Myoma Utery

(Myoma Geburt)

Muhammad Satya Arrif Z

1
 Name : Mrs. H
Age : 47 years old P4A0
Gender : Woman
Job : laborers
Religion : Islam
Address : Bulusan Canden Bantul
Date of entry : 13 of May 2017

Patient Identity 2
 Main complaint
Patients come with bleeding form vagina dan lower
abdominal pain complaints
Current Illness History
Patients complain of lower abdominal pain, irregular
menstruation, and fresh red blood when intercourse
History of contraception: (+) with IUD for 3 years

Anamnesis 3
 Obstetric history
I: 1999, aterm, spontaneous, female, 2900gr
II: 2005, aterm, spontaneous, women, 3100gr
III: 2009, aterm, sectio caesarea , female, 3500gr
IV: 2010, aterm, sectio caesarea, male, 3000gr
Menstruation history: age of menarche 13 years
Married history: married 1x with husband until now, for
about 20 years

Anamnesis 4
 GC:Composmentis
BP: 120/80mmhg, RR: 18x/m HR: 82x/m T: 36C
BH: 155 cm
BW: 52 kg
Head: CA (+) / (+), SI (-) / (-)
Neck: Thyroid Enlargement (-)
Thorax: Symmetrical (+), retraction (-), SDV (+) / (+), BJ (-),
S1 regular S2 (+)
Abdomen: tenderness (+) hypogastric region, Supel (+)
Extremities: warmer Acral (+) / (+) / (+) / (+), Edema (-)/(-)

Generalist status &

Physical examination 5
 Inspekulo
-The mass are round, pale, as big as chicken eggs, oval
lengthwise out of the servix uteri
-Bleeding out of the cervical canal
-Portio was slick
-OUE was oppened about 2cm
-Fluor (-)

Vaginal Toucher:
The palpable stumped (pedunculated) as big as of chicken eggs,
palpable rubbery, flat surfaces, move simultaneously as the
uterine fundus is moved, the size was like of an adult's finger

Internal Examination 6
 Hemoglobin :10.5 (14-18) g/dl
Lekosit : 6.84 (4-11) ribu/ul
Eritrosit : 5.3 (4.50-5.50) ribu/ul
Trombosit : 317 (150-450) ribu/ul
Hematokrit : 34. (42.0-52.0) vol%

Eosinofil :2 (2-4%) %
Basofil :0 (0-1%) %
Batang :5 (2-5%) %
Segmen : 60 (51-67%) %
Limfosit : 30 (20-35%) %
Monosit :3 (4-8%) %

Laboratory Examination 7
 Golongan darah :O
PPT : 13.4 (12-16) detik
APTT : 31.3 (28-38) detik
Control PPT : 14.0 (11-16) detik
Control APTT : 34.7 (28-36.5) detik
SGOT : 17 (<31) U/L
SGPT : 11 (<31) U/L
Protein Total : 7.66 (6.2-8.4) g/dl
Albumin : 4.27 (3.5-5.5) g/dl
Globulin : 3.39 (2.8-3.2) g/dl
Ureum : 18 (17-43) mg/dl
Creatinin : 0.97 (0.90-1.30) mg/dl
GDS : 91 (80-200) mg/dl
Natrium : 136.9 (137-145) mmol/l
Kalium : 4.22 (3.50-5.10) mmol/l
Klorida : 104.8 (98-107) mmol/l
HbsAg Titer : Non Reaktif (Non Reaktif)
8
HIV Screening : Negatif (Negatif)
 Ultrasound: there is a posterior uterine myoma, size 13x5
cm lengthwise out of OUE

USG 9
 Geburt Myoma in P4A0

DIAGNOSE 10
 leiomyoma of uterus
leiomyomas
fibromyomas
myofibromas
fibroids
fibromas
myomas

Synonyms 11
Prawirohardjo, S. (2014). Ilmu Kandungan. Jakarta: Sagung Seto.
Most common solid pelvic tumors

Develop in 2035% of women during

reproductive years

3050 years old

Incidence 12
Prawirohardjo, S. (2014). Ilmu Kandungan. Jakarta: Sagung Seto.
-Hormonal Factor: estrogen progesterone
-Growth factor
epithelial growth factorEGF
Insulin-like growth factorIGF
platelet-derived growth factor
-Molecular biology
-Nullipara
-Reproductive age

Correlative Factors 13
Parker, W. 2007. Etiology, Symptomatology and Diagnosis of Uterine Myomas.

