid &gt; 5 cm in size, requiring planned elective open abdominal myomectomy were included and equally divided in both oxytocin and non-oxytocin groups(n=54). 30 IU oxytocin infusion (in 500 ml normal saline) / 120 milliliter per hour were administered during myomectomy, starting after administration of general anesthesia and completing just prior to surgery in patients of oxytocin group. An infusion of pure normal saline was administered at the same amount in the patients of non-oxytocin group. Blood loss was estimated and need for blood transfusion was determined in both the groups. Data was analyzed using SPSS version 24. P-value&lt;0.05 was considered significant. Results: Patients age ranged from 35 to 45 years with mean age of 40.481± 1.84 years in Oxytocin group while 40.425± 2.68 years in Non-Oxytocin group. Mean blood loss was 290.463±120.91 cc in Oxytocin group and 424.981±106.21 cc in Non-Oxytocin group. Need for blood transfusion was seen in 7.4% patients in Oxytocin group as compared to 25.9% in Non-Oxytocin group (p=0.009). Conclusion: Our study concludes that to reduce loss of blood during abdominal myomectomy, infusion of intra- operative oxytocin may be efficient and safe. To confirm these results, more studies with varied dosages and protocols are required.

Clinicopathological Patterns and Biochemical Markers in Serum of Uterine Leiomyoma Patients

Background: Uterine fibroids (leiomyomas) are exceedingly common reproductive neoplasms with foremost public health impact. A cross-sectional study was performed to systematically investigate the marker enzymes, clinicopathological correlations, and electrolyte profile in myoma Method: This study enrolled 44 control and 46 leiomyoma subjects, aged 21- 50 years. Anthropometric parameters, detailed history of disease and clinicopathological outcomes were documented via a standardized questionnaire followed by uterine ultrasound investigation. Venous blood samples were taken for the measurement of marker enzymes and serum electrolyte concentration with commercially accessible kits Results: In the age group between 30-40 years high incidence of myoma (43.5%) was found. Majority of fibroids were observed single (52%) and Intramural uterine fibroids were found more common type (61%) of leiomyomas. Menorrhagia was frequent clinical demonstration with 63% leiomyoma cases. In 26% myoma women positive family history of leiomyomas was also observed. A significant increase in diastolic blood pressure (DBP) and body mass index (BMI) while in parity a significant decrease was recorded in leiomyoma patients in comparison with controls. Serum electrolytes investigation revealed a substantial increase in the calcium (Ca2+) as well as chloride (Cl–) concentration and significant drop in potassium (K+) concentration in myoma subjects when compared to the controls. While for serum sodium (Na+) concentration, a non-significant difference was documented between comparable groups. Analysis of marker enzymes manifested a significant increase in the serum concentration of aspartate transaminase (AST), alanine transaminase (ALT) and acid phosphatase (ACP) in fibroid patients in comparison to controls whereas non-significant variations were recorded for serum alkaline phosphatase (ALP) concentration. Conclusion: A reduced serum K+ concentrations and raised Ca2+, Cl–and Na+ levels in the leiomyoma patients illustrate increased estrogen concentration, that may be responsible for fibroid growth and serum concentration of AST, ACP and ALP are sustainable diagnostic markers of uterine fibroids.

Assessment of placental complex function and miscarriage prevention in pregnant women with uterine fibroid

