Skip to main content
SpringerLink
Log in

Innumerable Fibroids

  • Chapter
  • First Online:
Uterine Fibroids

  • 856 Accesses

Abstract

This case illustrates our approach to a patient with many uterine fibroids who desires future fertility. We tailor the surgical plan to each individual patient depending on one’s symptoms, age, anatomy, reproductive goals, and specific timeline for conceiving. This patient developed life-threatening acute blood-loss anemia in the setting of chronic iron-deficiency anemia related to menorrhagia from her fibroids, which required blood transfusions and hospitalization and careful preoperative optimization. While not all patients will present as such, this chapter outlines our approach to patients with symptomatic and significant fibroid burden who wish to maintain their reproductive options.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Ruffatti A, Veller-Fornasa C, Patrassi GM, Sartori E, Tonello M, Tonetto S, et al. Anticardiolipin antibodies and antiphospholipid syndrome in chronic discoid lupus erythematosus. Clin Rheumatol. 1995;14(4):402–4.

    Article  CAS  PubMed  Google Scholar 

  2. Kind P, Schuppe HC, Jung KP, Degitz K, Lakomek HJ, Goerz G. Cutaneous lupus erythematosus and cardiolipin antibodies. Incidence and clinical significance. Hautarzt. 1992;43(3):126–9.

    CAS  PubMed  Google Scholar 

  3. Kanis MJ, Rahaman J, Moshier EL, Zakashansky K, Chuang L, Kolev V. Detection and correlation of pre-operative, frozen section, and final pathology in high-risk endometrial cancer. Eur J Gynaecol Oncol. 2016;37(3):338–41. PubMed

    CAS  PubMed  Google Scholar 

  4. Fakhar S, Saeed G, Khan AH, Alam AY. Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding. Ann Saudi Med. 2008;28(3):188–91. PubMed

    Article  PubMed  Google Scholar 

  5. Hinchcliff EM, Esselen KM, Watkins JC, Oduyebo T, Rauh-Hain JA, Del Carmen MG, et al. The role of endometrial biopsy in the preoperative detection of uterine leiomyosarcoma. J Minim Invasive Gynecol. 2016;23(4):567–72. doi:10.1016/j.jmig.2016.01.022.

    Article  PubMed  Google Scholar 

  6. Harris JA, Swenson CW, Uppal S, Kamdar N, Mahnert N, As-Sanie S, Morgan DM. Practice patterns and postoperative complications before and after US Food and Drug Administration safety communication on power morcellation. Am J Obstet Gynecol. 2016;214(1):98.e1–98.e13.

    Article  Google Scholar 

  7. Pritts E, Parker W, Olive D. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215–2.

    Article  PubMed  Google Scholar 

  8. Dobrokhotova J, Grishin I, Ibragimova D, Knysheva I, Ilchenko V. Uterine artery embolization and pregnancy: actual and controversial issues of gestation terms and delivery. Int J Biomed. 2016;6(1):33–7.

    Article  Google Scholar 

  9. Eriksson LG, Mulic-Lutvica A, Jangland L, Nyman R. Massive postpartum hemorrhage treated with transcatheter arterial embolization: technical aspects and long-term effects on fertility and menstrual cycle. Acta Radiol. 2007;48(6):635–42.

    Article  PubMed  Google Scholar 

  10. Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG. 2010;117(1):84–93. doi:10.1111/j.1471-0528.2009.02381.x.

    Article  PubMed  Google Scholar 

  11. Salomon LJ, deTayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, Frydman R, Fernandez H. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod. 2003;18(4):849–52.

    Article  CAS  PubMed  Google Scholar 

  12. Soyer P, Dohan A, Dautry R, Gueurrache Y, Ricbourg A, Gayat E, et al. Transcatheter arterial embolization for post partum hemorrhage: indications, techniques, results, and complications. Cardiovasc Intervent Radiol. 2015;38:1068–81.

    Article  PubMed  Google Scholar 

  13. Deux JF, Bazot M, Le Blanche AF, Tassart M, Khalil A, Berkane N, Uzan S, Boudghène F. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? AJR Am J Roentgenol. 2001;177(1):145–9.

    Article  CAS  PubMed  Google Scholar 

  14. Spies JB. Current role of uterine artery embolization in the manadgement of uterine fibroids. Clin Obstet Gynecol. 2016;59(1):93–102.

    Article  PubMed  Google Scholar 

  15. Goldman K, Hirshfeld-Cytron J, Pavone M, Thomas A, Vogelzang R, Milad M. Uterine artery embolization immediately preceding laparoscopic myomectomy. Int J Gynaecol Obstet. 2012;116(2):105–8.

    Article  PubMed  Google Scholar 

  16. Reed SD, Newton KM, Thompson LB, Mccrummen BA, Warolin AK. The incidence of repeat uterine surgery following myomectomy. J Womens Health (Larchmt). 2006;15(9):1046–52.

    Article  Google Scholar 

  17. Sharp HT. Assessment of new technology in the treatment of idiopathic menorrhagia and uterine leiomyomata Obstet Gynecol 2006108(4):990-1003.

    Google Scholar 

  18. Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2011;11:CD005355.

    Google Scholar 

  19. Kongnyuy EJ, van den Broek N, Wiysonge CS. A systematic review of randomized controlled trials to reduce hemorrhage duringmyomectomy for uterine fibroids. Int J Gynaecol Obstet. 2008;100(1):4–9.

    Article  CAS  PubMed  Google Scholar 

  20. Lee HY, Shin JH, Kim J, Yoon H-K, Ko G-Y, Won H-S, et al. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Vasc Interv Radiol. 2012;264(3):903–9.

    Google Scholar 

  21. Chauleur C, Fagnet C, Levy R, Larchez C, Seffert P. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod. 2008;23(7):1553–9.

    Article  CAS  PubMed  Google Scholar 

  22. Papoutsis D, Georgantzis D, Daccò MD, Halmos G, Moustafa M, Mesquita Pinto AR, Magos A. A rare case of Asherman’s syndrome after open myomectomy: sonographic investigations and possible underlying mechanisms. Gynecol Obstet Invest. 2014;77(3):194–200.

    Article  PubMed  Google Scholar 

  23. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for management of intrauterine synechiae. J Minim Invasive Gynecol. 2010;17(1):1–7.

    Article  Google Scholar 

  24. Gambadauro P, Gudmundsson J, Torrejón R. Intrauterine adhesions following conservative treatment of uterine fibroids. Obstet Gynecol Int. 2012;2012:853269.

    Article  PubMed  Google Scholar 

  25. Asgari Z, Hafizi L, Hosseini R, Javaheri A, Rastad H. Intrauterine synechiae after myomectomy; laparotomy versus laparoscopy: non-randomized interventional trial. Iran J Reprod Med. 2015;13(3):161–8.

    PubMed  PubMed Central  Google Scholar 

  26. Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, Berghella V. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstet Gynecol Scand. 2016;95(7):724–34. doi:10.1111/aogs.12920.

    Article  PubMed  Google Scholar 

  27. Koo YJ, Lee JK, Lee YK, Kwak DW, Lee IH, Lim KT, Lee KH, Kim TJ. Pregnancy outcomes and risk factors for uterine rupture after laparoscopic myomectomy: a single-center experience and literature review. J Minim Invasive Gynecol. 2015;22(6):1022–8. doi:10.1016/j.jmig.2015.05.016.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Minimally Invasive Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Kari Plewniak MD & Hye-Chun Hur MD, MPH

Authors
  1. Kari Plewniak MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hye-Chun Hur MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hye-Chun Hur MD, MPH .

Editor information

Editors and Affiliations

  1. Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA

    Nash S. Moawad

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Plewniak, K., Hur, HC. (2018). Innumerable Fibroids. In: Moawad, N. (eds) Uterine Fibroids. Springer, Cham. https://doi.org/10.1007/978-3-319-58780-6_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-58780-6_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-58779-0

  • Online ISBN: 978-3-319-58780-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation