CLINICAL PROFILE OF CASES WITH LEIOMYOMA
Dedeepya Rambhakta,1*N. Madhavi2
1Senior Resident, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally *2Professor, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally
Fibroids have therapeutic, diagnostic, and psychological challenges, being the most commonest benign tumour of the uterus,1 It is essential to analyze its clinical manifestations in various perspectives. They are slow growing, monoclonal tumours, of smooth muscle cells of myometrium.2 They are composed of large amount of extra cellular matrix containing collagen, fibronectin, proteoglycan. Fibroid can be single or multiple in number. Fibroids are symptomatic in 50% of the cases, with peak incidence of symptoms in 30s or 40s. Symptoms depend on site and size. Studies have shown that women with myomas are more likely to present with menorrhagia, abdominopelvic mass 3-9 but may also present with dyspareunia, dysmenorrhea, abdominal discomfort, or bloating, painful defecation, backache, urinary frequency, or retention, and infertility.5-9 During pregnancy, fibroids may cause miscarriage, bleeding, abnormal lie and presentation. Commoner symptoms include abdominal mass, menorrhagia, pain, dysmenorrhea and pressure symptoms from myoma.
Aims and Objectives:
To study the clinical manifestations of fibroid uterus.
Materials & Methods:
Study Design: Prospective observational study
Place Of Study: Kamineni Institute of Medical Sciences.
Inclusion Criteria: 50
- Patient attending gynecological OPD who have abnormal uterine bleeding, abdominal lump or any other symptoms of fibroid who have been detected to have fibroid by ultrasonography.
- Age group 20-60 years.
- Patient undergoing hysterectomy or myomectomy for fibroid uterus.
- Patient willing to give consent for enrolment in the study.
- Patients age <20 and >60 years.
- Patients with intrauterine pregnancy.
- Patients having other pelvic pathologies.
Selected patients were informed about the study, written consent was taken and then enrolled into the study. Clinical presentation was studied by taking detailed menstrual, medical, personal and family history in a specifically designed proforma. Patients were subjected to investigations like ultrasonography scan to confirm the presence and location of fibroid, surgical profile. Patients were managed with appropriate management according to standard hospital protocol. Post-surgery the hysterectomy/ myomectomy specimens were sent for histopathological examination and leiomyoma confirmed.
Age-In the present study all the patients were in the range of 20-60 years. Maximum numbers of patients were in the age group of 36-45 years, accounting for (76%) of all the cases.
Table 1 - Age group distribution (n=50):
|Age groups||No. of patients||%|
Parity: (8%) of the cases are nullipara, 11 (22%) of them are para 1, 21 (42%) of them are para 2, 14(14%)of them are para 3 or more. Therefore, most of them were parous (92%).
Table 2 - Parity (n=50):
|Parity||No. of patients||%|
Clinical manifestations – majority (86%) had menstrual irregularities, 50% had lump abdomen, 40% had pain abdomen, and 22% had urinary complaints.
Table 3 - Clinical manifestation (n=50)
|Clinical manifestations||No. of patients||%|
|Mass Per Abdomen||25||50%|
Menstrual symptoms- Menorrhagia (60%), dysmenorrheal (42%), polymenorrhea (24%) were most common type of menstrual abnormality.
The present study was conducted in the Department of Obstetrics and Gynecology with objectives to study the clinical manifestations of fibroid uterus. In the present study a total of 50 cases manifested with the symptoms of fibroid
Table 4-Menstrual Symptoms
|Menstrual Symptoms||No. of patients||%|
were studied from January 2017 till august 2018. Histopathological examinations were conducted for confirmation of fibroid uterus. Out of the 50 cases studied, it was observed that majority of women were in the age group of 36-45 years. Thus fibroid cases were common in 3rd and 4th decade of life and majority of women were parous (92 %), the findings are comparable to Pradhan et al10 where mean age was 43.4 years, and 90% were parous and Okogbo et al11 where mean age was 39.4 years and 68% parous. The most common presenting symptom was menstrual irregularity (86%) followed by lump in abdomen (50%), pain abdomen (40%), urinary complaints were reported in (22%) of cases. Results are similar to pradhan’s study11 where patients reported menstrual disturbance (73%) pain abdomen (58.4%), lump abdomen (13%) , urinary complaints (2.2%) and okogbo’s study4 also showed similar results where menstrual irregularities (47.7%), abdominal lump (39%), pain (24%) were chief complaints.
Present study found that menorrhagia as principle menstrual irregularity (60%) followed by dysmenorrhoea (42%) and polymenorrhoea (24%). Similar presentation was reported at pradhan where menorrhagia is 73% dysmenorrhoea 18%, okogbo12 and jose alberto fonseca-moutiqwnho et.al. 13 On clinical examination, out of 50 cases of fibroid, 25 had a palpable mass. Fibroids are generally associated with increased risk of heavy or prolonged menstrual flow.14,15 Proposed reasons for this include increase in endometrial surface area, distortion and congestion of surrounding vessels, abnormal endometrial development, increase in blood flow to the uterus, and poor contractility. 16,17
Thus we conclude from this study that menstrual irregularity was most common presenting symptom, followed by lump in abdomen and pain abdomen. Menorrhagia, dysmenorrhea, polymenorrhea were most common type of menstrual abnormality.
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