| What is Type 0 in the FIGO classification of submucosal fibroids? | Pedunculated , intracavitary | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - Levonorgestrel-releasing intrauterine system (if uterine cavity normal) - Progestogenic agents* ALL THERAPUTIC OPTIONS NEED TO BE EXPLAINED TO THE PATIENT INCLUDING JUST KEEPING THE PATIENT ON OBSERVATION. | 208 | definition | 0.940 | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - | 1 | page=1,block=56 | 0.700 | valid |
| What measurement is used to classify fibroids as small? | <5cm | Small Fibroids (<5cm) Large Fibroids (Uterine size >12 weeks) Thick pedicle Polypectomy Asymptomatic Symptomatic No Relief Observation Non surgical *Norethisterone (max daily dose 40 mg) OR Medroxyprogesterone acetate (max daily dose 40 mg). | 16 | definition | 0.820 | Small Fibroids (<5cm) Large Fibroids (Uterine size >12 weeks) Thick pedicle Polypectomy Asymptomatic Symptomatic No Relief Observation Non surgical *Norethisterone (max daily dose 40 mg) OR Medroxyprogesterone acetate (max daily dose 40 mg). | 1 | page=1,block=26 | 0.700 | valid |
| What uterine size is used to define large fibroids? | >12 weeks | Small Fibroids (<5cm) Large Fibroids (Uterine size >12 weeks) Thick pedicle Polypectomy Asymptomatic Symptomatic No Relief Observation Non surgical *Norethisterone (max daily dose 40 mg) OR Medroxyprogesterone acetate (max daily dose 40 mg). | 51 | definition | 0.820 | Small Fibroids (<5cm) Large Fibroids (Uterine size >12 weeks) Thick pedicle Polypectomy Asymptomatic Symptomatic No Relief Observation Non surgical *Norethisterone (max daily dose 40 mg) OR Medroxyprogesterone acetate (max daily dose 40 mg). | 1 | page=1,block=26 | 0.700 | valid |
| What is Type 1 in the FIGO classification of submucosal fibroids? | <50% intramural | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - Levonorgestrel-releasing intrauterine system (if uterine cavity normal) - Progestogenic agents* ALL THERAPUTIC OPTIONS NEED TO BE EXPLAINED TO THE PATIENT INCLUDING JUST KEEPING THE PATIENT ON OBSERVATION. | 246 | definition | 0.820 | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - |
| What is Type 2 in the FIGO classification of submucosal fibroids? | >50% intramural | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - Levonorgestrel-releasing intrauterine system (if uterine cavity normal) - Progestogenic agents* ALL THERAPUTIC OPTIONS NEED TO BE EXPLAINED TO THE PATIENT INCLUDING JUST KEEPING THE PATIENT ON OBSERVATION. | 272 | definition | 0.820 | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - |
| What factors should be evaluated when tailoring treatment options for individual patients? | patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity | Treatment modality should be individualized to each patient after considering patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity • Primary and secondary Care Hospitals: Initial Detec- tion and Counselling • Symptom Management: Non-Steroidal Anti-Inflamma- tory Drugs (NSAIDs), iron and folic acid • Basic Medical Therapy: oral contraceptives or progestin for abnormal bleeding. • Referral: Cases requiring definitive diagnosis, special- ized treatment, or surgery Tertiary Care Hospitals Advanced Diagnostics: Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy Therapeutic Surgical Interventions: Myomectomy or hysterectomy Minimally Invasive Procedures: Laproscopic or hysteroscopic myomectomy and polypectomy Specialized non-surgical Management: May be considered in specialised situations eg fibroid with subfertility. | 78 | list | 0.820 | Treatment modality should be individualized to each patient after considering patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity • Primary and secondary Care Hospitals: Initial Detec- tion and Counselling • Symptom Management: Non-Steroidal Anti-Inflamma- tory Drugs (NSAIDs), iron and folic acid • Basic Medical Therapy: oral contraceptives or progestin for abnormal bleeding. |
