scholarly journals Reproductive outcomes following surgical removal of uterine fibroids

2019 ◽  
pp. 110-118
Author(s):  
A. E. Mitichkin ◽  
Yu. E. Dobrokhotova ◽  
N. Yu. Ivannikov ◽  
V. I. Dimitrova ◽  
O. A. Slyusareva ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Drug Withdrawal ◽  
Uterine Fibroids ◽  
Reproductive Function ◽  
Uterine Myoma ◽  
Surgical Removal ◽  
Birth Canal ◽  
Uterine Arteries ◽  
Natural Birth ◽  
Prospective Comparative Study

The cohort prospective comparative study investigated the efficacy of mifepristone use in patients after surgical treatment of uterine myoma. It was shown that the use of mifepristone at a dose of 50 mg/day in a continuous mode for 3 months after surgical treatment for proliferating uterine myoma led to the absence of recurrences of the disease for 2 years after the drug withdrawal. The use of mifepristone after embolization of uterine arteries allowed to significantly reduce the size of the node by 25% during 12 months and by 50% (p<0.05) after 24 months. Complex treatment of uterine myoma, including myomectomy and drug therapy with mifepristone, allowed to realize reproductive function in 46% of patients, and delivery through the natural birth canal occurred in 24% of patients.

scholarly journals The choice of the X-ray endovascular method for the treatment of uterine fibroids and the possibility of prolonging the remission of the disease

2021 ◽  
pp. 51-66
Author(s):  
A. E. Markarov ◽  
S. V. Apresyan ◽  
V. I. Dimitrova ◽  
S. A. Papoyan ◽  
D. G. Gromov ◽  
...  
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Function ◽  
Balloon Occlusion ◽  
Eligibility Criteria ◽  
Iliac Arteries ◽  
Uterine Arteries ◽  
Internal Iliac ◽  
Prospective Comparative Study ◽  
Laparoscopic Assisted ◽  
Continuous Use

Introduction. In the cohort prospective comparative study, the investigators examined the effectiveness of intraoperative administration of Antiadgesin and adjuvant therapy with Gynestril after laparoscopic-assisted myomectomy combined with temporary balloon occlusion of the internal iliac arteries and embolization of uterine arteries in the treatment of uterine fibroids.Objective. To achieve stable remission of the disease, improve reproductive outcomes after myomectomy.Materials and methods. 100 women who underwent organ-preserving treatment of uterine fibroids from January 1, 2015 to December 31, 2020 were enrolled in the study. The eligibility criteria were as follows: the age of 28–45 years (the mean age was 34 ± 4.5 years), organ-preserving treatment of uterine fibroids. The exclusion criteria from the study were as follows: the age of over 45 years; allergic reactions to mifepristone, Antiadgesin and contrast media; patients with contraindications for use of drugs, with aggravated medical history, with liver diseases, with endometrial hyperplastic processes (adenomyosis, endometrial hyperplasia).Conclusions. It has been shown that the continuous use of Gynestril at a dose of 50 mg/day for 3 months after surgical treatment due to proliferating uterine fibroids led to the absence of disease-recurrences within two years after discontinuation of the drug, and the occurrence of a relapse in one patient three years after treatment. The use of Gynestril after embolization of the uterine arteries made it possible to statistically reduce the size of the node by 25% within 12 months, 50% after 24 months and 70% – after 36 months. (p <0.05). Intraoperative use of Antiadgesin made it possible to prevent adhesion and development of tubalperitoneal infertility.Conclusion. The combination treatment of uterine fibroids, including myomectomy and drug therapy with Antiadgesin and Gynestril, made it possible to implement reproductive function in 73.3% of patients, moreover, 40% of patients had undergone a natural delivery

Myomectomy or conservative management of uterine fibroids: effects on reproductive potential

