Also, almost 50% of African women will have uterine fibroid by their 5th decade of life [1]. A woman can have one uterine fibroid or many. There are no clinical findings that reliably differentiate ordinary leiomyomas from leiomyoma variants and leiomyosarcomas. After three days in the hospital I have found out I have a large twisted fibroid on my uterus wall in 'red degeneration'. They are living tissue, requiring oxygen and nutrients to survivie and grow, supplied by blood vessels in an around the uterus. Posteriorly, fibroids may increase the rectal pressure or cause constipation or tenesmus. Fibroids are more common in obese women and women with an early menarc… Available from: Anatomical Classification of Uterine Fibroids, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon, Human Research Education and Networking, Cameroon, Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon. Most frequent complication of myoma during pregnancy. It should also be considered in the event of a rapidly enlarging fibroids, in which a reasonable likelihood of malignancy exists. Physiopathology and Management of Uterine Fibroids [Online First], IntechOpen, DOI: 10.5772/intechopen.94162. Malignant transformation of leiomyomas is very rare, seen in 0.04% women having uterine fibroids. They are benign clonal neoplasms that contain an increased amount of extracellular collagen, elastin and are surrounded by a thin pseudo-capsule. This is due to the oedema, increased vascularity and hypertrophy of uterine muscles that lead to the increase in size of fibroids during pregnancy. 1,2 On gross pathological examination, it is characterized by a red, hemorrhagic appearance of the leiomyoma if the surgery was performed during the acute phase of red degeneration. The management of uterine fibroids in pregnancy depends on the signs and symptoms: In the majority of cases, no treatment is required. Overall, there is reasonable tolerance, improvement in quality of life, and modest change in fibroid size. Red degeneration of fibroid in pregnancy is a well-established debilitating condition in the second Evidence from the contemporary literature reports that the prevalence rate of uterine fibroid varies between 16.7% - 30% of reproductive-age women and there is a two-fold increase in the prevalence in Afro American women [4, 5]. Generally, the effects of fibroids on pregnancy and labour are: Spontaneous abortion, especially with sub-mucousal leiomyomas due to the distortion of the uterine cavity and impairment of the vascular supply to the implanted ovum [36]. Occasionally they pass through the cervical canal while still attached within the corpus by a long stalk. Till date is pathophysiology and management both in the non-pregnant and pregnant woman have not been well described. Hence, this implies a genetic probability for the growth of uterine. According to their anatomic locations, there are three different types of leiomyomas: Subserosal or subperitoneal leiomyomata are the most common and are usually asymptomatic unless very large. In addition to pelvic pain, red degeneration may cause a low-grade fever and a temporary elevation in white blood cell count, notes 4 . It can be achieved using the following surgical procedures: open surgery, laparoscopy, robotic, transvaginal, and hysteroscopic surgery. They may manifest with swelling of the abdomen, menorrhagia and infertility. Types of degeneration include hyaline degeneration, myxoid or cystic degeneration, necrotic degeneration, red (hemorrhagic) degeneration, calcification or fatty degeneration, and sarcomatous transformation (very rarely, <0.05 % of resected fibroids) . Secondary changes may occur when the fibroids tend to outgrow their blood supply. It now means I am bed bound until the pain reduces, which it might not. Thus, laparoscopic uterine artery occlusion is likely to attract considerable interest as an effective alternative to hysterectomy treatment of symptomatic uterine leiomyomata. In this chapter, we present contemporary evidence to help elucidate this enigma. Built by scientists, for scientists. In the post-partum period, prophylactic antibodies should be given. On gross appearance, it resembles leiomyosarcoma, a malignant neoplasm of … Myomectomy should never be contemplated during caesarean section as vascularity of fibroid is increased during pregnancy (due to increased estrogen) leading to increased blood loss during cesarean section. Progestins: Progestational therapy using norethindrone, medrogestone, and medroxyprogesterone acetate has been successful. Contact our London head office or media team here. Licensee IntechOpen. In some cases, it can lead to miscarriage. Many women who are trying to fall pregnant will have fibroids. 