pregnancy with uterine fibroids
Introduction
Introduction to pregnancy with uterine fibroids Hysteromyoma is the most common benign tumor in female reproductive organs and one of the most common tumors in the human body, also known as fibromyoma, fibroid, due to uterine fibroids. It is mainly caused by the proliferation of uterine smooth muscle cells, in which a small amount of fibrous connective tissue exists as a supporting tissue, so it is more accurate to call it uterine leiomyoma. Referred to as uterine fibroids. basic knowledge The proportion of the disease: the incidence rate of women is about 0.01%-0.05% Susceptible population: pregnant women Mode of infection: non-infectious Complications: acute endometritis abdominal pain
Cause
Pregnancy with uterine fibroids
(1) Causes of the disease
The etiology of uterine fibroid formation and growth is still not well understood, and may involve somatic mutations in normal muscle layers, and more complex interactions between sex hormones and local growth factors.
According to a large number of clinical observations and experimental results, uterine fibroids are a hormone-dependent tumor. Estrogen is the main factor that promotes the growth of fibroids. For example, uterine fibroids are more common in women aged 30-50 years, but rare before puberty. Postmenopausal fibroids stop growing, gradually shrinking or even disappearing; in the case of pregnancy, exogenous high estrogen, fibroids grow faster; treatment to inhibit or reduce estrogen levels can make fibroids shrink; uterine fibroids often Combined with endometrial hyperplasia, endometriosis, experimental studies have shown that the concentration of estradiol in myoma tissue is higher than normal muscle tissue, suggesting that there is a high estradiol environment in the fibroids, Brandon et al also found that the same Estrogen receptor (ER) concentration and ER-mRNA levels in uterine fibroids were significantly higher than normal muscle tissues. Modern studies also found that progesterone is also a factor in promoting the growth of uterine fibroids. Studies have shown that fibroids are more peripheral muscles. The concentration of progesterone receptor (PR) and PR-mRNA increased in the tissue. The mitotic phase in the secretory uterine fibroids was significantly higher than that in the proliferative uterine fibroids. Progesterone and progesterone (MPA) In the treatment of uterine fibroids, the mitotic phase per high power field was found to be significantly higher in the tissue sections than in the control group. Friedman et al found that the low estrogen state induced by the growth hormone releasing hormone agonist (GnRH-a) can cause fibroids. Shrink, but this effect can be inhibited by progesterone, and can make the reduced fibroids grow up quickly.
In addition, some scholars believe that growth hormone (GH) is also involved in the growth of fibroids. GH can synergize with estrogen to promote mitosis and promote fibroid growth. It is speculated that human placental lactogen (HPL) can also cooperate with estrogen to promote mitosis. The role of uterine fibroids in pregnancy is accelerated. In addition to the high hormonal environment during pregnancy, HPL may also participate.
Modern studies also suggest that some growth factors may also play important roles in the growth of uterine fibroids, such as insulin-like growth factor I and II (IGF), epidermal growth factor (EGF), platelet growth factor A, B (PDGF). -A, B).
Modern cytogenetic research suggests that chromosome structural abnormalities are related to the occurrence and development of uterine fibroids. Uterine fibroids have structural abnormalities of chromosomes, such as ectopic, loss and rearrangement of chromosomes, and have been reported in uterine fibroid tissue culture. The abnormal karyotype can reach 34.4%~46.1%, and its karyotype abnormality is more prominent in histological special fibroids.
Uterine fibroids can also occur in patients with adrenal gland syndrome with high androgen levels. The mechanism of its development is still unclear. In addition, ovarian function and hormone metabolism are regulated by the high-level nerve center, so the central nervous system may also affect the onset of fibroids. Play an important role, factor uterine fibroids are more common in women of childbearing age, widowed and sexually uncoordinated women, long-term sexual disorders caused by chronic pelvic congestion may also be one of the causes of uterine fibroids, Chiaffarino believes that the incidence of uterine fibroids Related to diet, Zhou et al reported that patients with uterine fibroids have altered immune function, mainly due to low NK cell activity.
