30yrs female ,primigravida diagnosed with intramural fibroids 9*8*6 should she continued pregnancy ? report attached ,

128 Likes

LikeAnswersShare

Drs,in this pt fibroids r 2. We r worried for intramural fibroid which is indenting the endometrium &/pusing it anteriorly so already pressure symptoms r there,wt of fibroid is 264 gm,with further growth of myometrium in pregnancy fibroid is also going to increase making more pressure over endometrial cavity & thus pregnancy Leading to Abortion Pressure symptoms on foetus. Can lead to even oligo Practically at present she is just 5 wks ,so easy termination with less mental trauma. Afterwards fibroid can shrink with lupride depot or uliprital,Tt for 6 mths. Or Laproscopic resection of fibroid after giving 3 doses of lupride inj. by a skilled Person.

Dear dr vasundhara ,wat d decision u took for this case
3

View 3 other replies

Continue pregnancy, give her Folvite nd support with micronized progesterone until 16 wks .pt should have absolute bed rest until delivery. Careful monitoring of the pregnancy for fetal growth .Start progesterone .inj after 16 wks --wkly up to 36 wks.Advise the pt to report immediately whenever she has any problem.Most of the pts with fibroids are prone for abortion or preterm delivery.Explain the risk to both the partners.She is a primi,if you plan for myomectomy risk of hysterectomy nd scar dehiscense during pregnancy should be kept in mind.I had delivered pts with big fibroids up to d size of 20 wks nd 24 wks .Em. LSCS was done at 36 wks.Better to give Betnasol coverage at 34wks.

I completely agree with you expect on complete bed rest.
1

View 6 other replies

we should try to continue d pregnancy wit risks explained. continue reg anc bed rest progesterone. steroids at 34 wks elective lscs.some complication if occurs can terminate pregnancy.direct termination I don't agree.

it's not going to threaten d life of mother.we can give a try
0

Mam fibroid is large enough to cause compression.,there are chances of compression present.so chances of abortion are seen.,retention of urine.red degeneration seen.even sub serosal fibroid seen.i think very small sac seen. So adviced termination. After which myomectomy done for both fibroids.

We should try to save the pregnancy .give her folic acid and high doses of natural micronisd progesterone. Explain the risk of missed abortion and preterm labour. I had a pt with 14 wks size uterus with early pregnancy with essential hypertension. We did lscs at 35 wks with a baby wt 1800 gms. She should avoid exertion but I think absolute bed rest not necessarily in fact it increases chances of DVT and gestational diabetes. Even after myomectomy pt don't coceive and may be she can sue u if don't conceive in future. Because fibroid as such is not an indication for abortion in a 30 yrs old primi pt

As she is primi , continue the pregnancy with close monitoring. Counsel the patient properly about the situation. as gestational sac is small so it depends on the progression of the pregnancy weather the fibroids will make any harm or not. so it is better to explain the chances of abortion and emergency lscs also if the foetus grows well.

* Termite the pregnancy. As size of Fibroid is enough to interfere the out come of pregnancy. * Though you can continue it, But if something happens later on it will be more frustrating for patient's to tolerate the reality. * More reasonable is to terminate & came out from the fibroid & later on plan for pregnancy..

CONTINUE THE PREGNANCY WITH ABSOLUTE BED REST.MICRONISED P TILL 16THWK , LATER 170HP ACTS AS TOCOLYTIC COTINUED TILL TERM.ALONG WITH THE ROUTINE MEDICATION.AS THE INTRAMURAL NOT COMPRESS THE CAVITY THERE MAY NOT BE ANY DISTURBANCE. COMING TO SUBSEROSAL ABSOLUTELY NO PROBLEM.PT MAY HAVE PAIN ABDOMEN IF THERE IS DEGENERATIVE CHANGES NEEDS AGAIN ABSOLUTE BEDREST, ANALGESICS&ANTISPASMODICS. COMING TO TERMINATION OF PREGNANCY OTHERSIDE &MYOMECTOMY.....SHE IS PRIMI, SUCH LARGE FIBROID REMOVAL MAY NOT BE A SMOOTH RESULT.SOMETIMES THE CHANCES OF CONCEPTION ITSEL F IS DIFFICULT. ONE MORE THING IS REMOVAL THIS MYOMA DURING LSCS AS SHE IS PRIMI &THE FIBROID IS INTRAMURAL&IT MAY CAUSE DISTORTION OF UT CAVITY OR IN DIFFICULT SITUATIONS LAND IN HYSTERECTOMY.YOU CAN DO IT DURING 2NDLSCS .MONITORING FOR FETAL GROWTH TIMELY DOPPLER STUDIES&DELIVER THE BABY.

Terminate the pregnancy. Needs removal of the fibroids Maximum chances of abortion As fibroid is reaching to endometrium

I disagree ,after removal of fibriods possibility of infertility is more Ofcourse risk factor is more But v must carry pregnancy wid utmost care
1

View 1 other reply

1. We can't 100% how the fibroid growths n how she might end up 2. We can continue pregnancy n keep a close watch on the growth of baby, there is more chances she might spontaneously end up In abortion, also chance of continuing pregnancy- so let's continue n watch for growth scan n limb abnormality 3. coming to fibroid perse- if she is symptomatic treat based on emergency or else just concentrate on pregnancy, she might end up with red degeneration , also subserosal pedunculated might go into torsion n may require emergency surgry 4. keeping her age also in consideration,explain patient pros n cons , if they agree for all pregnancy complication,watch out for pregnancy or if they are ready for abortion go on 5. if she ends up in abortion , then we can go on with myomectomy n luorolide

Load more answers

Cases that would interest you