Hysteroscopic Submucous Myomectomy
Submucous fibroids were classified based on European Society of Gynaecological Endoscopy into type 0-whole of fibroid inside the uterine cavity. Type 1-less than 50% extension of submucous fibroid into myometrium. Type 2-more than 50% extension into myometrium. Fibroids bulging into the uterine cavity or within the cavity (submucous fibroids) can sometimes cause heavy menstrual bleeding or infertility. Submucous fibroids can often be removed having a hysteroscope, placed with the cervix and into the uterus. Hysteroscopic myomectomy is really a technique that can be performed only if fibroids are within or bulging in to the uterine cavity (submucosal). This procedure is performed as outpatient surgery without any incisions and virtually no postoperative discomfort. Anesthesia is needed because the surgery might take one or two hours and would otherwise be uncomfortable. A little telescope, the hysteroscope, is undergone the cervix and also the within the uterine cavity can be seen. A small camera is attached to the telescope and the view is projected on a video monitor. This magnifies the image and also permits the physician to do the surgery while sitting in an appropriate position. Submucosal myomas are associated with infertility and can be effectively treated by hysteroscopic resection. However the role of submucous fibroids which are reported in 5%-18% of patients as a causal factor for infertility is likely. Submucous fibroids are postulated to cause menometrorrhagia, preterm delivery, postpartum hemorrhage, and puerperal infection.
Hysteroscopic myomectomy is really a safe and an effective procedure which enhances fertility. Completely intracavitary myomas and absence of other contributing factors appear to be the best prognostic factors for more fertility. Elimination of large myomas has a much more beneficial impact on fertility than small ones. The mechanisms by which leiomyomas interfere with fertility are unclear, but presence of intramural myomas was discovered to impair delivery rate and fertility within our study. Removal of intramural myomas seems to be a sensible option in patients undergoing hysteroscopic myomectomy who are desirous of childbearing. The reason submucous fibroids can result in infertility isn't clear, but current theories are that the fibroids change blood supply to some developing embryo, or block passage of the embryo through the fallopian tube, or cause inflammation in the uterine lining, or produce proteins that interfere with the embryo’s journey through the tube, its attachment towards the uterine lining or its development.
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