Fibroids Narendra Malhotra, Poonam Goyal
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdomen
acute 19
for hemostasis before closing, inspecting 91f
lower 144
Abdominal cavity 103f
Abdominal examination 14f
Abdominal hysterectomy, total 177
Abdominal mass 146
occupying left hypogastrium 127f
Abdominal pain, lower 13
Acrochordons 155
Adenomyosis 7, 9f, 21, 79, 123
Adenomyotic tissue 163
Adherent placenta cesarean section 46
Adipocytes 181
Adiponectin 181
Adnexal mass, diagnosis of 193
American Association of Gynecologic Laparoscopists 85, 92, 97, 222
American College of Obstetricians and Gynecologist 97
Androgen receptor 164
Androgenic steroids 187
Anemia 75, 216
postpartum 175
severe 216
Angiofibromas 155
Antenatal complications 27
Antiadhesion barriers 94
Antifibrinolytic agents 33
Anti-inflammatory drugs 145
Anti-müllerian hormone 175, 191
Antiprogestin 57, 132, 187
Antiprogestogen 39
Antiretroviral therapy 41
Antral follicle count 175
Appendicitis 204
Aromatase inhibitor 39, 64, 114, 132, 167, 187
Arousal 139
Artery embolization 97
Asoprisnil 114, 164
Association of Fibroids and Infertility 75
Atrazine 181
Atypia 110
Automatic tissue extraction 104
B
Bacterial collagenase, purified 169
Bag morcellation, contained in 128
Bag with atraumatic graspers 100f
Bag with single tooth grasper 101f
Barbed suture, stitching with 82f
Birt-Hogg-Dubé syndrome 155, 155f
Bladder
injury 93
obstruction, chronic 148
Bladderwrack 183
Bleeding 42, 146
during myomectomy 84
issues, regression of 115
Blenching fibroid 84f
Blood
pressure 84
supply, inadequate 36
Bone demineralization 197
Bonney's myomectomy clamp 83
Bowel injury 93
Bridging vascular sign 19, 32
Bulky uterus with adenomyosis 15f
Bupivacaine 84
C
Cabergoline 114
Calcareous degeneration 6
Carboprost 85
Cardiac failure 89
Cell
growth, regulation of 109
proliferation 166
structures 109
Cellular leiomyoma 126
Cervical fibroid 147, 150, 200, 201
large 148f
operative management of 147
Cervix 18
Cesarean delivery 47
Chasteberry 183
Chromosomal abnormalities 135
Clinical pregnancy rate 192
Clostridium histolyticum 169
collagenase, injection of 170f
Collapse of patient, unexpected 207
Combined oral contraceptives 114
Complete blood count 216
Cytokines 135
D
Danazol 39, 132, 187, 223
Dandelion 182
Depomedroxyprogesterone acetate 64
Depression 139, 188
Detoxes 182
Detoxification, phase-I 179
Dietary supplements 165
Disseminated peritoneal leiomyomatosis 158
Doppler ultrasonography 147
Doppler ultrasound 16
enabled transvaginal clamp 120
Drug
current status of 113
facts about research on 113
newer 64
Dysglycemia 181
Dysmenorrhea 26, 106, 139, 146
prevalence of 57
Dyspareunia 139, 140, 146
Dystocia 43
E
Early pregnancy 42
loss 25, 27
Elagolix 165
Electrolyte imbalance 89
Electromechanical morcellation 96
Emotional and spiritual health, stress and 182
Endo bag
piecemeal removal from 86f
plastic 86f
Endocrine neoplasia type 1, multiple 156
Endometrial ablation 56, 117, 212
Endometrial biopsy 217
Endometrial carcinoma 7, 10f
Endometrial cavity 53
Endometrial curettage 21
Endometrial hemostasis 61
Endometrial hyperplasia 7, 9f, 173
Endometrial myomectomy, technique of 45
Endometrial polyp 9f
Endometrial stromal sarcoma 7, 103, 126
Endometriosis 79, 139
Endometrium 113, 117, 219
Epigallocatechin gallate 165
Estrogen 64, 70, 135, 179
dependence 2
dependent tumors 41
elimination, enhancing 179
environmental sources of 182