In short, the occurrence and development of uterine fibroids may be the result of multiple factors, the incidence of which involves local or global estrogen (E2), progesterone (P) changes, local polypeptide growth factor response, cell mitosis rate Alterations and somatic mutations, among which E2 regulates the increase of PCNA by increasing the expression of EGF receptor (EGFR) in cells; P regulates the expression of proliferating cell nuclear antigen (PCNA) by increasing the expression of EGF-like protein in cells. The increase will eventually lead to the transformation of normal smooth muscle cells of the uterus into fibroid cells, which may provide a new hypothesis for the occurrence of fibroids and will help clinically adopt new methods for treatment.
The effect of uterine fibroids on pregnancy varies depending on the size and location of the tumor. Small fibroids, subserosal fibroids or fibroids near the serosal surface have little effect on pregnancy, but multiple fibroids or intrauterine Prominent myofibrosaroma and submucosal fibroids can impair pregnancy, causing infertility or miscarriage. In the early pregnancy, uterine fibroids can grow faster under the action of pregnancy hormones, and the tumor enlarges. After the second trimester, due to the muscles The blood supply of the tumor is relatively reduced, and it is prone to red degeneration or infection. The enlargement of the uterus of the pregnant woman can trigger the pedicle torsion of the subserosal fibroids. The fibroids located in the uterine isthmus or the posterior lip of the cervix can block the birth canal, affecting the uterine contraction and causing dystocia, muscle. The presence of tumors can affect the contraction of the uterus, hindering the placenta to peel off after delivery, thereby causing postpartum hemorrhage. In addition, the growth of fibroids can deform the uterine cavity, the endometrium is compressed, the blood supply is blocked, and the placenta is in the placenta. Attached to the area, it can expand to the surrounding area and cause the placenta previa.
(two) pathogenesis
1. Giant examination of uterine fibroids can be single, but often multiple, different sizes, small only large rice, even under the microscope to identify, large can reach full-term pregnancy uterus, there are reports even more than 45kg ( 100 pounds).
Uterine fibroids may occur in any part of the uterus, but most of them grow in the body of the uterus, accounting for 90% to 96% of uterine fibroids, and only 2.2% to 8% of those growing in the uterine cervix. Round ligament, broad ligament, uterine ligament.
Uterine fibroids can be divided into three categories according to their relationship with the layers of the uterine wall:
(1) intramural myoma (intramural myoma): the most common type of fibroids, accounting for 60% to 70% of the total, fibroids located in the myometrium, surrounded by normal muscle layer, fibroids and muscles The boundary between the walls is clear, and the connective tissue bundle of the extruded peripheral muscle wall forms a "pseudo-envelope". The fibroids can be single or multiple, and the size of the fibroids is different. The shape of the uterus is not significantly changed, and the fibroids can be large. The uterus is enlarged or deformed to be irregular, and the uterine cavity is also deformed.
(2) subserous myoma: subficus myopia: the fibroids protrude to the surface of the uterus, the surface only covers a little muscle wall and serosal layer, called "subserosal uterine fibroids", sometimes only one fibroid The pedicle is connected to the wall of the uterus and is called pedunculate myoma. The uterine fibroids with pedicle can undergo pedicle torsion, tumor necrosis, and adhesion to adjacent organs, thereby obtaining blood supply and growth. Known as parasitic myoma, which is called the broadligamentary myoma when the fibroid grows in the uterine wall and grows into the broad ligament. Subserosal fibroids account for 20% of the total fibroids. ~30%.
(3) submucous myoma: submucous myoma: the myometrial fibroids in the uterine cavity grow in the direction of the uterine cavity, the surface of which covers the endometrium, called submucosal uterine fibroids, because of its sudden uterine cavity The uterine cavity is deformed, sometimes with pedicles, and the long fibroids can even protrude beyond the cervix. The intima on the surface of the fibroids may have bleeding, necrosis, and secondary infection.