2021 ◽  
Vol 70 (5) ◽  
pp. 95-104
Author(s):  
Alexandra I. Shapovalova ◽  
Eduard N. Popov ◽  
Elena V. Mozgovaya
Keyword(s):  
Caesarean Section ◽  
Comparison Group ◽  
Uterine Fibroids ◽  
Main Group ◽  
Uterine Myoma ◽  
Laparoscopic Myomectomy ◽  
Inclusion Criteria ◽  
Birth Canal ◽  
Natural Birth ◽  
Uterine Scar

AIM: The aim of this study was to analyze reproductive function, pregnancy and labor in women after laparoscopic myomectomy and in women with unoperated myoma. MATERIALS AND METHODS: The main group consisted of 60 patients aged 25-46 years with a scar on the uterus who had laparoscopic myomectomy. Inclusion criteria were full-term pregnancy, uterine scar after laparoscopic myomectomy for subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). The comparison group included 30 women aged 25-46 years who were not surgically treated. Inclusion criteria were full-term pregnancy, subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). All patients in the main group underwent laparoscopic myomectomy. In all cases, the myomatous nodule was removed intracapsularly, leaving the leiomyoma pseudocapsule, which, with a deep arrangement of the transmural myomatous nodules, avoided opening the uterine cavity; myomatous nodule morcellation being used. With a deep intramural arrangement of the leiomyoma, the myometrial defect was sutured layer by layer with the application of several rows of endosutures. RESULTS: Six months after myomectomy, the patients underwent MRI of their pelvic organs with contrast. In 95% of cases, the uterine scar had no anatomical insolvency. In assessing the anamnesis, gynecological diseases occurred two times more often in women in the main group: 22 (36.7%) patients resorted to the use of the in vitro fertilization method for pregnancy, while among the patients in the comparison group, there were only two (6.7%) of them (2 = 12.8; р 0.001). In the main group, moderate preeclampsia and gestational diabetes mellitus were twice as common. In the main group, all patients were delivered by caesarean section, of which 83.3% were planned and 16.7% were emergency. In the comparison group, 73.3% of patients were delivered through the natural birth canal and 26.7% by caesarean section (2 = 149, p 0.0001). The most unfavorable signs predisposing to obstetric complications and operative delivery were the presence of multiple nodules (OR = 5.96 (1.09-32.72), p 0.05), the location of the nodule or scar in the uterine bottom (OR = 2.52 (1.00-6.33), p 0.05), and their combination with IVF (OR = 9.09 (2.42-34.07), р 0.01). CONCLUSIONS: In 95% of women, the scar on the uterus after myomectomy was consistent, but all these pregnant women were delivered by cesarean section, mainly for combined indications. However, they carried out the pregnancy safely, with a good outcome for the fetus. In women with uterine myoma and its conservative management, there was a lower rate of aggravated gynecological history and obstetric complications, and 73.3% of them were delivered through the natural birth canal. Despite the increased risk of caesarean section, the presence of uterine fibroids, even of a large size (more than 4 cm), should not be considered as a contraindication to vaginal delivery.

scholarly journals Myoma pseudocapsule - a biological and surgical structure to respect during myomectomy

2020 ◽  
Vol 148 (3-4) ◽  
pp. 236-241
Author(s):  
Andrea Tinelli ◽  
Radmila Sparic
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Biological Process ◽  
Positive Impact ◽  
Uterine Fibroids ◽  
Reproductive Function ◽  
Muscle Scar ◽  
New Techniques ◽  
Anatomical Studies ◽  
Surgical Practice

Uterine fibroids affect almost one in two patients, causing many pelvic problems and requiring pharmacologic and surgical treatment. For many years, the importance of the fibroid was emphasized as uterine pathology, without focusing on the complex myometrial biology peripheral to fibroid. Moreover, the traditional surgical technique in fibroid removal has not been investigated for years. In recent years, on the contrary, morphological, neuroendocrine and anatomical studies have demonstrated the importance of a biological and surgical structure surrounding myoma, rich in neurotransmitters and neurofibres, the myoma pseudocapsule. This structure is formed in the womb peripheral to fibroid onset, it separates the fibroid from the myometrium and acts as a tissue regenerator after the removal of the fibroid from the uterus. The translation of scientific research on pseudocapsules into surgical practice has allowed us to identify new techniques of myomectomy, removing the myoma inside the pseudocapsule and promoting the pseudocapsules sparing surgery. All this to favor the subsequent biological process of uterine scarring and healing, by activating the neurotransmitters and neurofibres present in the myometrial fovea. The correct healing after fibroid removal restores the uterine anatomy, with a positive impact on subsequent reproductive function, reducing problems related to the muscle scar.

