Duration = 7:18<\/p>\n
<\/iframe><\/p>\n<input type='hidden' bg_collapse_expand='69e9dc14142bf3034303297' value='69e9dc14142bf3034303297'><input type='hidden' id='bg-show-more-text-69e9dc14142bf3034303297' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dc14142bf3034303297' value='Hide Transcript'><button id='bg-showmore-action-69e9dc14142bf3034303297' class='bg-showmore-plg-button bg-blue-button ' style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dc14142bf3034303297' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 53<br \/>\n00:02<br \/>\nuterine leiomyoma uterine liya my Omata<br \/>\n00:05<br \/>\nor fibroids are proliferations of smooth<br \/>\n00:07<br \/>\nmuscle cells they are very common and by<br \/>\n00:10<br \/>\nthe fifth decade of a woman’s life they<br \/>\n00:12<br \/>\nmay be present in 1 out of 4 white women<br \/>\n00:14<br \/>\nand one out of two african-american<br \/>\n00:16<br \/>\nwomen fibroids are the most common<br \/>\n00:19<br \/>\nindication for hysterectomy accounting<br \/>\n00:21<br \/>\nfor approximately 30% for this operation<br \/>\n00:23<br \/>\nthe objectives of this video are to cite<br \/>\n00:25<br \/>\nthe prevalence of uterine lion myoma to<br \/>\n00:27<br \/>\nidentify symptoms and physical findings<br \/>\n00:29<br \/>\nin patients with uterine leiomyoma<br \/>\n00:31<br \/>\ndescribe the diagnostic methods to<br \/>\n00:34<br \/>\nconfirm uterine leiomyoma and finally<br \/>\n00:36<br \/>\ndescribe the management options for the<br \/>\n00:38<br \/>\ntreatment of uterine leiomyoma we<br \/>\n00:40<br \/>\nclassify fibroids into three groups<br \/>\n00:42<br \/>\nbased on their anatomic location here is<br \/>\n00:44<br \/>\nthe uterus cervix and endometrium the<br \/>\n00:47<br \/>\nfirst type of fibroid is an intramural<br \/>\n00:49<br \/>\nfibroid which is entirely within the<br \/>\n00:51<br \/>\nwall of the uterus the second type of<br \/>\n00:54<br \/>\nfibroid is a sub serosa fibroid which is<br \/>\n00:57<br \/>\nlocated beneath the serosa layer of the<br \/>\n01:00<br \/>\nuterus the third type of fibroid is a<br \/>\n01:06<br \/>\nsub mucosal fibroid which is located<br \/>\n01:09<br \/>\njust beneath the endometrium this is a<br \/>\n01:14<br \/>\nphotograph of a uterus with multiple<br \/>\n01:16<br \/>\nintramural fibroids this next photograph<br \/>\n01:18<br \/>\nalso shows a uterus with multiple<br \/>\n01:20<br \/>\nfibroids and the arrow points to a large<br \/>\n01:22<br \/>\nsub serosa fibroid this last photograph<br \/>\n01:26<br \/>\nis a history scopic view of the<br \/>\n01:28<br \/>\nendometrial cavity and shows three sub<br \/>\n01:30<br \/>\nmucosal fibroids they are considered<br \/>\n01:33<br \/>\nbenign hormonal irresponsive tumors and<br \/>\n01:35<br \/>\nestrogen stimulates growth and the high<br \/>\n01:38<br \/>\nestrogen state of pregnancy fibroids can<br \/>\n01:40<br \/>\ninduce rapid growth when a woman goes<br \/>\n01:42<br \/>\nthrough menopause and is in a low<br \/>\n01:44<br \/>\nestrogen state there will be cessation<br \/>\n01:46<br \/>\nof growth and even some atrophy the<br \/>\n01:48<br \/>\nimportant message to remember is that<br \/>\n01:49<br \/>\nfor most women fibroids are asymptomatic<br \/>\n01:51<br \/>\nand cause no or minimal problems when<br \/>\n01:55<br \/>\nfibroids cause symptoms the symptoms are<br \/>\n01:57<br \/>\nusually related to bleeding the type of<br \/>\n01:59<br \/>\nbleeding can vary but the classic<br \/>\n02:00<br \/>\npresentation of abnormal bleeding<br \/>\n02:02<br \/>\nrelated to fibroids is heavy periods the<br \/>\n02:04<br \/>\nsimplest way of thinking about why<br \/>\n02:06<br \/>\nfibroids cause heavy periods is to<br \/>\n02:08<br \/>\nenvision the fibroids distorting the<br \/>\n02:09<br \/>\nendometrial cavity a sub mucosal fibroid<br \/>\n02:12<br \/>\nwill obviously<br \/>\n02:13<br \/>\nthe most likely type of fibroid to<br \/>\n02:15<br \/>\ndistort the endometrial cavity<br \/>\n02:17<br \/>\nintramural fibroids can distort the<br \/>\n02:19<br \/>\nendometrial cavity if they are of<br \/>\n02:20<br \/>\nsignificant