The above types of fibroids can occur alone or simultaneously, and two or more fibroids occur in the same uterus, called multiple uterine fibroids.
A typical fibroid is a substantial spherical mass with a smooth surface and a clear boundary with the surrounding muscle tissue. Although the fibroid has no capsule, it forms a pseudo-envelope due to the compression of the myometrium around the fibroid, and there is a fibroid between it and the fibroid. The layer looses the crevice area. After the capsule is cut, the fibroids will jump out and be easily removed. The blood vessels will pass through the pseudo-envelope to supply the fibroids. The larger the fibroids, the thicker the blood vessels, and the pseudo-envelope. The blood vessels are arranged radially, the tumor wall lacks the outer membrane, and it is easy to cause circulatory disturbance after being compressed, which causes various degenerative changes of the fibroids. Generally, the fibroids are white, hard and the section is grayish white swirling line pattern, which is slightly uneven. The more fibroids contain fibrous tissue, the whiter and harder the fibroids.
2. Microscopy The fibroids are composed of smooth muscles with myofibrils in the cytoplasm. The cell bundles are arranged in different directions to form a spiral shape. The longitudinal section cells are fusiform, the size is uniform, the cytoplasm is eosin, and the nucleus is rod-shaped. The ends are relatively blunt. If it is a cross-section, the cells are round or polygonal, the cytoplasm is rich, and the nucleus is located in the center. The fibroids contain unequal amounts of collagen fibers.
3. Special organization type
(1) Cellular leiomyoma: There are abundant smooth muscle cells in the tumor, which are closely arranged, and the cell size and shape are consistent. Only individual cells have abnormal shapes. Occasionally, mitotic figures are 1 to 4/10 high power fields. .
(2) bizarre leiomyoma (bizarre leiomyoma): the tumor is mainly round or polygonal cells, cytoplasmic acidophilus, periplasmic nucleus is translucent, characterized by cellular pleomorphism, nuclear abnormalities and even megakaryocytes, no The division is visible and the clinical manifestation is benign.
(3) Angiomyomyoma (angio-myoma): The vascular leiomyoma is rich in blood vessels. The tumor cells are arranged around the blood vessels and are closely connected with the vascular smooth muscle. The color of the tumor is red.
(4) epithelioid leiomyoma (epitheliod leiomyoma): leiomyomas consist of round or multi-deformed cells, often arranged in epithelial-like cords or nests, fibroids are yellow or gray, should pay attention to whether the marginal part of the muscle layer infiltration If there is infiltration, it should be considered malignant.
(5) Neurofibrillar leiomyomas: tumor nuclei are arranged in a fence, like neurofibroma.
4. Several special growth methods for leiomyomas
(1) intravascular leiomyomatosis: uterine leiomyoma tissue can enter the vein or lymphatic vessels, called intravascular leiomyomatosis, more common into the venous canal, intravascular leiomyomas in the tissue morphology It is benign, but in clinical leiomyomas can be worm-like growth into the inferior vena cava, which can cause death. Both domestic and foreign literatures have reported that leiomyomas enter the inferior vena cava and enter the right atrium to cause heart failure.
Intravenous tumor tissue is gray-white polypoid, plexiform or worm-like cord. This intravascular leiomyomas can be pulled out from the blood vessels, can exist freely, can also be connected with the muscle wall, and the microscopic tumor is composed of benign smooth muscle. The composition is grown in the vasculature of the endothelial cells. Some scholars believe that the tissue originates from the smooth muscle tissue of the blood vessel wall itself. Some scholars believe that the fibroid tissue infiltrates into the blood vessels in the muscular layer, and the tumor cells are rich. The estrogen receptor, endogenous estrogen plays a role in recurrence, so it is not appropriate to retain the ovaries in cases that cannot be completely removed.
