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:
- Uterine artery embolisation – POLYVENYL ALCOHOL inside UTERINE artery. (don’t use if desire future pregnancy)
- 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
