Uterine fibroids are the most common benign tumour in women — they are a mixture of smooth muscle cells and fibroblasts, which form hard, round, whorled tumours in the myometrium. This outpatient procedure uses MRI for real-time thermal monitoring of the thermoablative technique, which concentrates multiple waves of ultrasound energy on a small volume of tissue to be destroyed [16]. In cases—as in our patient—where red degeneration is found to be the cause of the pain, conservative management with input from pain specialists is the preferred option. The cause of uterine leiomyomata is idiopathic till date. These compounds produce a hypo-estrogenic effect by inhibiting gonadotropin secretion and suppressing ovarian function [17]. The most common symptom would be heavy and or prolonged menses. Fibroid in pregnancy is a relatively common complication, which aggravates pertaining to increase in size or red degeneration during pregnancy. Their size will then be described in menstrual weeks, as in a pregnant uterus [2]. Laterally, myomas may compress the ureters, leading to hydroureters. Symptoms are found only in about 35–50% of the patients. Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus. 1,2 On gross pathological examination, it is characterized by a red, hemorrhagic appearance of the leiomyoma if the surgery was performed during the acute phase of red degeneration. However, Laughlin et al. A rare complication of laparoscopic myomectomy is the occurrence of parasitic leiomyomas. Red degeneration of uterine leiomyoma (RDL) is a subtype of degeneration, which often occurs during pregnancy, or with the use of oral contraceptives. 25 mg mifepristone produces reduction in leiomyoma size and uterine volume and produces symptomatic improvement in women with fibroids [23]. On the other hand, multiparity and the late ages of last pregnancy are other protective factors for uterine fibroids [11]. They are sometimes mistaken to vaginal leiomyomas, which may present with the same clinical features [14]. Often fibroids >5–8 cm in diameter degenerate. Ectopic pregnancy if it interferes with the passage of the ovum. Other symptoms commonly associated are dysmenorrhea, infertility and recurrent abortions [13]. Red degeneration of fibroid in pregnancy is a well-established debilitating condition in the second Laparoscopic occlusion of the uterine vessel: It consists of cauterising the uterine artery at laparoscopy, with or without concurrent myomectomy. In case of pain, bed rest and narcotics are almost always successful [16]. In some cases, it can lead to miscarriage. Other conditions to be considered include sub involution, congenital anomalies, adherent adnexa, omentum or bowel benign hypertrophy, and sarcoma or carcinoma of the uterus [1]. Also, their incidence tends to peak at the age of 35 years and almost 50% of African women will have uterine fibroid by their 5th decade of life [1]. The topic is becoming more relevant in contemporary obstetrics due to the demographic shift towards delayed childbearing, the rising rate of obesity, and many pregnancies occurring after the treatment of fibroids. Furthermore, black women develop the disease five to six years earlier and their peak age at diagnosis is 40–44 years [7] as opposed to a to peak age of incidence of 35 years observed in Caucasians [1]. These include: Bleeding from the uterus is the most common symptom. Uterine fibroids, also known as uterine leiomyomas or fibroids, are benign smooth muscle tumors of the uterus. Malignant transformation of leiomyomas is very rare, seen in 0.04% women having uterine fibroids. When this happens, the cells of the fibroids begin to die; this process is called as fibroid degeneration. Total abdominal myomectomy maintains fertility compared with hysterectomy but increases recovery time and postoperative pain compared with laparoscopic myomectomy [24]. This is due to the oedema, increased vascularity and hypertrophy of uterine muscles that lead to the increase in size of fibroids during pregnancy. Publishing on IntechOpen allows authors to earn citations and find new collaborators, meaning more people see your work not only from your own field of study, but from other related fields too. Infertility may result because of impaired implantation, tubal function or sperm transport. Fibroids are more common among women who have a high body mass index. It is due to thrombosis of large veins in the tumor. The most common symptom of leiomyomata, recurrent abnormal bleeding, may be caused by any of the numerous conditions that affect the uterus. Patient is put to bed rest and given analgesics (to relieve the pain), sedatives and if required antibiotics. Posteriorly, fibroids may increase the rectal pressure or cause constipation or tenesmus. The diagnosis of leiomyosarcomas is based on the counts of 10 or more mitotic figures per 10 HPFs. When they arise laterally, subserous tumours may extend between the two peritoneal layers of the broad ligament to become intraligamentary leiomyomas. Incarceration of a retroverted gravid uterus in case of posterior wall uterine fibroid. In their study of 171 postpartum women, they found that 36% of fibroids resolved to an undetectable level and those that remain were reduced in diameter by a median of 0.5 cm [35]. Evidence from the contemporary literature reports that the prevalence rate of uterine fibroid varies between 16.7% - 30% of reproductive-age women and there is a two-fold increase in the prevalence in Afro American women [4, 5]. Intramural or interstitial