The objective: to reduce the frequency of the threat of pregnancy interruption and loss in women with uterine fibroid through treatment prediction and improvement.Materials and methods. A complex examination of 70 pregnant women with uterine fibroid at 15-16 weeks of pregnancy (main group) and 50 pregnant women without uterine fibroid at the same gestational term (control group) was carried out at 4 clinical bases of the Department of Obstetrics and Gynecology N1 of the Shupyk National Healthcare University of Ukraine in the time period of 2020-2022. Pregnant women in the main group were divided into 2 subgroups depending on the type of the nodes: Ia – 39 pregnant women with subserous type of fibroid nodes (type 5-6 according to FIGO) and Ib – 31 pregnant women with intramural fibroid (type 3-4 according to FIGO). The pregnant women in the main group received the complex of developed therapy for pregnancy interruption (micronized progesterone, magnesium preparations, vitamin B6, acetylsalicylic acid), in the control one – the common therapy (bed rest, abstinence from sexual life, micronized progesterone preparations, tranexamic acid).The concentrations of estradiol, progesterone, human chorionic gonadotropin (hCG) were determined in the blood plasma of all persons at 15–16 weeks and 24 weeks of pregnancy.Results. In the II trimester the concentration of estradiol in the blood of pregnant women with intramural uterine fibroid, especially with multiple forms, was significantly higher than in the control group (p&lt;0.05). At the same time, in pregnant women with intramural fibroid node(s) the mean concentration of estradiol exceeded the similar indicator in the group with the subserosal type (p&lt;0.05). These changes indicated the stress of the hormonal function of the placenta and were considered by us as one of the signs of the initial stage of placental dysfunction.With an increase in estradiol concentration, a significant decrease in progesterone amount was noted. Progesterone deficiency was significantly more common in the subgroup of pregnant women with multiple intramural uterine fibroid and nodes in contact with the uterine cavity, especially at the place of placenta attachment (type 3) – 165.24±14.71nmol/l compared to the control group – 219.96±16.63 nmol/l, and with pregnant women with subserosal node(s) – 210.61±18.57 nmol/l (р&lt;0.01), which confirms the threat of abortion and indicates the development of placental dysfunction. In the II trimester of pregnancy the concentration of hCG in women with uterine fibroid was significantly lower than in women without uterine fibroid and especially lower in multiple uterine fibroid. In the women of the main group progesterone and hCG concentrations in the blood plasma normalized (p&gt;0.05) after the treatment, but the level of estradiol in the group of pregnant women with multiple intramural uterine leiomyoma remained significantly higher (p&lt;0.05).Conclusions. Pregnant women with uterine fibroid have an increased risk of placental dysfunction with a disbalance of the main placental hormones: an increase in estradiol concentration and a relative decrease in progesterone and human chorionic gonadotropin, a shift in the estrogen-progesterone balance towards relative hyperestrogenia.The use of medical measures with long-term support with progesterone, magnesium and low doses of acetylsalicylic acid for the prevention of miscarriage in persons with the clinical manifestations of the threat of gestation is quite effective.

Effect of ultrasound on subserosal and intramural fibroids in vitro: A quasi-experimental study of physical therapy

The aim of this study was to determine the effect of ultrasound (US) on extra subserosal and intramural uterine fibroids in vitro. A quasi-experimental, randomized, pre-post intervention study of physical therapy was conducted. Thirty women, who underwent myomectomy for subserosal or intramural fibroids with any leiomyomas' volumes in the operating room of Bab El-Sharia Hospital, participated in the study. Thirty uterine fibroids whose were collected from participants were randomly divided into three groups (I, II and III), and exposed to ultrasound therapy for 15, 30, and 45 minutes respectively. Leiomyomas volumes were measured using the fluid displacement method before and after the application of US. The samples were kept in saline solution immediately after their excision from operating room to be transferred to physical therapy department in same hospital to apply ultrasound therapy. Results of all study groups (I, II, and III) showed a statistically significant decrease in the volume of subserosal and intramural leiomyoma post US application (p&gt;0.05). However, there was no statistically significant difference in the size of the subserosal and intramural leiomyoma between study groups (p&lt;0.05). In conclusion, the ultrasound therapy is effective in shrinking the volume of subserosal and intramural leiomyomas without effect of long duration ultrasound therapy.

Use of a microsurgical vascular clip system for temporary bilateral occlusion of the four main uterine vessels for laparoscopic enucleation of very large intramural uterine fibroids

ObjectivesThe goal of this study was to examine the safety, feasibility, and effectiveness of the use of a microsurgical temporary vascular clip system to facilitate the laparoscopic enucleation of very large intramural uterine fibroids.MethodsIn this retrospective study, the surgical outcomes of 26 patients who underwent laparoscopic myomectomy with temporary uterine vessel clipping for very large (the largest measured diameter ≥ 9 cm) symptomatic intramural uterine fibroids in two tertiary referral hospitals between September 2017 and March 2020 were examined. Titan-made vascular clips (YASARGIL® Aneurysm Clip System) were used to temporarily occlude the bilateral uterine arteries and utero-ovarian vessels. Main outcomes included operating time, blood loss, number of leiomyomas and weight, conversion rate, intra- and postoperative complication rates, and length of hospital stay.ResultsTwenty six patients were included. Dominant intramural uterine fibroid diameters were 9–22 cm. The general characteristics of the patients were similar. The mean surgery duration and intraoperative blood loss were 175.3 ± 32.7 (range 120–250) min and 241.1 ± 103 (range 100–450) ml, respectively. The median postoperative drop in hemoglobin was 0.89 ± 0.75 g/dL. No patient required blood transfusion. No procedure was converted to laparotomy. No major intra- or postoperative complication occurred.ConclusionsLaparoscopic myomectomy for very large intramural uterine fibroids can be performed safely and effectively, with less intraoperative blood loss, using vascular clips for temporary clamping of the bilateral uterine vessels.