glucuronide 180
nutritional sources of 182
production, normalizing 180
receptor 164
modulator, selective 39, 63, 64, 71, 108, 114, 132, 165, 166f, 187
therapy, cyclical 198
Ethinyl-testosterone 132
Ethisterone 132
European Society of Gastrointestinal Endoscopy 85
F
Fadrozole 39
Female reproductive system 185
Female sexual dysfunction 139
cause of 139, 141
cycle of 140, 141fc
Fertility 174
after myomectomy 38
implications on future 34
preservation of 62
reduce 36
Fertility-preserving strategy 59
Fetal growth restriction and malformations 43
Fibrofolliculomas 155
Fibroid 1, 13, 16, 19, 22, 24, 31, 36, 41, 46, 49, 74, 79, 126, 139-141, 161, 163, 170f, 172, 174, 203f, 211, 215, 219
ablation, vizablate system during 169f
affect sex life 139
after myomectomy 26f
alone 74
and fertility 36, 175fc
and gastrointestinal symptoms 143
and in vitro fertilization outcome 37
and infertility 36
and sexual dysfunction 139
artery embolization 72
associations, rare 28
asymptomatic 211
broad ligament 193
capsule around 3f
cases of large 44
cells 91
cervical 143
classification of atypical 152
clinical effects of 75b
comparison of surgeries for 80t
counseling of 209
degeneration of 42, 75
diagnosed, number of 162
diagnosis of 13, 144, 176fc
differential diagnosis in 7t
distorted by 27
during pregnancy, diagnosis of 41
enlarging 222
epidemiology 24
evaluation of 172
growth rate of 173f
herbs for 182
holistic approach to 179
in adolescent age group, large 216
in adolescent girl, management of 31
in menopausal woman, management of 69
in postmenopausal woman, management of 70fc
in pregnancy 41, 43, 175, 222
infection of 42
infertility
associated with 75
with submucous 198
intramural 143
location of 37, 49
magnetic resonance imaging of 55f
management guidelines 222
management of 56fc, 211
manifestations of symptomatic 140fc
medical management of 106
medical treatment of 108fc, 144, 223
morcellation of 98, 103f, 104f
controversies regarding 96
multiple 173
new occurrence of 130
newer nonsurgical treatment options for 117
nonsurgical
newer options 145
treatment of 41
nonsymptomatic presence of 211
number of 32, 39
occurrence of 130
on pregnancy, effects of 42, 43f
on sexual dysfunction 141
on transabdominal scan 52f
on USG with increased peripheral vascularity 29f
pedunculated 20
pedunculated large 42
perimenopausal big 194
perplexing situations with 207
polyp 13
presence of 71
presentation of 25f, 176fc
primary parasitic 207
progressions of 170
pseudocervical 13
reassuring with 172
recurrence of 130
incidence of 130
reduce 179
reduction of 182
registry 119
regrowth 79
removal of 65
resectable with hysteroscope 123
retroplacental 43
secondary changes in 6
secondary parasitic 207
shrinkage 109
size of 69, 115
small 31, 77
stepwise slow enucleation of 82f
submucosal 143
subserosal 143
symptomatic 59
subserous and intramural 58
surface, incision on 82f
surgical management of 79, 145
surgical treatment of 41
symptomatic 74, 139, 141, 211, 223
treatment 145
symptoms of 146, 176fc
treatment for 39, 64, 113, 144, 222
treatment outcomes in 130
types of 16, 36, 143
understanding 1
using hysteroscopy, location of 55f
volume 43
with menorrhagia 176
world of 161
Fibroid and malignancy 126
management 128
proposed alternatives 128
role of imaging 127
Fibroid and pregnancy 75
outcome 39
Fibroid disease
clinical spectrum of 24
patients with 209
Fibroid in perimenopausal