3 Varieties of fibroid degenerations can also occur in pregnancy. Brief introduction to this section that descibes Open Access especially from an IntechOpen perspective, Want to get in touch? The incidence of abnormal uterine bleeding was 47.7% in a study done by Okogbo et al. It is easy to diagnose fibroids with ultrasound scanning, and most pregnant women have one or more ultrasound examinations. This type of fibroids degeneration is common during pregnancy or after pregnancy. In increment in the exposure of circulating oestrogens is another hypothesis for the growth of uterine fibroids. Though the exact cause is still not clear but it is beleived to be vascular in origin, pain and fever may indicate infection but in real terms infection has no role in red degeneration of pregnancy. Therefore many women who are pregnant will have a fibroid or fibroids. 3 article feature images from this case Uterine leiomyoma The definitive diagnosis in cases of uterine bleeding usually can be established by endometrial biopsy or fractional D&C [16]. Patient is put to bed rest and given analgesics (to relieve the pain), sedatives and if required antibiotics. In cases—as in our patient—where red degeneration is found to be the cause of the pain, conservative management with input from pain specialists is the preferred option. Red degeneration usually begins around 20 weeks and the pain can vary from no pain to severe pain around the fibroid as well as the lower back. Myomectomy: There may be a beneficial effect of surgical resection of myomas to enhance fertility or successful pregnancy outcome [25]. Most fibroids are asymptomatic; usually asymptomatic in pregnancy but may interfere with conception and may cause spontaneous abortion, missed abortions, painful red degeneration or infarction of the fibroids, abnormal foetal presentation, obstructed labour, and an increased likelihood of premature deliveries, caesarean deliveries, postpartum haemorrhage and, whereas, in the non-pregnant state its signs and symptoms are menorrhagia, metorrhagia, menometorrhagia, infertility, constipation, urinary incontinence, and leiosarcoma transformation [3]. Uterine fibroids can occur in the non-pregnant woman and then continue into pregnancy/may develop de novo in pregnancy. Pain may either be due to red degeneration, infarction or torsion of a uterine fibroid, or mat stem from attempts to expel a pedunculated submucousal fibroid [ 1 ]. The laparoscopic procedure resulted in less postoperative pain and nausea and shorter hospital stays, although significantly more participants experienced heavy menstrual bleeding six months after laparoscopic occlusion, indicating a more favourable effect after uterine leiomyoma embolization. A second study reported that malignant change developed in less than 0.13% of uterine leiomyomas [17]. They originate in the myometrium and grow out toward the serosal surface of the uterus, lying beneath the peritoneum [1]. Fibroid degeneration takes place when the fibroid has been increasing in size over a number of years, and its blood supply is no longer adequate to support the center of the tumor. In their study of 171 postpartum women, they found that 36% of fibroids resolved to an undetectable level and those that remain were reduced in diameter by a median of 0.5 cm [35]. Chronic degeneration may be atrophic, hyaline (65%), cystic, calcific (10%), myxomatous (15%), or fatty [1]. Login to your personal dashboard for more detailed statistics on your publications. Hello! Furthermore, black women develop the disease five to six years earlier and their peak age at diagnosis is 40–44 years [7] as opposed to a to peak age of incidence of 35 years observed in Caucasians [1]. In cases—as in our patient—where red degeneration is found … To confirm the diagnosis different types of imaging techniques are used: A Pelvic ultrasound scan is the test of first choice. Other times, the fibroid outgrows its blood supply, turns red and dies. Pain—the most common complication—is usually caused by torsion of a pedunculated fibroid or red degeneration. A fibroid can undergo a different type of degeneration known as red degeneration, or necrobiosis. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the world’s most-cited researchers. Red degeneration in uterine fibroid is most common in Second trimester, Treatment of Red degeneration of fibroid during pregnancy include Analgesics, Red degeneration of fibroid is due to Thrombosis of the veins, Red degeneration of uterine fibroid  Is aseptic infarcation, Red degeneration of fibroid is associated with Pregnancy. Here, three-dimensional scan is preferred to a two-dimensional scan due its higher resolution which helps to rule out a pregnancy, other pelvic masses, a congenital uterine malformation [21]. *Address all correspondence to: These degenerations include necrotic, haemorrhagic (red degeneration) or septic for the acute ones. These may press on nerves within the bony pelvis, creating pain that radiates to the back or lower extremities. Although fibroids constitute the most common tumour in women of reproductive age, it is remarkable how very rarely they cause acute complications. They may lie just at the serosal surface of the uterus or may become pedunculated. Myomectomy is generally contraindicated during pregnancy due to increased vascularity that may lead to haemorrhagic complications. As fibroid is common in reproductive age group therefore pregnancy coexisting with fibroid is not uncommon with a prevalence rate estimated at 10.7% in the first trimester.3 Varieties of fibroid