Low first trimester maternal serum PAPP-A concentrations in women with non-cavity-distorting intramural uterine fibroids.

Reliable aneuploidy risk estimation in first trimester is prominently interconnected with accurate assessment of maternal serum biomarkers. Some maternal factors like insulin-dependent diabetes, weight, and rhesus status are known to alter levels of these biomarkers. Adjustment of biomarker values for specific factor is crucial to avoid excessive invasive procedures or missed diagnoses. We aimed to investigate the effects of noncavity distorting intramural uterine fibroids on first trimester aneuploidy screening test maternal serum biomarkers. Pregnant women who underwent first trimester aneuploidy screening test in a single tertiary center between 2011 and 2020 were retrospectively assessed. One hundred ninety-eight women were found to have at least one noncavity distorting intramural uterine leiomyoma (Figo type 3-6) of at least 2cm diameter and remaining women were assigned as controls. First trimester aneuploidy screening test parameters were compared. Pregnancy associated plasma protein-A (PAPP-A) MoMs were found significantly lower in leiomyoma group in comparison to control group (1.19 ± 0.60 MoM vs. 1.40 ± 0.73 MoM, p=0.002). PAPP-A MoMs in women with leiomyomas larger than 5.5cm were significantly lower in comparison to both control group and women with ≤5.5cm leiomyomas (0.82 ± 0.376 vs. 1.40 ± 0.73, p < 0.001; 0.82 ± 0.376 vs. 1.33 ± 0.61 p < 0.001, respectively). PAPP-A MoM and size of leiomyoma were found inversely correlated when fibroid size exceeds 5.5cm (r=-0.467, p < 0.001). Noncavity distorting intramural uterine leiomyomas >5.5cm are associated with low first trimester PAPP-A MoMs (<0.5). PAPP-A concentrations are inversely correlated with fibroid size in women with >5.5cm intramural uterine leiomyomas. Fibroids ≤5.5cm are not associated with alterations in first trimester aneuploidy screening test parameters.

1306 Robotic Myomectomy

Video Objective Describing a minimally invasive technique for a solitary intramural myomectomy. Setting A 28-year-old African American nulliparous woman presented with pelvic pressure and ultrasound evidence of a large posterior/fundal intramural fibroid measuring 6 cm. She had abnormal and heavy uterine bleeding that was refractory to medical therapy. Definitive surgical treatment was desired and thus a robotic approach was planned. Interventions Myomectomy of a solitary intramural uterine fibroid is performed robotically. Several surgical tips are utilized and described herein. Tip#1: horizontal incision; Tip#2: Utility of a tenaculum for traction; Tip#3: Electrosurgical coagulative dissection; Tip#4: Layered closure with a resorbable barbed suture. Conclusion Hemostatic horizontal incisions, traction with a tenaculum, coagulative dissection, and the utility of a barbed resorbable suture are all steps one can utilize for successful completion of a myomectomy via robotic route.

An intramural uterine fibroid became submucosal in the puerperium \u2013 proposed probable mechanism: a case report

BackgroundVaginal prolapse of a large uterine fibroid is a rare phenomenon in a woman who delivered vaginally recently, given that this fibroid might have obstructed labor. The author presents a case report of a vaginally prolapsed large pedunculated submucosal uterine myoma in a woman with a recent uncomplicated vaginal delivery.Case presentationA 25-year-old black African woman had four intramural uterine fibroids of diameters 62 to 94 mm diagnosed in April 2013 with standard ultrasound scan. She got pregnant in July 2014. An ultrasound scan done on 31 August 2014 at 10 weeks’ gestation identified four intramural uterine fibroids, with sizes varying from 70 to 150 mm. Her pregnancy was well followed up, without any complications. She had an uneventful vaginal delivery on 10 April 2015. During uterine exploration, indicated for retention of parts of fetal membranes, no pedunculated submucosal fibroid was found. On 15 May 2015, she consulted for difficult micturition and partial urinary retention that occurred 2 days ago. A vaginally prolapsed 10 cm uterine fibroid was diagnosed. Forty-eight hours after administration of intravenously administered broad spectrum antibiotics, the myoma was successfully twisted off by means of vaginal route under general anesthesia, which relieved her symptoms.ConclusionsTo the best of our knowledge, this is the first case of vaginally prolapsed large submucosal uterine fibroid in a woman who delivered vaginally recently. The author recommends that women with known large low situated uterine fibroid should be well observed during the postpartum period to diagnose a vaginally prolapsed uterine fibroid early, so as to prevent fibroid superinfection and obstructive complications.

