Obs & Gynaecology


        

Case Discussion

Myomectomy b& Successful Pregnancy Oitcome   Posted By Dr. Ranjit Chakraborti    Date : 25-Aug-07   01:20 AM     Reply

Myomectomy & Successful Pregnancy Outcome

Mrs. Anuradha Mitra, aged about 33 years, was suffering from heavy bleeding /menorrhagia and severe abdominal pain since early 2005.

By the time she saw Dr. Ranjit Chakraborti, a senior gynaecoilosit, she was frail and in a very bad shape.

In the words of Dr. Chakraborti, Her condition at that time was such that it warranted removal of the whole uterus itself. But keeping in mind, her childbearing age coupled with their desire to have their own child, since they had none, my whole effort centered around preserving the uterus.

After a complicated and prolonged operation, called Myomectomy, at a leading city hospital, I took out 24 myomas /fibroids of various sizes from her uterus, as recollected by Dr. Chakraborti.

Myomectomy is the surgical removal of the fibroids from the uterus. It allows the uterus to be left in place and preserves the fertility of the woman for future pregnancy.

Myomectomy preserves the uterus while treating fibroids. This is a reasonable option if the patient does not have: · Anaemia · Pain

According to Dr. Chakraborti, surgical methods for Myomectomy include any one of the following procedures:

1. Hysterocsopy, which involves inserting a lighted viewing instrument through the vagina and into the uterus. 2. Laparoscopy, which uses a lighted viewing instrument and one or more small cuts in the abdomen 3. Laprotomy, which uses a larger incision in the abdomen

As a doctor we decide on any of the above methods based on the Size, location and number of fibroids.

Hysteroscopy is generally used to remove fibroids on the inner wall of the uterus that have not grown deep into the uterine wall.

Laparoscopy is usually used reserved for removing one or two fibroids that are growing on the outside of the uterus.

Laparotomy is used to remove large fibroids, multiple fibroids at once, which grow deep into the uterine wall.

Successful pregnancies are quite rare in patients with multiple fibroids as such says Dr. Chakraborti, but this one in particular is nothing short of a miracle, because of the size and number of fibroids which required removal. Although consent for removal of the uterus was taken, we did our best & managed to preserve it at that time and it has been a particularly rewarding experience to deliver the newborn almost exactly 2 years later!

Dr. Chakraborti foresight at that juncture has paid off and paved the way for a successful pregnancy of Mrs. Anuradha Mitra.

They are now proud parents of a bonny baby boy! Mrs. Mitra underwent a Caesarean section in June 2007 under Dr. Chakraborti, to deliver the hale and hearty infant.

Inspite of having such a critical surgery before delivery, followed by the c-section, Mrs. Mitra did quite well post operatively and was discharged home within 5 days of her hospitalization!

Because fibroids can grow back, we suggest the patient to conceive as soon after a myomectomy as is safely possible. We recommend to wait for 4 to 6 months to allow the uterus to heal before pregnancy. Sometimes a hysterosalpingogram is suggested after 4 months to check the uterus and fallopian tubes, as suggested by Dr. Chakraborti.

It may take 6 to 8 weeks for a full recovery depending on the womans lifestyle and activity level.

A successful Myomectomy relieves or reduces symptoms in about 80% of the women.

The main advantages can be summarized as: 1. 80% successful 2. preserves the uterus 3. may allow future pregnancy 4. can be used for large fibroids

Dr. Chakraborti goes on to add, Given the advances in medical science, most women with fibroids have no more trouble becoming pregnant than women who do not have fibroids, and their risk of a bad pregnancy outcome is no higher.

Fibroids especially located in the cavity of the uterus may increase the chance of a miscarriage or may cause the woman to pre-term labour. Fibroids may also increase the chance for the baby to come out headfirst. This can increase the probability of C-Section.

The major symptoms are:

· Heavy or long menstrual periods · Pressure on organs like bowel and bladder · Pain in the pelvis · Pain during intercourse · Pain in legs or back · Constipation or bloating

Compiled By: Dr. Ranjit Chakraborti, DGO, DNB, MRCOG





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