size or quantity some serosa<br \/>\n02:23<br \/>\nfibroids are the least likely type of<br \/>\n02:25<br \/>\nfibroid to cause bleeding problems again<br \/>\n02:27<br \/>\nunless they are big enough or if there<br \/>\n02:28<br \/>\nare enough of them<br \/>\n02:29<br \/>\nthe second classic symptom of fibroids<br \/>\n02:31<br \/>\nis pelvic pressure or the sensation of a<br \/>\n02:33<br \/>\npelvic mass fibroids can attain a<br \/>\n02:36<br \/>\nmassive size and here’s a photograph of<br \/>\n02:38<br \/>\na large sub serosa fibroid growing on<br \/>\n02:40<br \/>\nthe posterior wall of the uterus<br \/>\n02:42<br \/>\nthis second photograph illustrates<br \/>\n02:44<br \/>\nanother example of a uterus that has<br \/>\n02:46<br \/>\nmultiple fibroids of significant size<br \/>\n02:48<br \/>\nand we refer to this as a large my<br \/>\n02:50<br \/>\namitis uterus the third classic symptom<br \/>\n02:54<br \/>\nof fibroids is dysmenorrhea or painful<br \/>\n02:56<br \/>\nmenses let’s now move to physical<br \/>\n02:58<br \/>\nexamination<br \/>\n02:59<br \/>\nyou may remember dr. pom Cohen from the<br \/>\n03:02<br \/>\nAffco abnormal uterine bleeding video<br \/>\n03:04<br \/>\nremember that the L of the pom Cohen<br \/>\n03:07<br \/>\nabnormal uterine bleeding classification<br \/>\n03:09<br \/>\nsystem stands for leiomyoma physical<br \/>\n03:12<br \/>\nexamination findings depend on the size<br \/>\n03:14<br \/>\nand number of the fibroids if the uterus<br \/>\n03:16<br \/>\nis large then it can be palpated<br \/>\n03:17<br \/>\nabdominally and since we are<br \/>\n03:20<br \/>\nobstetrician gynecologists we often<br \/>\n03:22<br \/>\ndescribe the size of the uterus in terms<br \/>\n03:24<br \/>\nof week size compared to the pregnant<br \/>\n03:26<br \/>\nuterus you have a twenty week sized<br \/>\n03:27<br \/>\nuterus or we will describe the number of<br \/>\n03:30<br \/>\nfinger breasts beneath the unbel a cos<br \/>\n03:32<br \/>\nyou’ll either respond Papes to two<br \/>\n03:33<br \/>\nfinger breasts below the umbilicus<br \/>\n03:35<br \/>\nsmaller fibroids or fibers that are<br \/>\n03:37<br \/>\nsubmucosal or intramural may not be<br \/>\n03:40<br \/>\npalpable on physical examination the<br \/>\n03:42<br \/>\ndiagnosis is made through physical<br \/>\n03:43<br \/>\nexamination and imaging studies pelvic<br \/>\n03:46<br \/>\nultrasound can have quantify the number<br \/>\n03:48<br \/>\nand size of the fibroids here is an<br \/>\n03:50<br \/>\nultrasound with a sagittal view of the<br \/>\n03:52<br \/>\nuterus the hyper akoha Karia is the<br \/>\n03:54<br \/>\nendometrial cavity and the arrow points<br \/>\n03:57<br \/>\nto a small intramural fibroid a Sano<br \/>\n03:59<br \/>\nhistogram can better visualize the<br \/>\n04:01<br \/>\nendometrial cavity saline is instilled<br \/>\n04:04<br \/>\nthrough the cervix into the endometrial<br \/>\n04:06<br \/>\ncavity and this image shows a normal non<br \/>\n04:08<br \/>\ndistorted cavity a sauna history cam can<br \/>\n04:11<br \/>\nhelp to characterize the percent of a<br \/>\n04:13<br \/>\nfibroid that is in the endometrial<br \/>\n04:15<br \/>\ncavity in order to determine whether<br \/>\n04:17<br \/>\nhistory or scopic<br \/>\n04:20<br \/>\nare a can be useful to better visualize<br \/>\n04:22<br \/>\nthe exact size and location of the<br \/>\n04:24<br \/>\nfibroids let’s now move to manage<br \/>\n04:27<br \/>\noptions and remember that most women do<br \/>\n04:29<br \/>\nnot require any treatment especially if<br \/>\n04:31<br \/>\nthe fiber it is small and found<br \/>\n04:33<br \/>\nincidentally on imaging study when<br \/>\n04:35<br \/>\nbleeding is the main symptom that the<br \/>\n04:37<br \/>\npatient is experiencing the medical<br \/>\n04:38<br \/>\ntherapy can be used to try to minimize<br \/>\n04:40<br \/>\nthe abnormal bleeding<br \/>\n04:41<br \/>\nthis can be estrogen and progesterone<br \/>\n04:43<br \/>\nusually with oral contraception since<br \/>\n04:46<br \/>\nfibroids often become symptomatic and<br \/>\n04:48<br \/>\nwomen in their fifth decade of life<br \/>\n04:49<br \/>\nremember that oral contraception should<br \/>\n04:51<br \/>\nnot be given to women over age 35 with<br \/>\n04:53<br \/>\nhypertension who’s smoked or who have<br \/>\n04:56<br \/>\nmigraines progestins are another option<br \/>\n04:58<br \/>\nto help temper eyes bleeding<br \/>\n05:00<br \/>\nprostaglandin synthesis inhibitors such<br \/>\n05:02<br \/>\nas ibuprofen can decrease the amount of<br \/>\n05:04<br \/>\ndysmenorrhea and the amount of menstrual<br \/>\n05:06<br \/>\nflow and finally GnRH agonist suppress<br \/>\n05:09<br \/>\nthe hpo axis and thus produce a false<br \/>\n05:11<br \/>\nmenopause and this can lead to a<br \/>\n05:12<br \/>\nreduction at fibroid size this can be<br \/>\n05:14<br \/>\nused as a temporary measure in women to<br \/>\n05:17<br \/>\nboost their red blood cell counts prior<br \/>\n05:18<br \/>\nto definitive surgery or short-term and<br \/>\n05:21<br \/>\nwomen who are close to getting to<br \/>\n05:22<br \/>\nmenopause it is a short-term solution<br \/>\n05:24<br \/>\nsince it does cause a false menopause<br \/>\n05:26<br \/>\nand thus will have the detrimental<br \/>\n05:27<br \/>\neffect of the hypo estrogen state on<br \/>\n05:30<br \/>\nbone and cardiovascular health uterine<br \/>\n05:32<br \/>\nartery embolization is a procedure<br \/>\n05:34<br \/>\nperformed by interventional radiologists<br \/>\n05:36<br \/>\na catheter is inserted into the femoral<br \/>\n05:38<br \/>\nartery to the uterine arteries which are<br \/>\n05:44<br \/>\nthen embolized<br \/>\n05:45<br \/>\nwith tiny microspheres this results in a<br \/>\n05:50<br \/>\nfibroid avascular is a ssin and<br \/>\n05:52<br \/>\ninvolution there is short and long-term<br \/>\n05:55<br \/>\ndata that supports that uterine artery<br \/>\n05:57<br \/>\nembolisation is a safe and effective<br \/>\n05:58<br \/>\nmanagement option for fibroids for<br \/>\n06:00<br \/>\nappropriately selected women who wish to<br \/>\n06:02<br \/>\nretain their uteri let’s now move to<br \/>\n06:04<br \/>\nsurgical options myomectomy is another<br \/>\n06:07<br \/>\noption for women who desire to preserve<br \/>\n06:09<br \/>\ntheir uteri<br \/>\n06:10<br \/>\nthe myomectomy can be performed either<br \/>\n06:12<br \/>\nabdominally either via laparoscopy or<br \/>\n06:14<br \/>\nlaparotomy approach hysteroscopic<br \/>\n06:17<br \/>\nmyomectomy can be performed if there is<br \/>\n06:19<br \/>\na distinct submucosal fibroid the<br \/>\n06:22<br \/>\nfollowing video will demonstrate a<br \/>\n06:23<br \/>\nhistory or scopic myomectomy you can see<br \/>\n06:26<br \/>\nthe small submucosa library that is<br \/>\n06:28<br \/>\nbeing removed with a history scopic<br \/>\n06:30<br \/>\ninstrument at the completion of the<br \/>\n06:33<br \/>\nprocedure the endometrial cavity has<br \/>\n06:35<br \/>\nbeen restored to normal anatomy<br \/>\n06:41<br \/>\nand finally hysterectomy is definitive<br \/>\n06:44<br \/>\ntherapy for fibroids indications should<br \/>\n06:46<br \/>\nbe specific and well-documented it can<br \/>\n06:48<br \/>\nbe performed vaginally or abdominally<br \/>\n06:50<br \/>\ndepending on the size and location of<br \/>\n06:52<br \/>\nthe fibroids this concludes the aapko<br \/>\n06:54<br \/>\nvideo on uterine Leah my OMA we have<br \/>\n06:56<br \/>\ndiscussed the prevalence symptoms<br \/>\n06:58<br \/>\nphysical exam findings and diagnostic<br \/>\n07:00<br \/>\nmethods and management options for this<br \/>\n07:02<br \/>\ncommon finding in women<br \/>\n07:04<br \/>\n[Music]<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 7:18<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":46,"menu_order":53,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-235","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/235","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=235"}],"version-history":[{"count":3,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/235\/revisions"}],"predecessor-version":[{"id":1275,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/235\/revisions\/1275"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=235"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}