Aberrant Akt Activation During Implantation Window in Infertile Women With Intramural Uterine Fibroids.

The objective of the study was to examine the expression and cellular distribution of key signaling components of the phosphatidylinositol-3-kinase (PI3K)/Phosphatase and Tensin Homolog Deleted on Chromosome Ten (PTEN)/Protein Kinase B (PKB/Akt) pathway during the window of implantation in infertile women with noncavity-distorting intramural uterine fibroids (n = 21) as compared to fertile controls (n = 15). Relative gene expression analysis of PIK3CA, PTEN, Akt1, and Akt2 genes in midluteal endometrial biopsies was performed by real-time polymerase chain reaction. Immunohistochemistry was used to evaluate the expression of PIK3CA, PTEN, phospho-PTEN, Akt1, Akt2, phospho-Akt1 (serine 473), phospho-Akt1 (threonine 308), and Ki67 proteins. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling assay was performed for apoptosis detection. In comparison to fertile controls, significant upregulation of Akt1 messenger RNA levels (2.16-fold; P < .05); cell-specific upregulation of the proteins phospho-PTEN ( P < .05), Akt1 ( P < .05), Akt2 ( P < .05), and p-Akt (S473; P < .001); and downregulation of PTEN ( P < .01) were observed in endometrium of infertile women with intramural fibroids. The ratio of p-PTEN/PTEN and p-Akt1 (S473)/Akt1 was also significantly higher in infertile women. Increased Ki67 labeling index in the glandular epithelium and significantly lower apoptotic index in glandular epithelium and stroma were seen in infertile women during the window of implantation. Aberrant Akt activation and the associated imbalance in endometrial proliferation and apoptosis observed in infertile women with intramural fibroids during the midsecretory phase might contribute to impaired endometrial receptivity leading to infertility in these patients.

Laparoscopic uterine artery bipolar coagulation plus myomectomy vs traditional laparoscopic myomectomy for “large” uterine fibroids: comparison of clinical efficacy

Laparoscopic myomectomy is the uterus-preserving surgical approach of choice in case of symptomatic fibroids. However, it can be a difficult procedure even for an experienced surgeon and can result in excessive blood loss, prolonged operating time and postoperative complications. A combined approach with laparoscopic uterine artery occlusion and simultaneous myomectomy was proposed to reduce these complications. The aim of this study was to evaluate the safety and efficacy of the combined laparoscopic approach in women with symptomatic "large" intramural uterine fibroids, compared to the traditional laparoscopic myomectomy alone. Prospective nonrandomized case-controlled study of women who underwent a conservative surgery for symptomatic "large" (≥5cm in the largest diameter) intramural uterine fibroids. The "study group" consisted of women who underwent the combined approach (laparoscopic uterine artery bipolar coagulation and simultaneous myomectomy), while women who underwent the traditional laparoscopic myomectomy constituted the "control group". A comparison between the two groups was performed, and several intraoperative and postoperative outcomes were evaluated. No significant difference in the overall duration of surgery between women of the "study group" and "control group" emerged; however, a significantly shorter surgical time for myomectomy was observed in the "study group". The intraoperative blood loss and the postoperative haemoglobin drop were significantly lower in the "study group". No difference in the postoperative pain between groups emerged, and the postoperative hospital stay was similar in the two groups. The laparoscopic uterine artery bipolar coagulation and simultaneous myomectomy is a safe and effective procedure, even in women with symptomatic "large" intramural uterine fibroids, with the benefit of a significant reduction in the intraoperative blood loss when compared to the traditional laparoscopic myomectomy.

OP24.04: Value of “elasto strain ratio” ultrasound elastography in the diagnosis of intramural uterine fibroids: preliminary study

OP24.04: Value of “elasto strain ratio” ultrasound elastography in the diagnosis of intramural uterine fibroids: preliminary study

Transvaginal postpartum manual removal of a prolapsed submucous leiomyoma, initially diagnosed hybrid predominantly intramural

We present a rare case of a large infarcted submucous fibroid removed manually after a normal vaginal delivery. This patient was known to have a large postero-fundal hybrid predominantly intramural...