scholarly journals Current trends in the pharmacotherapy of uterine myoma, associated with heavy menstrual bleeding and anemia: review

2020 ◽  
Author(s):  
Z. V. Revazova ◽  
L. V. Adamyan ◽  
O. N. Loginova ◽  
L. M. Manukyan ◽  
K. N. Arslanyan
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Function ◽  
Uterine Myoma ◽  
Reproductive Age ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Cochrane Library ◽  
Pharmacological Agents ◽  
Surgical Interventions ◽  
Current Trends

Aim: to summarize results of up-to-date world researches on the current trends of symptomatic myoma treatment.Materials and Мethods. A search of publications was carried out in the main international databases in Russian and English languages: PubMed/MEDLINE, The Cochrane Library, Embase, eLibrary. The analysis included studies published over the past 10 years examining the clinical efficacy and safety of various groups of pharmacological agents for the treatment of uterine myoma combined with heavy menstrual bleeding in women of reproductive age.Results. Currently, the treatment of uterine fibroids is divided into three main methods: surgical, minimally invasive organ-preserving methods, and pharmacotherapy. Until now, surgical intervention remains the main method of treatment, and, unfortunately, is often carried out in the volume of hysterectomy. However, today it is important to have a personalized approach to the management of a patient with symptomatic uterine myoma, taking into account her desire to preserve reproductive function. The development of the possibilities of drug therapy made a great contribution to the optimization of managing such patients.Conclusion. The global trend is to decrease the number of radical interventions, as well as the development and improvement of new methods of treating symptomatic uterine fibroids. Currently, pharmacotherapy of leiomyoma can significantly improve the quality of life of patients, reduce radical surgical interventions, optimize surgical treatment, and in certain situations, completely eliminate the need for surgery.

Uterine fibroids, laparoscopic surgery and morcellation. Literature review

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 22-25
Author(s):  
Alexander A Seregin ◽  
Anastasiia B Nadezhdenskaya ◽  
Aleksandra V Asaturova ◽  
Dmitry L Ovodenko
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Uterine Fibroids ◽  
Extraction Process ◽  
Uterine Myoma ◽  
Historical Aspect ◽  
Surgical Interventions ◽  
Oncological Safety ◽  
High Level

Aim. To analyze the literature data on modern approaches to morcellation of myomatous nodes in laparoscopic surgery and to highlight this area in a historical aspect. To form an idea of the main difficulties associated with morcellation, which contributed to and contribute to the improvement of the technique of this manipulation. Materials and methods. The review includes data from foreign articles published in the elibrary.ru and PubMed databases on this topic. Results. It describes both modern trends in the surgical treatment of patients with uterine myoma, and historical aspects of improving methods aimed at reducing risks, reducing the time of surgical intervention and improving its safety. Analyzed data on the use of electromorcellation, carried out both with the use of plastic containers, and without them. Conclusion. High requirements for surgical interventions contributed to the emergence of such a method of intracorporeal fragmentation of drugs, such as morcellation, which led to a significant reduction in the proportion of laparotomic operations in the treatment of patients with my uterus. The introduction of laparoscopy in the surgical treatment of uterine myoma allowed to achieve a fundamentally new high level of rehabilitation of patients. Removing removed drugs from the abdominal cavity is associated with a certain risk. Despite the significant number of proposed methods and devices for morcellation, they all require further improvement, since it is necessary to completely exclude contact of the myoma node tissue with abdominal organs in the extraction process. Currently, active research continues on ways to realize all the benefits of minimally invasive technologies in compliance with the rules of oncological safety.