(2) Leiomyomatosis peritonealis disseminata: more common in pregnancy, related to the stimulation of sex hormones, tumors can occur in the ovary, round ligament, genital serosal surface, omentum, mesentery and stomach Intestinal wall and other places, similar to the implantation and metastasis of malignant tumors, the general morphology and nodules are nodular, hard texture, smooth surface, histologically benign leiomyomas, few mitotic figures, no invasive growth, The tissue is unclear. It is believed that the sub-peritoneal mesenchymal tissue can be metamorphosed into smooth muscle tissue, and hormones promote its growth and nodular growth. Some scholars believe that it is the development of homologous multicentric leiomyoma, and the whole uterus and After double attachment resection, the stimulation of special hormones is removed, and the abdominal cavity lesions often disappear. The peritoneal disseminated leiomyoma in pregnancy can partially or completely disappear after the pregnancy.
(3) benign metastatic leiomyomas (benign metastasizing leiomyoma): rare, in addition to uterine fibroids, can also be combined with lung, kidney, striated muscles, lymph nodes, etc., clinically presented various symptoms of the corresponding parts, patients There is often a history of uterine fibroids removed from the uterus many years ago, histologically showing the same tissue changes in benign leiomyomas. When clinical dissemination and metastasis occur, it is necessary to exclude benign metastatic smoothing when there is no malignant change. Fibroids.
5. Denaturation When fibroids grow faster or the formation of tumor pedicles, it is easy to cause insufficient blood supply and nutrient deficiency, so that the fibroids lose their original typical structure and appearance, called degenemtion, and degeneration can be divided into benign degeneration and There are two types of malignant degeneration.
(1) Benign degeneration:
1 glassy degeneration: the blood supply of the fibroids is insufficient, part of the tissue edema becomes soft, loses the swirling texture, and has a smooth gray-white transparent appearance. The microscopic transparent connective tissue can be seen by microscopy, and the muscle cell shadow is occasionally seen. Generally progress is slow and does not cause clinical symptoms.
2 cystic degeneration: further development of hyaline degeneration, tissue liquefaction, the formation of a cavity containing mucus-like or transparent liquid, if the cystic cavity is larger, the whole fibroid can become soft as a cyst, irregular urine can be seen by microscopy. The cyst is composed of hyaline degenerated fibroid tissue, and the inner wall is free of epithelial contrast, which is different from the true cyst.
3 red degeneration: more common in pregnancy and puerperium, the volume of fibroids increases rapidly, manifested as ischemia, infarction, congestion, thrombosis and hemolysis, blood spilling into the tumor, fibroids are red, like raw beef, lost the original Vortex-like structure, under the microscope, there are embolizations in the large veins and tumor venules in the pseudocapsular, and there is hemolysis, muscle cells are reduced, and there are more fat globules deposited.
4 steatosis: more common in postmenopausal women's fibroids, the profile is yellow, the swirling structure disappears, the special denaturing area can be seen as a uniform cell-free structure, adipose tissue deposition, vacuoles formed by fat dissolution .
5 calcification: more common in the pedicle small, blood supply insufficient subserosal fibroids, decomposed into triacylglycerol after fatty degeneration, and then combined with calcium salts into calcium carbonate, can form a calcified shell around the fibroids, can also be broadcast Scattered in the entire tumor, the uterus is as hard as a stone, forming a so-called uterine stone. The calcified area under the microscope is layered and deposited in a circular or irregular shape. The hematoxylin staining has deep blue fine particles infiltrated.
(2) malignant degeneration: uterine fibroids malignant transformation is sarcoma, the incidence is low, accounting for about 0.5% of uterine fibroids, more common in older women, easily ignored because of no obvious symptoms, the lesion area is grayish yellow The quality is soft as raw fish, and the tumor grows faster. Therefore, the fibroids may increase rapidly in the short term or have irregular vaginal bleeding. The sarcoma may be considered. If the fibroids of menopausal women have an increasing trend, they should be alert. Malignant changes are possible.