age 177fc
group 177
women 61
management of 62fc
Fibroid on transvaginal
sonography 16f
USG, posterior wall 51f
Fibroid syndrome
atypical 152, 152fc
rare 24
Fibroid tumors 12
symptoms related to 13
Fibroleiomyoma 1
Fibroma 1
Fibromyoma 1
Fibrous tissue, tumors of 24
Fimbrial cyst, small 11f
Fine-needle aspiration cytology 106
Fluorodeoxyglucose 127
Follicle-stimulating hormone 56, 109
Food and Drug Administration 96, 135
Fundal right cornual fibroid after vasopressin injection 82f
G
Gastroenteritis 204
Gastrointestinal symptoms 143
Genetic predisposition 2
Genitourinary dysfunction 146
Gentle tissue handling 94
Gestrinone 132, 187
Ginger 183
Gonadotropin-releasing hormone 56, 62, 63, 70, 107, 108, 133, 144, 166, 211
agonist 39, 64, 107, 109, 131, 187, 213
role of 109
side effects of 188
use of 135
analogs 33, 56, 223
pretreatment with 132
antagonist 109, 133, 165, 188
disadvantages of 109
side effects 107
Gravid uterus, comparing with 143
Green tea extract 165, 167f
Growth factor-beta, transforming 109
Gynecological ailments 139
Gynecological symptoms 24, 26
Gynecological tumors 74
benign 94
H
Haematocrit, postoperative 109
Haemoglobin, postoperative 109
Hair loss 188
Halt ablation system 168, 169f
Headaches 188
Hematogenous dissemination 128
Hemorrhage 93
intraoperative 45
postpartum 25, 44, 175
risk of postpartum 44
Hepatotoxicity 215
Hereditary leiomyomatosis 158
High-intensity focused ultrasound 34, 188
Hormone replacement therapy 65, 69, 72
Hostile endometrial environment 36
Hot flashes 197
Human chorionic gonadotropin 7
Human menopausal gonadotropin 219
Hyaline degeneration 6
Hydronephrosis 148
Hydroxylation 179
Hypermenorrhea 39
Hyperplasia 113
atypical 113
Hypointense lesion 127f
Hysterectomy 65, 74, 92, 94, 98, 119, 126, 189
abdominal 92
crude rate of 134
indication for 222
subtotal 141
total 141
Hysteroscopic myomectomy 58, 85, 134
complications 89
Hysteroscopic resection 133
advantages of 87
Hysteroscopy 19, 53, 64
lesions on 55f
ultrasound-guided 20
I
In vitro fertilization
cycle of 191, 218
results after myomectomy 38
treatment 37
Infection 75
Infertility 20, 36, 61, 106, 146
treatment for 41
unexplained 133
Infrequent fibroid
classification of 152
syndrome 152
Infundibulopelvic ligament 83, 84
Insulin and glucose dynamics, normalizing 181
Intermenstrual bleeding 61, 75
International Federation of Gynecology and Obstetrics 53b
classification 212f
Intraclinical myomatous nuclei, small 131
Intralesional drug delivering systems 167
Intramural fibroid 37, 38, 192
cause 217
in reproductive age group 217, 218
pushing endometrial cavity, posterior wall 53f
with subfertility 191
Intramural myoma, adverse effect of 174
Intranatal complications 28
Intraoperative adjuncts 93
Intrauterine
contraceptive device 198
growth restriction 39
insemination, cycles of 191
Intravenous leiomyomatosis 126, 153
Intravenous pyelogram 176
Invasive prenatal testing, difficulty in 43
K
Kidney function test 216
L
Labor
and puerperium 43
dystocia 47
cause 43
preterm 25, 43, 47
Lap myomectomy, stepwise 90f
Laparoscopic approach 132
Laparoscopic hysterectomy 58, 96
complications of 93
total 177
Laparoscopic morcellation 104
Laparoscopic myolysis 189
Laparoscopic myomectomy 58, 91
advantages 91
complications 92
in intramural fibroid, steps of 83f
specimen morcellation 91
Laparoscopic uterine artery occlusion 189
Laparoscopy 20, 21f, 65, 135
hemostatic options at 91
