Fibroids issues

Women with big intramural (fibroids occurring in the muscle layer of the uterus) can be found to have very actively ovulating ovaries and good    patent fallopian tubes, yet no pregnancy to show.
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INTRAMURAL FIBROIDS

 Big intramural fibroids can literally block the uterine cavity ‘plastering’ the anterior endometrial plate to the posterior plate. This blocks sperms from swimming to the Fallopian tubes to meet the egg. Inbox me for more info.

FIBROID WITH HAEMORRHAGIC SPOY

 

FIBROID WITH A HAEMORRHAGIC SPOT

It has been noticed that heavy menstrual flow can be due to loss of blood from one bleeding point on a fibroid in the endometrial space. It is usually a pedunculated submucous fibroid with an area of conspicuous redness (usually at its tip. It is the haemorrhagic spot.  Such fibroid may not be big, but can cause tremendous loss of blood. The endometrial plate must be opened and such haemorrhaging fibroids removed, if one is to expect a satisfactory outcome of the                                                                                                                                  surgery.

UTERINE RUPTURE

 

UTERINE RUPTURE

Uterine rupture can be said to have occurred when there is a total disruption of uterine wall with or without the extrusion of the baby or the placenta. It is usually accompanied by bleeding into the peritoneal (abdominal) cavity. The extent of blood loss depends on the part of the uterus and the vessels that were disrupted. It is a monumental disaster that can kill the baby or the mother due to ignorance of the grave danger unskilled childbirth practice pose.

Cessation of uterine contractions can be the first signal of uterine rupture.  A woman shouting from time to time from the pains of strong uterine contractions suddenly feels relief from such contractions. However, such relief is temporary as she is greeted by constant abdominal pain. She can also feel like fainting.

Some women notice vaginal bleeding following uterine rupture. Many may not see any blood in their private parts because a deeply impacted fetal presenting part has effectively walled off the blood in the peritoneal cavity from egress to the vagina.

The doctor can notice that it is easy to palpate fetal parts in a woman whose uterus has ruptured especially when the baby was forcefully extruded from the uterine cavity. The womb can be found contracted down in the abdominal cavity. In such cases the peritoneal covering of the womb (the serosa), the muscle layer, the decidua (inner layer) and the fetal membranes (amnion and chorion) are all disrupted.

Blood can be found in the urine following uterine rupture. This is evidence of the disruption (rupture) of the urinary bladder. However, in obstructed labour, blood can also be found in the urine without uterine rupture because of compression of the bladder by an impacted fetal presenting part. There is interruption of blood flow from the bladder. Some blood vessels can break and release blood into the urine. Outflow of urine is also interrupted and bladder can become swollen from retained urine or oedema

Epigastric pain accompanied by respiratory embarrassment can occur following uterine rupture. It can be due to extrusion of the baby or placenta into the epigastric area (area over the stomach or gaster). The baby impinges on the diaphragm restricting respiratory movements. Blood, liquor or urine that piled up in the paracolic gutters can also flow to the diaphragm restricting respiratory movements

 All pregnant women with fibroids should go for skilled childbirth care by the most senior members of the delivery team. Such pregnancies are high-risk pregnancies. Women with fibroids should not be handled by unskilled childbirth attendants. They need specialized care. Their haemoglobin levels must be high because the women with fibroids generally bleed more than others. They bleed more than others during caesarean section. They also bleed more than others following vaginal birth.

 PREGNANT WOMEN WITH FIBROIDS, HUSBANDS, MENTORS AND FRIENDS

Abdominal pains that come and go can be the first signal of fibroid co-existing with pregnancy in a young woman. It is the due to degeneration of the interior of the fibroid with a relatively poor blood supply. As a fibroid grows, it can outgrow its blood supply especially in its interior. The dying fibroid tissue produces pain. The pain can be excruciating in some people requiring hospitalization, infusions, analgesiss and antibiotics for there to be relief. Occasionally. There is no relief requiring myomectomy even in pregnancy. Read our account of a case like that in our recommended.

Book of the week

Pregnancy-Related challenges due to fibroids.

FIBROIDS AND INTRAUTERINE FETAL DEATH

An intrauterine fetal death (IUFD) is said to have occurred when a conceptus whose gestational age is greater than 8 weeks dies.

The following are challenges that can lead to IUFD 

Chromosomal abnormality that is not compatible with life 

Congenital infection 

Progesterone deficiency 

Antiphospholipid syndrome 

Fibroids 

Fibroid is an important reason for recurrent IUFDs.

Fibroid in the intramural or submucous areas over which you have the chorion frondosum can prevent the full development of the placenta 

The placenta is completely formed and functioning from 10weeks after fertilization

These are four layers of tissue separating the maternal blood from the fetal blood 

These include the following: 

The endothelial lining of the fetal blood vessels 

The mesoderm 

Cytotrophoblast

Syncytiotrophoblast 

In its early stages it is a relatively loose structure, but becomes more compact as it matures. Between 12 and 20 weeks’ gestation the placenta weighs more than the fetus because the fetal organs are insufficiently developed to cope with the metabolic process of nutrition 

Later in pregnancy some of the fetal organs, such as the liver begin to function, so the cytotrophoblast and the syncytiotrophoblast gradually degenerate and this allows easier exchange of oxygen and carbon dioxide.

In the presence of fibroid this process of maturity of the placenta can be hampered leading to poor passage of oxygen and nutrients from the maternal circulation to the baby. The maternal blood circulates slowly, enabling the villi to absorb food and oxygen and excrete waste. It appears the presence of fibroids further slows down the maternal blood flow to the blood spaces in the placenta. This makes it difficult for a growing fetus to meet its demands for oxygen and nutrients.

Death can occur.

The following can be seen on scan

No heart beats

Fetal scalp oedema

Significant overlap of fetal skull bones (Spalding’s sign)