Prevention
Pregnancy with uterine fibroids prevention
Early detection, early treatment.
Complication
Pregnancy with complications of uterine fibroids Complications, acute endometritis, abdominal pain
1. Infected fibroid infections are mostly the consequences of tumor pedicle torsion or acute endometritis. A few cases of pelvic infections involving uterine fibroids, blood-borne infections are rare, submucosal fibroids are most susceptible to infection, especially mucosa The lower fibroids protrude into the vagina, prone to necrosis, followed by infection, clinical manifestations of irregular vaginal bleeding, a large number of bloody drainage, with fever.
2. The subserosal fibroids can be reversed in the pedicle, causing acute abdominal pain. If the tumor pedicle is severely twisted and failed to be operated or reset in time, the free fibroids may be formed due to the rupture of the tumor pedicle.
Symptom
Pregnancy with uterine fibroids Symptoms Common symptoms Menstrual volume, lower abdomen, bulging, poor urination, endometriosis, abdominal pain, abdominal mass, vaginal discharge, back pain, uterine bleeding, frequent urination
Symptom
Most patients are asymptomatic and are only found during pelvic or ultrasonography. If symptoms are present, they are closely related to the growth site, speed, presence or absence of degeneration and complications, but not related to the size and number of fibroids. Large, with multiple subserosal fibroids may not have symptoms, and a small submucosal fibroids can often cause irregular vaginal bleeding or menorrhagia, clinically common symptoms are:
(1) Uterine bleeding: the most common symptom of uterine fibroids, which occurs in more than half of the patients, including periodic bleeding, which can be expressed as increased menstrual flow, prolonged menstruation or shortened cycle, can also be expressed as no menstruation Periodic irregular vaginal bleeding, the cause of uterine bleeding is related to the following factors:
1 With the increase of the uterus, the endometrial area of the uterus is also increased, the endometrial detachment surface is large, the repair time is longer, and the menstrual volume is increased, and the menstrual period is prolonged.
2 Myometrial fibroids affect the uterus contraction, and even the amount of menstruation increased.
3 As the fibroids increase, the veins near the fibroids are compressed, leading to dilatation and congestion of the endometrial and intramuscular venous plexus, resulting in more menstrual flow.
4 patients with fibroids can often be combined with endometrial hyperplasia; 5 submucosal fibroids often ulceration, necrosis, resulting in irregular uterine bleeding.
Uterine bleeding is more common in submucosal fibroids and intermuscular fibroids, while subserosal fibroids rarely cause uterine bleeding.
(2) Abdominal mass and compression symptoms: The fibroids gradually grow. When the uterus is enlarged more than 3 months pregnant uterus size or is a large subserosal fibroid located at the bottom of the uterus, it is often able to get a lump in the abdomen. In the morning, when the bladder is full, the mass is more obvious. The mass is solid, movable, and there is no tenderness. When the fibroid grows to a certain size, it can cause symptoms of surrounding organs. The anterior wall of the uterus can be close to the bladder and can produce frequent urination and urgency. Compression of the bladder can cause poor urination or even urinary retention. The posterior wall of the uterus, especially the isthmus or posterior lip of the cervix, can compress the rectum, causing poor bowel movements, discomfort after defecation, and large ligament fibroids can compress the ureter. Even caused hydronephrosis.
(3) Pain: Under normal circumstances, uterine fibroids do not cause pain, but many patients can complain of lower abdominal bulge, low back pain, when the subserosal fibroids pedicle torsion or uterine fibroids red degeneration can produce Acute abdominal pain, fibroids with endometriosis or adenomyosis have dysmenorrhea.
(4) increased vaginal discharge: increased uterine cavity, increased endometrial glands, combined with pelvic congestion, can increase vaginal discharge, uterine or cervical submucosal fibroids ulceration, infection, necrosis, the production of bloody or purulent vaginal discharge .
(5) infertility and abortion: some patients with uterine fibroids with infertility or prone to miscarriage, the impact on pregnancy and pregnancy outcome may be related to the growth site, size and number of fibroids, huge uterine fibroids can cause uterine cavity deformation It hinders the implantation of the gestational sac and the growth of the embryo; the compression of the fallopian tube by the fibroid can lead to the patency of the lumen; the submucosal fibroids can hinder the implantation of the gestational sac or affect the entry of sperm into the uterine cavity, and the spontaneous abortion rate of the patients with fibroids is higher than that of the normal population. Its ratio is about 4:1.
(6) anemia: due to long-term menorrhagia or irregular vaginal bleeding can cause hemorrhagic anemia, more severe anemia is more common in patients with submucosal fibroids.
(7) Others: A very small number of patients with uterine fibroids can produce polycythemia, hypoglycemia, which is generally thought to be related to the production of ectopic hormones in tumors.
2. Signs
(1) Abdominal examination: the uterus is enlarged for more than 3 months of pregnancy or the subserosal fibroids at the bottom of the larger uterus. It can be in the middle of the pubic symphysis or in the lower abdomen and the mass, solid, no tenderness, if multiple uterus The fibroids are irregular in shape outside the mass.
(2) pelvic examination: gynecological double-combination, triple examination, uterus increased to varying degrees, less regular, irregular surface of the uterus, solid, if degenerated, the texture is soft, uterine muscle during gynecological examination The signs of the tumor vary according to their different types. If the pedicled subserosal fibroids are long, they can be paralyzed and paralyzed in the uterus, and the activity is free. This situation is easily confused with ovarian tumors, and the submucosal fibroids are reduced to At the end of the cervix, the cervix is loose. The examiner's finger can penetrate into the cervix to touch the smooth spherical tumor. If the cervix is removed, the tumor can be seen. The surface is dark red, sometimes ulcerated, necrotic, and larger cervix. Fibroids can displace and deform the cervix, and the cervix can be flattened or moved up to the back of the pubic symphysis.
Examine
Examination of pregnancy with uterine fibroids
1. Ultrasound examination is a commonly used auxiliary diagnosis method, which can show the uterus enlargement, irregular shape, number of fibroids, location, size and uniformity or liquefaction inside the fibroids, cystic changes, etc. Ultrasound examination is helpful for diagnosis Uterine fibroids, and provide a reference for distinguishing whether fibroids have degeneration, and also help identify ovarian tumors or other pelvic masses.
2. Diagnostic curettage through the uterine cavity probe to detect the size and direction of the uterine cavity, feeling the shape of the uterine cavity, to understand whether there is a mass in the uterine cavity and its location, while scraping the endometrium for pathological examination, in order to exclude endometrial hyperplasia Too long or other endometrial lesions.
3. Hysteroscopy can directly observe the morphology of the uterus under hysteroscopy, with or without sputum, which is helpful for the diagnosis of submucosal fibroids.
4. Laparoscopy When the fibroids must be differentiated from ovarian tumors or other pelvic masses, laparoscopy is available to directly observe the size, morphology, tumor growth site and nature of the uterus.
5. Radiological examination of uterine fallopian tube iodine oil angiography can help diagnose submucosal uterine fibroids, fluoroscopy with fibroids shows filling defects in the uterine cavity, CT and MRI also contribute to the diagnosis of fibroids, but generally do not need Use these 2 checks.
Diagnosis
Diagnosis and diagnosis of pregnancy complicated with uterine fibroids
diagnosis
According to the medical history, symptoms and gynecological examination, the general diagnosis is not much difficulty. For those who cannot be diagnosed, the above-mentioned auxiliary examination method can be used to assist in diagnosis.
