USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

Table II-4-2. Management    of  Leiomyomas

Management Clinical effect/Method of Treatment

Observation Most
Serial pelvic exams

Presurgical shrinkage ↓ size by 70%
GnRH analog 3–6 months; regrowth after stopping

Myomectomy Preserves fertility
Laparotomy, laparoscopy

Embolization Preserves uterus
Invasive radiology

Hysterectomy Fertility completed
Total abdominal hysterectomy; total vaginal hysterectomy

performed.

Myomectomy  if  patient wishes  to  maintain    fertility.  The uterus  is  incised and

the myoma   removed through either  a   laparoscopic    or  laparotomy  approach.   If

the myomectomy  incision    entered the endometrial cavity, delivery    of  any

subsequent  pregnancy   should  be  by  cesarean    section because of  increased   risk

of  scar    rupture in  labor.

Embolization:   an  invasive    radiology   procedure   in  which   a   catheter    is  placed

into    the vessels supplying   the myoma.  Microspheres    are injected,   causing

ischemia    and necrosis    of  the myoma.

Hysterectomy:   If  patient has completed   her childbearing,   definitive  therapy

is  an  abdominal   or  vaginal hysterectomy.