Departemen of Obstetric and GynekologyUCLA School of Medicine California. Vol.87. No.4. April 2007 : 725-733
Pathology

14
-Pathologically, uterine
myoma is round, pearly
white, slippery, and supple.
The uterine myoma does not
coalesce in the myometrial
layer but is coated with a thin
connective tissue on its outer
surface
-Histologically, uterine
myoma is composed of
smooth muscle, fibrous
connective tissue, and many
blood vessels

Gross Appearance 15
 Smooth muscle tumors of the uterus are often
multiple. Seen here are submucosal, intramural,
and subserosal leiomyomata of the uterus.
16
 17

Kate E. Rice et all (2012), Etiology, Diagnosis, and Management of Uterine Leiomyomas. Journal of Midwifery &Womens Health. Vol 57. p:242
According to growth location

Myomas on the body of uterus90%

Myomas on the cervix of uterus10%

Classification 18
According to the relation
to uterine muscle
Submucous10-15%
Intramural60-70%
Subserosal20%

Classification 19
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. 2003
Clinical
Manifestation

20
-Menorrhagia and prolonged menstrual period

-Pelvic pain
occurs in pregnancy if undergoing degeneration
or torsion of a pedunculated myoma
-Pelvic pressureurinary frequency
bowel difficultyconstipation
-Spontaneous abortion
-Infertility

Symptoms 21
Prawirohardjo, S. (2014). Ilmu Kandungan. Jakarta: Sagung Seto.
-A palpable abdominal tumour

-Pelvic examination
uterus: enlarged, irregular, hard

-Cervix examination: pedunculated, out from portio/cervix

Signs 22
Prawirohardjo, S. (2014). Ilmu Kandungan. Jakarta: Sagung Seto.
 -Anamnesis > Menorrhagia and feel a mass out from
cervix
-Physical examination > uterus: enlarged, irregular,
hard
-Ultrasonography > USG transabdominal / transvaginal
-Hysteroscopy
-Laparoscopy
-Hysterography
-MRI

Diagnosis 23
Kate E. Rice et all (2012), Etiology, Diagnosis, and Management of Uterine Leiomyomas. Journal of Midwifery &Womens Health. Vol 57
Prawirohardjo, S. (2014). Ilmu Kandungan. Jakarta: Sagung Seto.
Differential
Diagnosis 24

Kate E. Rice et all, 2012, Journal of Midwifery &Womens Health

Treatment

25
-Smallasymptomatic fibroids not need to be treated
especially near menopause.

-Interval36 months

Observation and Follow Up 26

- GnRH agonist > decrease size of myoma and
vascularization of tumor
- Oral contraception (progesteron) > only decrease
bleeding

Medical Treatment
(hormonal) 27
Djuwantono T. 2004. Terapi GnRH agonis sebelum histerektomi. Mioma: Farmacia 3:38-41.
 -Uterine bleeding is not responsive to conservative
therapy
-Probability of malignancy
-Myoma grow during menopause
-Infertility due to disruption of the uterine cavity or
due to tubal occlusion
-Pain and emphasis/pressure are very disturbing
-Urinary tract obstruction
-Anemia due to bleeding

Surgery Indication 28
Budi R. Hadibroto. 2005. Mioma Uteri. Majalah Kedokteran. Volume 38. No. 3:September 2005: 256-258.
-Myomectomy > removal only of the myoma nest
without removal of the uterus

-Hysterectomy > radical therapy, removal of the uterus,

Hysterectomy is performed when patients complaints of
menorrhagia, metrorrhagia, obstruction of the urinary
tract and uterine size like 12-14 weeks gestation

Surgery Method 29
 Malignant Degeneration
Torsion
Necrosis and Infection
Affect in pregnancy

Complication 30
-impact on pregnancyabortion
-impact on deliverypremature labour
fetal malpresentation
retained placenta
placenta previa
need for operative delivery
birth canal obstruction
postpartum hemorrhage

Uterine Leiomyomas Complicating

Pregnancy 31
THANK YOU

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