over laparotomy, advantages of 58
robotic-assisted 92
Laparotomy 65, 134, 135
Leiomyofibroma 1
Leiomyoma 1f, 13, 17, 18, 61, 74, 79, 126, 146, 153, 161, 185, 194, 222, 223
atypical 126
benign 58, 126, 128
location of 162
presumed 103
Leiomyomata 97, 109, 134
after myomectomy, risk of recurrence of 134
Leiomyomatosis peritonealis disseminata 126
Leiomyosarcoma 7, 65, 126, 173, 177
detection of 127t
risk of 222
Letrozole 64
Leukorrhea 146
Levonorgestrel intrauterine system 62, 63, 110, 114, 144, 163, 176, 223
Levonorgestrel-releasing intrauterine contraceptive device 186
Libido, decreased 140
Ligament leiomyoma 150
Ligand-agonist binds 112f
Liver function test 216
Lower abdomen, heaviness in 28
Lower segment cesarean section 192
in case of fibroid 203f
Luteinizing hormone 109
M
Magnetic resonance imaging 7, 18f, 32, 52, 174
guided focused ultrasound 70, 71, 133
on fertility, effects of 124
surgery 65
Magnetic resonance-guided focused ultrasound 62, 121
contraindications of 123t
procedure for 122f
Malignancy, risk of 34, 58, 65, 135
Malpresentation 47
Masses, benign 106
Maternal and fetal well-being 44
Matrix metalloproteinases 164
Medical diseases 139
Medical management, counseling before 107
Medical therapy, selection of women for 106
Medroxyprogesterone acetate 33
Menorrhagia 39, 49, 75, 146, 216
and menstrual irregularities 139
mild 106
Menstrual bleeding
heavy 26, 49, 166
profuse 26
treatment options for heavy 166f
Menstrual disturbances 8
Menstrual history 220
Menstrual symptoms 75
Mesodermal tumor, mixed 7
Metastasizing fibroid, benign 152
Metastasizing leiomyoma, benign 126, 152, 154f
Meticulous hemostasis 94
Metrorrhagia 26, 49
Mifepristone 32, 39, 110, 163
emergence of 111
Minilaparotomy 65, 128
Minimal invasive surgery, recurrence after 133
Minimally invasive technique 63, 64
Miscarriage 43
increased risk of 46
Misoprostol 93
Mitotic activity, low or nil 110
Morcellation done under vision 101f
Morcellation techniques, modified 128
Muscle
tissue 143
tumors, smooth 126
Musculoskeletal stiffness 188
Myofibroma 1
Myohyperplasia 21
Myolysis 174
Myoma 1, 24, 75, 79, 135, 161f, 185, 189, 222
abutting endometrium, posterior wall 219f
after surgery, newer 178
cells 107
complications of 6
conservative treatment for 74
development 161
differential diagnosis of 6
distribution of 5f
in adolescent 173
girl 174fc
in body of uterus, distribution of 4
in unmarried girl 173
large 58, 85, 88f, 126, 218
posterior wall 220f
location of 197
management
of type 0 213f
of type 1 213f
of type 2 214f
multiple 85
number of 130,
on open myomectomy, multiple 88f
rapid growing 126
shrinkage of 77
types of 13
Myomata
family predisposition to 135
individual 135
number of 131
preoperative detection of 132
Myomatous nuclei
perioperatively 131
preoperatively 131
Myomectomy 33, 38, 65, 74, 81, 94, 97, 120, 126, 130, 131, 134, 174, 189, 210, 216
abdominal 134, 135
after 135
and pregnancy outcome 39
by hysteroscopy 134
by laparoscopy 134
by laparotomy 134
complications of 59
conventional 141
delivery after 223
during cesarean section 44
during pregnancy 44
effectiveness of 38
hemostasis during 81
parity after 132
series of 132
suture line, after 192f
Myometrial contractility 192
Myometrial disease 131
Myometrial stretching 28
Myometrial-cultured cells 64
Myometrium 117, 223
meticulous palpation of 131
normal 110
N
National Institute for Health and Care Excellence 224
Necrotic tissue, excision of 94
Neurological disorders, absence of 148
Newer conservative methods 34
Nonmenstrual abdominal pain 57
Nonpeptide 165
Nonperfusion volume 122
Nonsteroidal anti-inflammatory drugs 33, 63, 70, 186
O
Obstetrical history 218, 200, 220
Obstetrical symptoms 24, 27
Obstructed labor 43
Occult malignancy, dissemination of 97
Oligoasthenoteratozoospermia, severe 219
Open myomectomy, steps of 87f
Oral contraceptive 186, 223
pills 33, 163, 166
Oral progesterones 176
Orally active gonadotropin-releasing hormone antagonist 165
Orgasm 139
Ormeloxifene 187
Ovarian cancer 7, 10f
Ovarian cyst, torsion of 204
Ovarian mass 79
Ovarian tumor 21
Oxidized regenerated cellulose 94
P
Packed cells 216
Pain 61, 146
Parasitic fibroid 207
Parasitic myoma 6
Pedunculated subserous fibroid 203
Pelvic
congestion 29
discomfort 146
disease, coexistent 196
endometriosis 20
examination 14, 51
bimanual 14f, 185
inflammatory disease 123, 204
pain 13, 20, 74
chronic 140
in fibroids 61
pressure 57
tumors in women 130
Perifollicular fibromas 155
Perimenopausal status 63
Perimenopausal symptomatic fibroid 196
Peritoneal cavity 102
Peritoneal leiomyomatosis, diffuse 153
Placenta
abruption 47
adherent and retained 44
Plastic bag, strong 99f
Pneumothorax 156
Polymenorrhea 49
Polymeric membrane 167
Postcoital bleeding 140
Post-gadolinium administration 19
Postmenopausal
fibroids 72
women 58
Postmyomectomy 219
Postnatal complications 28
Pregnancy 21
after high-intensity focused ultrasound 46
after myomectomy 45
after uterine artery embolization 46
common symptom in 47
complications during 75
late 43
on fibroid
disease, effect of 28, 41
effects of 42fc
wastage 146
with fibroid disease 11f, 201
Premenopausal women 63
Pressure effects 28
Pressure symptoms 24, 29, 61, 106
relief of 115
Preterm premature rupture of membranes 25
Progesterone 70, 135
long-acting 132, 186
pills 163
therapy, cyclical 198
Progesterone receptor 41, 110, 112f, 164
ligands 112f
modulator 110, 164f, 165
action of 111f
advantages of 164
selective 34, 57, 62, 64, 108, 111, 132, 163, 187, 197, 211, 213, 214, 223
selective 63
Progestin 33, 57, 63, 64, 167, 223
Proinflammatory cytokines 181
Proinflammatory enzyme cyclooxygenase 181
Prolactin 216
Prophylactic therapy 185
Pulmonary and cerebral edema 89
Pulmonary manifestation 156
Q
Quality of life, impact on 77
R
Racial predominance 2
Radiofrequency
ablation system 168
cryomyolysis 65
Raloxifene 39, 63, 70, 132
Randomized controlled trial 119t, 164
Recurrent pregnancy loss 25
Renal cell cancer 158
Renal tumor 156
Reoperation and hysterectomy, role of 134
Reproductive problems 24, 26
Residual myomatous nuclei, growth of small 135
Resveratrol 166
Routes of surgery, comparison of 80t
Rubber-shod clamps 83
S
Saline infusion
sonography 17f, 51
of fibroids 54f
sonohysterography 16, 17, 176
Saline injection 17
Salpingo-oophorectomy, bilateral 62, 128, 177
Sarcoma
dissemination 103
undifferentiated 126
Scar with intercede, covering 86f
Secrete proinflammatory cytokines 181
Semen analysis 191
Serum
ferritin 216
lactate dehydrogenase 127
Sex hormone-binding capacity 182
Sex pain disorders 139
Sexual abuse, history of 139
Sexual desire in women, decreased 139
Sexual dysfunction 139, 141
woman suffering from 140
Sexual functioning 141
Shear wave elasticity imaging 163
Society of Obstetricians and Gynaecologists 81, 222
Solitary intramural fibroid 195
Sonosalpingography 51
Spasmodic dysmenorrhea 61, 75
Spontaneous miscarriage 47
Stress urinary incontinence 149
Submucous fibroid 13, 36, 38, 43, 53b, 223, 198
cavity-distorting 37
classification of 54f
diagnosis of 222
in perimenopausal age group 219
on hysteroscopy 20f
resection for 46
with infertility 223
Submucous leiomyomas
diagnosis of 85, 223
management of 85, 223
Submucous myomectomy 85
Subserosal fibroids 18, 37
in hysterectomy specimen, multiple 25f
multiple small 11f
on laparoscopy 5f
Suprapubic ultrasound investigation 131
Supraumbilical trocar 201
Surgery and routes, types of 80
Surgery, planning of 79
Surgical procedure, property of 131
Symptomatic fibroid
treatment for 141
young girl with 199
Symptomatic intracavitary fibroids, management of 58
Symptomatic submucous fibroids, treatment of 59
Symptomatic uterine fibroids
presumed 96
treatment for 94
Synthetic vasopressin, use of 94
T
Take-home message 104
Tamoxifen 63
Telapristone acetate 163
Thyroid-stimulating hormone 216
Tibolone 70
Tissue
disruption 97
inhibitors of metalloproteinases 164
retrieval 97
Torsion 6, 42
Tranexamic acid 33, 63, 84
Transabdominal sonography 174, 177
Transabdominal ultrasonography 148f
Transabdominal ultrasound 216
Transcervical resectoscopic myomectomy 85
Transformation, malignant 77
Transient ischemia 120
causes 117
Transvaginal
sonography 51, 176, 177
sonohysterogram 192
ultrasonography 191, 218
uterine artery occlusion 117, 212
Trichodiscomas 155
Triptorelin 64
Tubo-ovarian mass 21
Tumor
benign 61
degeneration in central part of 3f
U
Ulipristal acetate 34, 111, 163, 187, 219
chemical structure of 112
structure of 112f
Ultrasonography 33, 175177
Ultrasound 32
Upper abdomen 144
Ureteric injury 93
Urinary incontinence 149
mixed 149
Urinary retention 147
Urinary symptoms 75
Urinary tract symptoms, lower 146, 149
Urine, acute retention of 148
US Food and Drug Administration 92, 106
Uterine artery embolism 210
Uterine artery embolization 18, 34, 46, 58, 64, 74, 117, 119, 119f, 119t, 120, 121t, 130, 133, 174, 212, 223
advantages 118
and myomectomy 120t
complications 119
contraindications 118
disadvantages 118
effects of 120
for fibroids 224
in women 141
indications 118
mode of action 117
pretreatment 118
procedure 118
Uterine artery occlusion 121
transvaginal temporary 120, 121f
Uterine bleeding
abnormal 25, 26, 49, 61, 62, 69, 74, 79, 106, 174, 175, 194, 216, 221, 223
clinical presentation in 49
pain and pressure symptoms 74
causes of abnormal 53b
conservative treatment for abnormal 74
diagnosis of abnormal 50fc
with fibroids, management of abnormal 49
Uterine cavity 20
Uterine dehiscence 59
Uterine fibroid 2, 18, 27, 58, 61, 74, 94, 111f, 126, 133, 146, 164f, 166f, 174, 185, 222
color Doppler of 54f
development of 161
diagnostic modalities for 185
distribution of 5fc
embolization 56, 71, 188
on fertility 120
in nutshell 185
large 150
management of 66, 76f, 186
hormonal treatment 186
medical therapy 186
nonhormonal treatment 186
surgeries 57
symptomatic 65, 97
symptoms of 143
tissue 121
treatment of 74, 111f, 130, 154f
ultrasound for 224
Uterine leiomyoma 49, 126, 149, 204
management of 81, 224
treatment of women with 81
Uterine leiomyomatosis, diffuse 153
Uterine leiomyosarcoma, risk for 97
Uterine masses 17
Uterine morcellation 92
Uterine muscle, laparoscopic closure of 91
Uterine musculature, tumors of 22
Uterine myoma 31, 130
asymptomatic 98
Uterine sarcoma 7, 10f, 103, 126, 127
Uterine serosa 85
Uterine smooth muscle tumor 154, 155f
Uterine stone 161, 161f
Uterine surface, posterior 192f
Uterine surgery 124
Uterine tissue
benign 98
malignant 98
normal 163
Uterine vascular perfusion 192
Uterine volume 109
Uterus 62
conserve 223
inversion of 8
morcellation of 98
normal sized 148f
V
Vaginal bleeding, undiagnosed 123
Vaginal delivery 124
Vaginal dryness 109, 188, 197
Vaginal hysterectomy 93
complications 93
prerequisites 93
Vaginal morcellation 128
Vaginismus 139
Vascular control systems 120
Vasopressin 94
Vilaprisan 164
Vitamin D3 165
structure of 167f
Vitex 183
Vizablate treatment device 168f
von Hippel-Lindau disease 157
differential diagnosis 157
prognosis 158
signs and symptoms 157
treatment 157
×
Chapter Notes

Save Clear


_fm1Fibroids_fm2
_fm3Fibroids
Editors Narendra Malhotra MD FICOG FICMCH FICS FRCOG FMAS FIAP Management Director Global Rainbow Healthcare Agra, Uttar Pradesh, India Vice President World Association of Perinatal Medicine Past President, FOGSI Poonam Goyal MBBS MD FICOG ART Specialist and Ultrasonologist Department of IVF and Infertility Max Superspecialty Hospital New Delhi, India Co-Editors Jaideep Malhotra MD Management Director Rainbow IVF Agra, Uttar Pradesh, India President, FOGSI President Elect, ISAR, ISPAT, SAFOG Bhavana Mittal DNB FNB MNAMS Director Shivam IVF and Infertility Centre New Delhi, India Foreword Alka Kriplani (Padma Shri)
fm4
Jaypee Brothers Medical Publishers (P) Ltd
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Office
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
© 2019, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Fibroids
First Edition: 2019
9789352705498
Printed at
_fm5Dedication
The debilitating disease, uterine fibroid is affecting a lot number of women.
This book is a small effort to create a better world for women by imparting the knowledge to clinicians taking care of women's health.
I am thankful to my better half Dr Jaideep Malhotra for her continuous unconditional support.
I am grateful to my parents for their blessings.
Narendra Malhotra
This book is dedicated to all patients, who blindly trusted me to treat them and in the process, they taught and made me what I am today.
I am thankful to my parents for their blessings. I am grateful to my spouse and children for their love.
Poonam Goyal
We as a clinician should be always updated with recent advances in medical science.
This is an effort towards that I am thankful to my spouse Dr Narendra Malhotra and my kids for their 24/7 support in all my endeavors.
I am grateful to my FOGSI family for their faith in me.
Jaideep Malhotra_fm6
fm_7Contributors fm_11Foreword
Fibroids is a book containing comprehensive encyclopedic insightful and in-depth information about the fibroid disease. It is amazing to see how the book unfolds step-by-step covering each and every aspect related to fibroids. The goal behind is to provide clinical guidance to busy practitioners. In recent decades, there has been significant change for the good in medical knowledge and experience. Loads and loads of information are just a click away but still there is no match for concise, practical and well-written book. It provides evidence-based management, according to the guidelines for specific condition related to fibroids. The text gives detailed knowledge supported by flowcharts.
As a physician, caring for women with fibroid disease, it is painful to witness frustration, pain and angst caused by uterine fibroids. The issue is further aggravated by the prevalence of uterine fibroids in women. Every third woman is affected by the disease and suffers from the adverse impact of fibroids in their lives. I myself have tackled so many nuisance creating fibroids at AIIMS. I realize sometimes the treating physicians is in dilemma to decide between the two treatment options. In such cases, this handy book can act as a guide. It covers a whole lot of spectrum of treatment, which is currently available. It will help in better understanding of these enigmatic tumors having infinite presentations with varied location, size and number. Currently, there is no preventive therapy available, so we have to fight fibroids head on. Dr Jaideep Malhotra is dear friend, very hard working and she has command on the subject. Her contribution makes this book special.
I greatly appreciate the efforts of the editors in bringing out such book. Dr Narendra Malhotra is a visionary and has a laser-like focus. He has contributed a lot towards our gyne fraternity. Dr Poonam Goyal is a hard-working person with good knowledge of the subject. I admire her continuous efforts in spite of being a busy practitioner.
At the end, I would say, this book will be of great help to the practicing doctors and post- graduate students in providing precise guidance. I wish good luck to Dr Narendra Malhotra, Poonam Goyal, Jaideep Malhotra and Bhavana Mittal and also to the budding authors who have really contributed the best. Dr Prakash Trivedi's chapter is a wonderful contribution.
Alka Kriplani (Padma Shri)
MD FRCOG FAMS FICOG FIMSA FICMCH FCLS
Director and Head
Department of Gynecology, Obstetrics and ART
Paras Hospitals, Gurugram, Haryana, India
Ex-Professor and Head
Department of Obstetrics and Gynecology
All India Institute of Medical Sciences
New Delhi, Indiafm_12
fm_13Preface
Uterine fibroid is a common gynecological pathology. This debilitating yet abstruse disease affects over 40% women worldwide. In fact, statistics show that 1 out of every 3 women in India are suffering from uterine fibroids. The disease may be asymptomatic or patient may present with severe symptoms of pain and bleeding.
Medical experts have been trying to conquer the disease since the earliest times to provide better service to the patients. Till date, there is a rapid innovation in the field of fibroid management to improve the quality of life of the suffering patients. Focus now has shifted to medical and conservative approaches rather than surgical approach.
We are highly thankful to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for publishing the book on a very interesting topic. We also express our gratitude to the contributors of the book who have provided pearls of knowledge from their expertise. We must also mention the unconditional support of our family members.
We whole heartedly dedicate this book to our patients who had confidence in us.
May God forever cherish the desire of every medical professional to gain knowledge.
Narendra Malhotra
Poonam Goyalfm_14
fm_15Acknowledgments
When Dr Narendra Malhotra floated the idea of a book on Fibroids, it seemed to be a Herculean task. But the concept came alive with extended hands of many to give a push. Dr Narendra Malhotra was always there 24×7 for guidance. We also extend special thanks to Dr Jaideep Malhotra for being a critic as well as guide.
We express our gratitude to Dr Alka Kriplani, who in spite of her packed schedule agreed to write foreword for the book. We sincerely thank Dr Prakash Trivedi for his contribution.
We express our heartfelt thanks and acknowledge the help of advocate Ms Aditee Goyal, Dr Pallaavi Goel, Dr VK Goyal, Dr AK Mittal, Dr Manju Mittal and Dr Tarun Mittal.
Contributors/Authors who all are best in their fields have worked hard and have done full justice to the chapters.
We especially appreciate the constant support and encouragement of Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Managing Director), M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, in helping to publish this textbook and also their associates particularly Ms Chetna Malhotra Vohra (Associate Director—Content Strategy) and Ms Prerna Bajaj (Development Editor), who have been prompt, efficient and most helpful.
Now waiting for the response of our readers.
Poonam Goyal
Bhavana Mittal