| What diagnostic methods are available at tertiary care hospitals for advanced cases? | Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy | Treatment modality should be individualized to each patient after considering patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity • Primary and secondary Care Hospitals: Initial Detec- tion and Counselling • Symptom Management: Non-Steroidal Anti-Inflamma- tory Drugs (NSAIDs), iron and folic acid • Basic Medical Therapy: oral contraceptives or progestin for abnormal bleeding. • Referral: Cases requiring definitive diagnosis, special- ized treatment, or surgery Tertiary Care Hospitals Advanced Diagnostics: Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy Therapeutic Surgical Interventions: Myomectomy or hysterectomy Minimally Invasive Procedures: Laproscopic or hysteroscopic myomectomy and polypectomy Specialized non-surgical Management: May be considered in specialised situations eg fibroid with subfertility. | 605 | list | 0.820 | • Referral: Cases requiring definitive diagnosis, special- ized treatment, or surgery Tertiary Care Hospitals Advanced Diagnostics: Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy Therapeutic Surgical Interventions: Myomectomy or hysterectomy Minimally Invasive Procedures: Laproscopic or hysteroscopic myomectomy and polypectomy Specialized non-surgical Management: May be considered in specialised situations eg fibroid with subfertility. |
| What are some non-surgical treatment options for patients who do not want surgery? | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) may be considered if facilities are available Essential- CBC , Ultrasound Desirable – TFT Optional – HIGHER IMAGING LIKE MRI ASYMPTOMATIC FIBROIDS <5CM DO NOT NEED TO BE TREATED SUPPORTIVE MEASURES MAY BE REQUIRED Indications for alternative management strategies • Patient not desirous of surgery. • During Pre- operative optimization • Short term alternative to surgery in perimenopausal women Counselling + Patient Education Approximately 80 percent of females will have fibroids in their lifetime Fibroids are commonest benign uterine tumours and risk of malignancy is very low Treatments are available for fibroid-related problems like heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility There are chances of recurrence in case of conservative surgical or non-surgical treatments | 0 | list | 0.820 | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) may be considered if facilities are available Essential- CBC , Ultrasound Desirable – TFT Optional – HIGHER IMAGING LIKE MRI ASYMPTOMATIC FIBROIDS <5CM DO NOT NEED TO BE TREATED SUPPORTIVE MEASURES MAY BE REQUIRED Indications for alternative management strategies • Patient not desirous of surgery. |
| What issues caused by fibroids can be treated? | heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) may be considered if facilities are available Essential- CBC , Ultrasound Desirable – TFT Optional – HIGHER IMAGING LIKE MRI ASYMPTOMATIC FIBROIDS <5CM DO NOT NEED TO BE TREATED SUPPORTIVE MEASURES MAY BE REQUIRED Indications for alternative management strategies • Patient not desirous of surgery. • During Pre- operative optimization • Short term alternative to surgery in perimenopausal women Counselling + Patient Education Approximately 80 percent of females will have fibroids in their lifetime Fibroids are commonest benign uterine tumours and risk of malignancy is very low Treatments are available for fibroid-related problems like heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility There are chances of recurrence in case of conservative surgical or non-surgical treatments | 755 | list | 0.820 | • During Pre- operative optimization • Short term alternative to surgery in perimenopausal women Counselling + Patient Education Approximately 80 percent of females will have fibroids in their lifetime Fibroids are commonest benign uterine tumours and risk of malignancy is very low Treatments are available for fibroid-related problems like heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility There are chances of recurrence in case of conservative surgical or non-surgical treatments |
| What are the warning signs of complications related to fibroids? | • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - Levonorgestrel-releasing intrauterine system (if uterine cavity normal) - Progestogenic agents* ALL THERAPUTIC OPTIONS NEED TO BE EXPLAINED TO THE PATIENT INCLUDING JUST KEEPING THE PATIENT ON OBSERVATION. | 15 | list | 0.820 | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - |