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Best Coaching Centre for FMGE 2023

Kings International Medical Academy is widely recognized as a premier coaching institute for medical students preparing for the Foreign Medical Graduate Examination (FMGE) in India. With a reputation for providing excellent training and guidance, KIMA has helped countless students achieve their dreams of becoming successful doctors.

As part of their commitment to offering the highest quality education, Kings recently invited Dr. Vidhya, an eminent expert in the field of Obstetrics and Gynecology, to deliver a session on Fibroid Uterus. Dr. Vidhya’s vast knowledge and experience in this area made her the perfect candidate to teach the students at Kings and her insightful lecture left a lasting impression on all those in attendance. Let’s learn about Fibroid Uterus in a bit more detail, shall we?

 

FIBROID UTERUS

BENIGN tumour, DISORGANIZED/POOR blood supply

Arise from SMOOTH MUSCLE CELL OF MYOMETRIUM

TRANSLOCATION 12 – 14 >>> Deletion of chromosome 6

Types:

  • Intramural – MC type/ Most primitive
  • Subserosal – least degenerative
  • Submucus- Most symptomatic, MC degenerative
  • Intracavitary
  • Cervical
  • Broad ligament

Degenerations types:

  • Hyaline/Myxoid (MC)
  • Cystic
  • Fatty
  • Calcareous
  • Red (Pregnancy)

 

Special Features:

All type of degeneration MC seen in: SUBMUCOUS

Except: CALCAREOUS (MC in SUBSEROUS)

 

CALCAREOUS – Peripheral to Centre

All other: Centre to Peripheral

 

RED – PAINFUL

Others: painless

 

RED degeneration: MC in PREGNANCY (2nd Tri)

MC Sx: PAIN ABDOMEN

Special Fea: BEEFY RED/FISHY ODOR Hemorrhage in Myoma

Others: Fever, vomiting, inc WBC, ESR (non infective etioloogy)

Ddx: Abruption, preterm labor, appendicitis, Cholecystitis, Pyelonephritis

 IOC: <12 wk: TVS      >12 wk: Transabdominal US

Tx: Symptomatic (NSAIDS, Antibiotics, fluids)

 

For all fibroid:

Gold standard: MRI (d/f b/w fibroid n adenomyosis

Mx: Expectant/medical/surgical

Expectant Mx: OBSERVE in

  • Asymptomatic patients
  • Post-menopausal fibroid
  • Pregnancy (shrink in post-partum)

 

Surgery: MYOMECTOMY or HYSTERECTOMY

Choose either based on family completion

DEFINITIVE THERAPY – both

 

Recent advances:

  1. Uterine artery embolisation – POLYVENYL ALCOHOL inside UTERINE artery. (don’t use if desire future pregnancy)
  2. MRI guided focus ultrasound

HIFU – High intensity focused ultrasound

 

MEDICAL MX: CONTINUOUS GnRH analaogue

GnRH antogonists

Mifepristone – Progesterone receptor antagonist

Progesterone receptor modulator (ULIPRISTIL)

ASOPRISNIL

Mirena & Progesterone – REDCUE BLOOD LOSS (symptomatic relief but make fibroid grow)

All others: SHRINKS FIBROIDS

Other not in use: androgen analogue (Gestrinone), Danazol

MIFEPRISTONE: RU486

Used for: MTP, FIBROIDS, Cushing syn, cervical ripening, also ectopic pregnancy (but DOC for ectopic: METHOTREXATE)

For MTP: 200mg single shot

For Fibroid: 20-30mg/day

A/E: vASOMOTOR syndrome, Endometrial hyperplasia/cancer

 

Ulipristil:(SPRM/Asoprisnil) –30mg/day–SHRINKS FIBROIDS

A/E: vASOMOTOR syndrome, Endometrial hyperplasia/cancer

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