Differential diagnosis
Fibroids are often confused with the following diseases and should be identified:
1. Both adenomyosis and adenomyoma can enlarge the uterus, but the uterus often has uniformity when the adenomyosis is agglomerated, and the adenomyoma has a limited nodular uterus, and the texture is hard. Sometimes other signs of endometriosis can be found in the pelvic cavity, and more than half of the patients have progressive dysmenorrhea. Ultrasonography is helpful for diagnosis. It can be found that the uterine fibroids are combined with adenomyosis. It is not uncommon for patients to see the disease. Finally, the pathological examination of the surgical specimens can be made clear.
2. Pregnancy uterus pregnancy uterine soft, uniformity increased, patients have a history of menopause, and patients with fibroids show increased menstrual flow or irregular vaginal bleeding, fibroids in addition to denaturation, the texture is hard, so the clinically all married childbearing age Women with uterus enlargement should be carefully asked about the history of menstruation, except for pregnancy, if necessary, supplemented by pregnancy test, ultrasound examination to identify, uterine fibroids patients can be combined with pregnancy, must also think of.
3. Ovarian tumor subserosal uterine fibroids and substantial ovarian tumors, fibroids with degeneration and cystic ovarian tumors or ovarian tumors and uterus adhesion, there are certain difficulties in differential diagnosis, detailed history, careful gynecological examination Pay attention to the relationship between the tumor and the uterus. If necessary, the uterine probe can be used to detect the depth and direction of the uterine cavity, supplemented by ultrasound examination, and more can be identified, but some must be diagnosed in the operation.
4. Uterine malignant tumors intrauterine submucosal fibroids secondary infection, bleeding, increased secretions, easy to be confused with endometrial cancer, ultrasound, uterine cytology, diagnostic curettage for pathological examination, are beneficial Identification, submucosal fibroids out of the vagina with infection, causing irregular vaginal bleeding and odorous drainage, easy to be confused with exogenous cervical cancer, careful gynecological examination is not difficult to identify, if necessary, pathological examination can be helpful to diagnose.
5. Patients with uterine hypertrophy also have menorrhagia, uterus enlargement, easy to be confused with small fibroids or intrauterine submucosal fibroids, but the uterus of uterine hypertrophy is uniform, usually in 2 months. The size of the uterus is normal, the shape of the uterine cavity is normal, and ultrasound examination is helpful for identification.
6. The shape of the large submucosal fibroids that are suspended in the vagina is similar to that of the uterus that is turned out. Both have more menstrual flow and more vaginal secretions, but it is not difficult to identify them carefully. In addition to the vaginal sputum to the mass in the vaginal cavity, the pelvic cavity can not reach the uterus, the uterus probe can not enter the uterine cavity, sometimes the double fallopian tube opening can be seen on the surface of the tumor, and the submucosal fibroids, the fingers reach into The neck can be licked and the tumor pedicle.
7. Uterine malformation Double uterus or residual uterus is easily misdiagnosed as uterine fibroids, uterine tubal iodine angiography, ultrasound or laparoscopic examination can be clearly diagnosed.
8. The pelvic inflammatory mass pelvic inflammatory mass can be misdiagnosed as uterine fibroids when it is closely adhered to the uterus, but patients often have a history of pelvic infection, repeated episodes of lower abdominal pain, fever and other symptoms. The mass is often bilateral. More fixed, tenderness, ultrasound examination helps identify.
When the uterine fibroids grow deeper than the deep wall of the muscle wall, the uterus is evenly enlarged, and the fibroids are not easily detected and missed. When the actual size of the pregnant uterus is found to exceed the menopause time, or the pregnant woman exerts a slight physical exertion to induce mild contractions. Should pay attention to whether it is a pregnancy with uterine fibroids, on the contrary, such as the placenta of early pregnancy implantation on the side of the uterus, resulting in uneven uterus, easy to be mistaken for pregnancy with uterine fibroids; but the uterus increased in the second trimester After significant, the irregular increase of the uterus will disappear, the uterus will regenerate after delivery, and the enlarged fibroids during pregnancy will also shrink.
