Gynaecologic tumours with pregnancy
Transcript of Gynaecologic tumours with pregnancy
Gynaecologic Tumours with Pregnancy
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Fibroids with pregnancy
• Incidence: 1%.
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Effect of Fibroid on Pregnancy and Labour
1.Abortion: particularly in submucous myomas due to:
distortion of the uterine cavity, affection of the decidual development, affection of the vascular supply to the
implanted ovum.2. Ectopic pregnancy: if it interferes with the
passage of the ovum.x
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Effect of Fibroid on Pregnancy and Labour
7. Torsion of the uterus: very rare in subserous fundal myoma.
8. Premature labour. 9. Nonengagement. 10. Prolonged labour: Inertia may be present due
to interference with normal uterine contractions. 11. Obstructed labour: in cervical myoma or
pedunculated subserous myoma impacted in the pelvis.
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Effect of Fibroid on Pregnancy and Labour
12. Postpartum haemorrhage: due to> interference with uterine retraction,> increased vascularity.13. Puerperal sepsis.14. Inversion of the uterus: rare.15.Subinvolution of the uterus.
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Effect of Fibroid on Pregnancy and Labour
> Increase in size: due to a.oedema and increased vascularity, b.hypertrophy of the uterine muscles.> Softening: due to oedema and increased vascularity.> Red degeneration.> Torsion of a pedunculated myoma.> Internal haemorrhage: from rupture of a surface vein.> Infection: supervenes bruising during labour.> Extrusion: of submucous myoma may rarely occur in
puerperium.www.freelivedoctor.com
Management
• During pregnancy• During labour• Postpartum
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Management>During pregnancy
During pregnancy: a. No treatment is indicated in the majority of cases. b. Myomectomy carries the risk of abortion and
severe haemorrhage so it is indicated in the following conditions only:
Red degeneration which is not responding to the conservative treatment in the form of:
Torsion of a pedunculated myoma. Internal haemorrhage from rupture of a surface vein.
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Management>During labour
a. If the myoma lies above the pelvic brim not causing obstruction: vaginal delivery is allowed and myomectomy is done after 3-6 months if indicated.
b. If the myoma lies in the pelvis causing obstruction: caesarean section is indicated, but myomectomy is contraindicated.
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Management> Postpartum
> Give prophylactic antibiotic.> Observe for postpartum haemorrhage.
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Ovarian tumours with pregnancy
• Incidence: 1:1500. The commonest is simple serous cyst followed by dermoid cyst.
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Effect of Ovarian Tumours on Pregnancy and Labour
a.Abortion and preterm labour in large and complicated tumours.
b.Pressure symptoms.c. Malpresentations and nonengagement.d. Obstructed labour: if a pedunculated tumour
is impacted in the pelvis.
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Effect of Pregnancy and Labour on Ovarian Tumours
• 1.Torsion: is the commonest complication particularly in pedunculated tumours that lie above the pelvic brim. It is more common during puerperium than pregnancy due to;
a. lax abdominal wall,b. large intra-abdominal space after birth allows
free mobility of the tumour.
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Effect of Pregnancy and Labour on Ovarian Tumours
2. Rupture.3. Infection.4. Rapid growth.5.Haemorrhage.
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Management>Ovarian Tumours
• During pregnancy:• During Labour• During puerperium
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Management> During pregnancy: 1. Cyst less than 6 cm in diameter: is left and followed up by
periodic examination and ultrasound as it is usually a functional corpus luteum cyst.
2. Cyst of 6 cm or more in diameter: a. Discovered in the first half of pregnancy: is removed
after the 12th week when the placenta is formed so there is less liability for abortion.
b. Discovered in the second half of pregnancy: is left to be removed in the first week of puerperium.
be removed in the first week of puerperium. 3. Complicated or malignant tumours: a. are removed immediately irrespective of the
duration of pregnancy.www.freelivedoctor.com
Management> During Labour
a. If the tumour lies above the pelvic brim- causing no obstruction: vaginal delivery is allowed and tumour is removed in the first week in puerperium.
b. If the tumour is impacted in the pelvis - causing obstruction: caesarean section with immediate removal of the tumour is done.
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Management> During puerperium
• Tumours discovered for the first time should be removed immediately for fear of torsion.
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Cancer cervix with pregnancy
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Pre-invasive Cancer (CIN)
1. Cytological examination: can be done during pregnancy taking in consideration that some features of dysplasia as increased cells showing mitosis are normally present during pregnancy.
2. Colposcopy: is easier to be done during pregnancy due to physiological eversion of the cervix.
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Pre-invasive Cancer (CIN)
3. If CIN I or CIN II is detected: follow up only as many cases will regress.
4. If CIN III is detected: follow up is indicated till one month after delivery where conisation can be done or hysterectomy if the patient had taken the decision that she had completed her family.
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Invasive Cancer Cervix
• Incidence: very rare 1:10.000 because;
1.The mean age of cancer cervix is 45-50 years.2.The associated infection prevents conception.
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Effect of invasive carcinoma on pregnancy and labour:
1. Abortion and preterm labour: due to haemorrhage, infection and general health affection.
2. Cervical dystocia, obstructed labour, cervical laceration and/or uterine rupture may occur.
3.Puerperal sepsis.
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Effect of pregnancy and labour on invasive carcinoma:
1. Rapid growth: as young patients tend to have a rapidly growing tumours.
2. Rapid spread: if vaginal delivery is allowed.
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Management:
1. Early pregnancy: a. Wertheim’s operation or b. Hysterotomy followed by radiotherapy.2. Late pregnancy: a. Upper segment caesarean section followed
by either Wertheim’s operation (caesarean hysterectomy) or radiotherapy.
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