جستجوی مقالات مرتبط با کلیدواژه « Submucosal myoma » در نشریات گروه « پزشکی »

Myoma is the most common benign tumor of the female genital tract. The incidence of myoma increases with age. It mostly presents in the fifth decade of life. Since myoma is often asymptomatic and incidentally diagnosed, the true prevalence is unknown. This tumor may also become symptomatic and affect women’s quality of life. This study was performed to report a rare case of vaginal myomectomy in post-partum severe hemorrhage caused by a submucosal myoma.

A 39-year-old G2P1 woman with previous cesarean section and decreased fetal movement at 38th week of gestation was hospitalized. In sonography and biophysical profile, due to fetal compromised, pregnancy was terminated. After delivery of fetus, a submucosal myoma (12 × 12 cm) was protruded through cervical canal. Massive hemorrhage occurred and then vaginal myomectomy was done and the bed of myoma was packed with two long gauzes that removed after one day.

Vaginal myomectomy after natural vaginal delivery or possibly during cesarean section is a safe and reliable method to remove submucosal myomas especially large myomas and decrease the risk of complications and costs of re-surgery. Due to the increased risk of hemorrhage, it is better to conduct this surgery in third-level referral hospitals.

According to age, history and physical examination findings, there are different diagnoses including anatomic lesions for abnormal uterine bleeding (AUB). In these conditions, hysteroscopy can be performed as a diagnostic and therapeutic procedure.

The aim of this study was defining the diagnostic value of hysteroscopy in evaluating uterine cavity in patients with AUB compared to pathologic findings.

This was a prospective descriptive-analytic study in which hysteroscopy was performed for 105 patients with AUB. The patients were in reproductive and perimenopausal (86.7%) or postmenopausal ages (13.3%).Hysteroscopy was done and biopsy was taken from any pathology. After removing of hysteroscope, dilatation and curettage were done. Both samples were sent for pathologist. At the end, reports of hysteroscopic findings were compared with pathologic results.

Diagnostic value of hysteroscopy in evaluation of uterine cavity showed 100% sensitivity, 80.5% specificity, 88.9% positive predictive value (PPV) and 100% negative predictive value (NPV). Sensitivity, specificity, PPV and NPV of the procedure for endometrial polyp were 93%, 100%, 100%, and 95.4%, respectively. These results were respectively 100%, 96.4%, 88% and 100% for submucosal myoma, and 25%, 89.7%, 12.5% and 93.3% for endometrial hyperplasia.

The results of this study show that hysteroscopy is a reliable method for evaluation of AUB, especially in benign lesions such as endometrial polyp and submucosal myoma and it can be used as the first line diagnostic method for these abnormalities. However hysteroscopy without directed biopsy has insufficient value for diagnosing endometrial hyperplasia.