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Complications of Fibroid
Definition of Fibroid
This is the commonest benign tumor in the female. It is women. What causes fibroid is not yet known but some factors such common in Nigeria and in general very common among black occurs mostly in the body of uterus but may also occur in the cervix as genetic, race, nulliparity, and infertility are associated with it.
It, or even the broad ligament. The fibroid may be symptomless in the body but the clinical features are:
1. Abdominal mass.
2. Menorrhagia.
3. Irregular bleeding.
4. Dysmenorrhoea.
5. Pressure symptoms. It presses on the urinary bladder to cause frequency or pretension. It presses on the rectum to cause constipation.
6. Infertility if a fibroid is at turbo ovarian junction. The investigation done now to diagnose fibroid is an ultrasound scan. Fibroid can reduce in size especially in postmenopausal women.
Complications of Fibroid:
(b) Bleeding.
(c) Infection
(d) It can become cancerous.
(e) It can undergo degeneration. If it co-exists with pregnancy can undergo red degeneration.
If a pregnant woman has a well-developed fibroid, surgery is never done until after delivery to avoid severe bleeding. For fibroid that is symptom-free, it may be good to leave it alone.
But if it is more than the 12th-week pregnancy size, it should be removed more so if the woman complains of infertility. Treatment is by Myomectomy.
If the woman is post-menopausal abdominal hysterectomy is preferred. The recurrence rate following myomectomy is about 10%. Hysterectomy is better.
VESICO-VAGINAL FISTULAE (V.V.F)
By definition, a fistulae is an abnormal connection between two epithelial surfaces and are lined by granulation tissue. Vesico-final fistulae is an abnormal connection between the urinary bladder and vagina. Causes are:-
- Trauma to the anterior vaginal wall.
- An obstetric problem such as in:
(a) Prolonged and obstructed labor.
(b) Destructive obstetrics operations.
(c) Deep transverse arrest with subsequent forceps or ventuse delivery
(d) Cesarean section
(e) Gishiri cut practiced in Northern Nigeria.
The obstetric causes are common in short women with cephalon pelvic disproportion. Teenage mothers especially in northern Nigeria are also implicated here.
3. Gynaecology problems such as:
(a) Hysterectomy
(b) Amputation of the cervix
4. Infections
(a) Lymphogranuloma venerum (LGV)
(b) Schistosomiasis.
The clinical features fibroid are as follows:
1. The woman leak and smell of urine
2. Excoriation around the inner aspect of the thigh
3.The woman is depressed and also thinks of how people feel about her.
4. She is usually infected by bacteria.
Fibroid Treatment:-
If a woman has WF due to obstetrics causes, the fistulae are not repaired until after three months of delivery.
The management is conservative with:
(a) Broad-spectrum antibiotics.
(b) Catheterise patient with foley’s catheter for about two to three weeks. Some fistulae will heal and close on their own.
The mainstay of management is surgery for fistulae that do not respond to conservative treatment. Post-Operative Management:-
1. Catheterise patient.
2. Analgesics
3. Antibiotics
4. Embark on bladder drill exercise after three weeks.
5. Avoid intercourse for three months.
5. Avoid pregnancy for one to one and half years after the surgery.
If pregnancy does occur, the woman should book in a specialist hospital and the patient must deliver by cesarean section.
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