New aspects in the treatment of uterine leiomyoma associated with endometriosis

2017 ◽  
pp. 32-35
Author(s):  
V.V. Kaminskiy ◽  
◽  
E.V. Prokopovych ◽  
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Uterine Fibroids ◽  
Progesterone Receptors ◽  
Objective Evaluation ◽  
Treatment Method ◽  
Integrated Treatment ◽  
Uterine Myoma ◽  
Ulipristal Acetate ◽  
High Level

Despite the high level of development of modern surgery and pharmacology, none of the surgical techniques (hysterectomy / myometectomy or embolization of the uterine arteries) or drug therapy is not a guarantee of the absence of a future recurrence of uterine fibroids and endometriosis. However, there are methods of effective pharmacotherapy for their manifestations. In particular, selective progesterone receptor modulators (SMPR) demonstrate high efficacy in respect of the symptoms of myoma and the size of the nodes, which allows them to be considered as a complete alternative to the surgical treatment of uterine fibroids. The objective: evaluation of the effectiveness of the use of SMPR in the treatment of combined gynecological diseases. Patients and methods. The study included materials for the observation of 40 women 20–52 years old with uterine myoma against the background of combined gynecological pathology (endometriosis, infertility), which carried out the enucleation of myomatous nodes by laparotomy, laparoscopic or transcervical access. Patients were divided into two groups. In the main group (n=20), women received SMPR – ulipristal acetate (UPA) 5 mg daily for 3 months. The UIA's bioavailability is 70%. The optimal therapeutic single dose for the analyzed pathology is 5 mg. After 3 months, the first assessment of the effectiveness of the drug with combined gynecological pathology was conducted, then 14 women were exposed to surgical treatment, and 6 of 20 patients continued conservative treatment for another 1–4 months. After the operation to prevent the recurrence of uterine fibroids and endometriosis, 8 patients continued treatment of UPA for 4 months. In the comparison group (n=20), women underwent surgical treatment at similar rates, but the SMPR was not assigned to surgery. Results. Of the studies indicate that the use of such a selective modulator of progesterone receptors, like vandalite acetate, in the treatment of uterine myomas in combination with endometriosis is safe and well tolerated, leads to rapid persistent coping of uterine bleeding, a significant decrease in the size of nodes and foci of endometriosis, and the achieved The therapeutic effect is maintained even after the abolition of therapy. Conclusion. Thus, the use of the drug ulipristal acetate in the treatment of uterine fibroate on the background of combined gynecologic pathology is highly effective and promising as an independent and integrated treatment method of this category of patients. Key words: uterine myoma, endometriosis, selective modulators of progesterone receptors, viperpatel acetate, combined oral contraceptives.

Reproductive function in patients with uterine myoma

1985 ◽  
Vol 66 (2) ◽  
pp. 105-107
Author(s):  
I. M. Mazitov ◽  
T. I. Timofeeva ◽  
N. I. Raimova ◽  
I. M. Bogolyubova
Keyword(s):  
Sexual Function ◽  
Uterine Fibroids ◽  
Reproductive Function ◽  
Uterine Myoma

The concept of the role of sexual function in the development of uterine fibroids is still controversial.

Prenatal diagnosis of Down syndrome in pregnant woman with giant uterine myoma and hereditary thrombophilia

2018 ◽  
pp. 24-29
Author(s):  
N.P. Veropotvelyan ◽  
◽  
L.V. Gazarova ◽  
Yu.S. Pogulyay ◽  
E.S. Savarovskaya ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Prenatal Diagnosis ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Uterine Myoma ◽  
Operative Delivery ◽  
Birth Canal ◽  
Uterine Myomas ◽  
Prophylactic Measures ◽  
Natural Birth

The article describes the case of prenatal diagnosis of Down’s syndrome in a 17 weeks of gestation fetus in a 39-year-old pregnant woman with the first detected giant necrotic uterine myoma and a tendency to hypercoagulable against the background of the heterozygous carriage of the Leyden mutation. At 20 weeks of gestation, due to the inability to proliferate through the natural birth canal, extirpation of the uterus with the fetus (without appendages) was carried out along the Rhine-Poros. At autopsy the diagnosis was confirmed. Timely medical and prophylactic measures allowed to avoid the development of thrombogenic complications. The article discusses the complications of the course of pregnancy with uterine myomas, as well as the features of the echographic pattern of degenerative changes in the myomatous nodes, indications for an operative delivery for uterine myomas, and the frequency of carriage of the Leiden mutation in the population. Key words: uterine myoma, Leyden mutation, ultrasound diagnosis,invasive prenatal diagnosis, Down’s syndrome.