degenerations can also occur in pregnancy. It should be noted that these pressure symptoms are quite unusual and are difficult to directly relate to fibroids. It is due to thrombosis of large veins in the tumor. They originate in the myometrium and grow toward the endometrial cavity, protruding into the uterine cavity that they tend to compress. By making research easy to access, and puts the academic needs of the researchers before the business interests of publishers. Don’t Forget to Solve all the previous Year Question asked on Red degeneration of fibroid. The most common symptom would be heavy and or prolonged menses. It is a well-known complication especially during pregnancy. Fibroid in pregnancy is common in clinical obstetric practice. The cause of uterine leiomyomata is idiopathic till date. Specifically, a rapidly growing uterine mass is not a reliable predictor of leiomyosarcoma according to Parker et al. Uterine fibroid is the most encountered benign tumour in women of reproductive age. It’s based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. They may enlarge to cause significant distortion of the uterine surface or cavity. Dr. Tracey Leaver-Williams answered 17 years experience Obstetrics and Gynecology The potential effects of fibroids on pregnancy and the potential effects of pregnancy on fibroids are a frequent clinical concern since these tumors are common in women of reproductive age. To date our community has made over 100 million downloads. They are however not suitable for long term use because they are associated with menopausal symptoms and bone loss but are likely to be beneficial preoperatively [24]. When fibroids bec… A rare complication of laparoscopic myomectomy is the occurrence of parasitic leiomyomas. Based on the study of Helal et al. Fibroids has various symptoms including abnormal or heavy bleeding during periods, swelling in the lower abdomen, weight gain and frequent urination. However, laparoscopic myomectomy may be considered safe if done in early pregnancy but only in the hands of experienced laparoscopic surgeons [37]. They may also cause pain during sex or lower back pain. Indications for it include red degeneration not responding to medical therapy, torsion of a pedunculated myoma or internal haemorrhage from rupture of a surface vein [36]. We are IntechOpen, the world's leading publisher of Open Access books. Symptoms are found only in about 35–50% of the patients. Fibroids may have a detrimental effect on fertility in up to 10% of the cases [20]. These compounds produce a hypo-estrogenic effect by inhibiting gonadotropin secretion and suppressing ovarian function [17]. Total abdominal hysterectomy is considered to be beneficial in reducing fibroid-related symptoms, but total vaginal hysterectomy and total laparoscopic hysterectomy may have lower risks of complications, and shorter recovery times [18]. Uterine artery embolization (UAE): It is the occlusion of the uterine artery, which reduces the blood supply to the uterus and ultimately to the uterine fibroids. Pressure effects may either be anteriorly on the bladder, causing mainly frequent micturation, and urinary incontinence. Abdominal discomfort if the tumour is large. in 2010, both laparoscopic occlusions of the uterine vessel and embolization improve symptoms associated with uterine fibroids [31]. Background: Red degeneration of fibroid is a rare event, but when it occurs, it is reported more often during pregnancy as an acute clinical presentation. A sensation of pelvic heaviness or fullness or a feeling of a mass in the pelvis is particularly characteristic of large tumours. Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus. Plain X-Rays of the lower abdomen and pelvis usually identify only calcified fibroids and sometimes large fibroids may be seen as soft tissue or calcified masses displacing bowel gas [22]. Most women have no symptoms while others may have painful or heavy periods. Tocolytics may be necessary to control the uterine contractions in threatening premature labour. Multiple: Fibroids are common benign tumors of the uterus . Red (carneous) Fibroids Degeneration This type of fibroids degeneration is common during pregnancy or after pregnancy. One of the main indicators of degenerating fibroid is an acute stabbing pain and swelling in the abdomen. Placenta praevia due to interference with implantation of the ovum in the upper uterine segment. Leiomyomas also called uterine myomas, uterine fibroids, or fibromyomas are discrete, rounded, firm, white to pale pink, benign myometrial tumours composed mostly of smooth muscle with varying amounts of fibrous connective tissues [1]. in 2011in Nigeria [19]. Also, the women should be carefully observed for post-partum haemorrhage. Uterine fibroids, also known as uterine leiomyomas or fibroids, are benign smooth muscle tumors of the uterus. Intramural or interstitial myomas are located within the uterine wall of the myometrium and may distort the shape of the uterine cavity and surface. With respect to the location of the fibroids, 89.4% submucous, 10.6% subserous and 74.5% were intramural according to a study done in Cameroon [15].