myomas are located within the uterine wall of the myometrium and may distort the shape of the uterine cavity and surface. fibroids have uneventful pregnancies: nonetheless, 10–20% will develop fibroid-related complications. They may lie just at the serosal surface of the uterus or may become pedunculated. It’s based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. One of the main indicators of degenerating fibroid is an acute stabbing pain and swelling in the abdomen. It should also be considered in the event of a rapidly enlarging fibroids, in which a reasonable likelihood of malignancy exists. They are however not suitable for long term use because they are associated with menopausal symptoms and bone loss but are likely to be beneficial preoperatively [24]. On gross appearance, it resembles leiomyosarcoma, a malignant neoplasm of … In the post-partum period, prophylactic antibodies should be given. Till date is pathophysiology and management both in the non-pregnant and pregnant woman have not been well described. Uterine fibroids are the most common pelvic tumor, occurring in about 70% of women by age 45. How? 3 Varieties of fibroid degenerations can also occur in pregnancy. Red degeneration in uterine fibroid is most common in Second trimester, Treatment of Red degeneration of fibroid during pregnancy include Analgesics, Red degeneration of fibroid is due to Thrombosis of the veins, Red degeneration of uterine fibroid  Is aseptic infarcation, Red degeneration of fibroid is associated with Pregnancy. Malpresentations; in the study of Tchente et al. Fibroid uterus with acute abdominal pain  ,low grade fever and mild leucocytosis is suggestive of Red degeneration of fibroid . Cause is vascular in nature (Thrombosis of large veins in the tumor). Most fibroids are asymptomatic; usually asymptomatic in pregnancy but may interfere with conception and may cause spontaneous abortion, missed abortions, painful red degeneration or infarction of the fibroids, abnormal foetal presentation, obstructed labour, and an increased likelihood of premature deliveries, caesarean deliveries, postpartum haemorrhage and, whereas, in the non-pregnant state its signs and symptoms are menorrhagia, metorrhagia, menometorrhagia, infertility, constipation, urinary incontinence, and leiosarcoma transformation [3]. in 2010, both laparoscopic occlusions of the uterine vessel and embolization improve symptoms associated with uterine fibroids [31]. Careful patient selection and use of pre-treatment imaging are important components for predicting the success of MR-guided focused ultrasound surgery of uterine leiomyomas [32]. Fibroids are more common in obese women and women with an early menarc… If because of mistaken diagnosis iaparotomy is done, abdomen is closed without doing anything. A history of tamoxifen use for more than five years … The tumor assumes a peculiar purple-red colour. As leiomyomas enlarge, they outgrow their blood supply, which may lead to one of many types of degeneration such as hyaline degeneration (most common, 63%), red degeneration, fatty changes, and calcification, which is most commonly seen in post-menopausal women. Pain may either be due to red degeneration, infarction or torsion of a uterine fibroid, or mat stem from attempts to expel a pedunculated submucousal fibroid [1]. 2. Location of the fibroid in the lower uterine segment predispose towards a higher frequency of Cesarean section by obstruction of the birth canal(15). Also, the women should be carefully observed for post-partum haemorrhage. Laboratory investigations may reveal anaemia as a consequence of the menometrorrhagia of fibroids and depletion of iron stores or leucocytosis and raised C-reactive proteins in case of acute degeneration or infection. 3 article feature images from this case Uterine leiomyoma With respect to the location of the fibroids, 89.4% submucous, 10.6% subserous and 74.5% were intramural according to a study done in Cameroon [15]. Here, three-dimensional scan is preferred to a two-dimensional scan due its higher resolution which helps to rule out a pregnancy, other pelvic masses, a congenital uterine malformation [21]. Pain may either be due to red degeneration, infarction or torsion of a uterine fibroid, or mat stem from attempts to expel a pedunculated submucousal fibroid [ 1 ]. However, laparoscopic myomectomy may be considered safe if done in early pregnancy but only in the hands of experienced laparoscopic surgeons [37]. Most frequent complication of myoma during pregnancy. Table 1 summarizes ordinary leiomyomas, including their various forms of degeneration, and their main variants. Hysterectomy: It is the procedure of choice whenever surgery is indicated for leiomyomas and when childbearing has been completed. They usually decrease in size after menopause and whenever myomas grow after menopause, malignancy must be seriously considered [17]. Uterine fibroids are the most frequent benign uterine tumours in females of reproductive age. Open access peer-reviewed chapter - ONLINE FIRST, By Joel Noutakdie Tochie, Therese Gaelle Badjand, Gregory Ayissi and Julius Sama Dohbit, Submitted: July 1st 2020Reviewed: September 23rd 2020Published: December 8th 2020. Fibroids are very common. Hysterosalpingography may be useful in the infertile patient. MRI- guided focused ultrasound surgery. Therefore many women who are pregnant will have a fibroid or fibroids. Treatment of Red degeneration of fibroid during pregnancy include Analgesics. 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