Pregnancy management in patients with uterine fibroids. Case report

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. 448-453
Author(s):  
Iuliia E. Dobrokhotova ◽  
Sonia Zh. Danelian ◽  
Ekaterina I. Borovkova ◽  
Elena A. Nagaitseva ◽  
Dzhamilia Kh. Sarakhova ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Uterine Fibroids ◽  
Uterine Cavity ◽  
Pain Syndrome ◽  
First Trimester ◽  
Reproductive Age ◽  
Node Degree ◽  
Birth Canal ◽  
Large Size ◽  
Natural Birth

Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, red degeneration of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

The structure of somatic dysfunctions in women with a nodular form of uterine myoma

2020 ◽  
pp. 29-40
Author(s):  
G. N. Chebotaeva ◽  
D. S. Lebedev
Keyword(s):  
Local Level ◽  
Randomized Study ◽  
Random Number Generator ◽  
Uterine Fibroids ◽  
Reproductive Function ◽  
Uterine Myoma ◽  
Dynamic Monitoring ◽  
Control Group ◽  
Gynecological Examination ◽  
The Impact

Introduction. Uterine myoma (leiomyoma) occupies one of the first placesin the structure of gynecological diseases.This disease negatively affects both the state of health and the reproductive function of women. Now the problem of the effective methods for the treatment of leiomyoma (including non-medicinal methods, one of which is the osteopathic correction of somatic dysfunctions) is still acutedespite some progress in understanding the mechanisms of this disease pathogenesis. However, the structure of these functional disorders has not been practically studied.The goal of research — to investigate the structure of somatic dysfunctions (SD) in women with uterine myoma before and after osteopathic correction and its relationship with the severity of subjective indicators.Materials and methods. A simple longitudinal randomized study was conducted in 2018–2019 on the basis of a women’s consultation in Kirov, it included 30 women aged 35 to 44 years being under the medical supervision of an obstetrician-gynecologist, with a diagnosis of intramural uterine myoma, nodular form. All women with intramural nodular leiomyoma were divided into 2 groups of 15 people, comparable in age, presence of comorbidities and duration of the disease, using a simple randomization method (a random number generator was used). The main group received osteopathic treatment, and for patients of the control group it was carried out dynamic monitoring. According to the scheme, all patients underwent a clinical gynecological examination, a clinical osteopathic examination, and the dynamics of the severity of subjective manifestations (complaints) was evaluated.The collected data was processed by nonparametric statistics.Results. In the course of osteopathic diagnostics in women with uterine fibroids the following SD were identified: the somatic dysfunctions of the pelvic region dominated among the regional SD, and the most common among the local SD were the somatic dysfunctions of the segment С0–СI and the thoracic diaphragm. As the result of osteopathic correction of diagnosed SD in patients with leiomyoma, the decrease of the total number of SD (p<0,05) and the change of their structure has occurred (before treatment the SD at the regional level prevailed, after treatment there was a reduction in their number, and the increasing of the number of SD local level due to the carried out correction of most existing regional violations); and the severity of subjective symptom (algodismenorrhea) has decreased (p<0,05).Conclusion. In women with uterine myoma (leiomyoma), SD can manifest at different levels. Osteopathic correction of SD in women with uterine myomasignificantly reduces the severity of subjective manifestations (algodismenorrhea), which allows us to continue the research in studying of the impact of the SD osteopathic correction in the complex treatment of women with intramural nodular form of uterine myoma. 

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