妇产科学(英文版)

InflammationoftheFemaleReproductiveTractSelf-cleaning(lactobacillus)Mucus1.Vulvitis(外阴炎)

Bartholinitis/Bartholin’scyst(前庭大腺炎／前庭大腺囊肿)2.Vaginitis(阴道炎)3.Cervicitis(宫颈管炎)4.Pelvicinflammatorydisease(PID)(盆腔炎)

Genitaltuberculosis(生殖器结核)

Sexuallytransmitteddiseases(STD)(性传播疾病)

Vulvitis(外阴炎)ClinicalManifestation

Vulvarpruritus(瘙痒)PainBurningsensationCongestion(充血)SwellingEczema(湿疹)Etiology

Specificorganismsornon-infectivedermatitis(皮炎)Irritationfromvaginaldischarge(分泌物)ormensesLackofvulvarhygiene

Glycouria

Treatment

KeepthevulvacleananddryRemovethecause1/5000kMnO4(potassium

permanganate,PP)

solutionbathAntibioticsointment

Bartholinitis

(前庭大腺炎)Infectionofthemajorvestibularglands(前庭大腺)(Bartholin’sglands)(巴氏腺)Bartholin’sCyst(前庭大腺囊肿)Majorvestibularglands(Bartholin’sglands)BartholinitisEtiologyStaphylococcus,E.coli,streptococcus,enterococcus,gonococcus,andpolymicrobialinfectioniscommon.ClinicalmanifestationSymptomsofalocalinfectionAbscessofBartholingland:apainfulredswellingTreatmentAntibiotics(Ampicillin)intheearlystageDraintheabscess(excisionofanellipticalpieceofskin)

Marsupialization(造口术)forpreservationoftheglandfunctionExcisionforrecurrentcasesBartholin’sCyst

Trichomonalvaginitis

(滴虫性阴道炎)

CandidalVulvovaginitis

(假丝酵母菌性外阴阴道炎)

BacterialVaginosis(BV)

(细菌性阴道病)

Senilevaginitis(老年性阴道炎)Infantilevulvovaginitis

(婴幼儿外阴阴道炎)VaginitisTrichomonalVaginitis

滴虫性阴道炎

(Trichomoniasis)

EtiologyTrichomonad(毛滴虫)：Aflagellateprotozoan(有鞭毛原虫)Bestlivingenvironment:Moist,anaerobic,pH:5.2-6.6

Transmission1.Sexualcontact(70%maleinfection,asymptomaticcarrier)2.Nonsexualtransmission(iatrogenic)

PathogenesisThetrichomonadlivesonglycogenandironofthehostcellDirectcontactanddamageofthetargetcellInductionofimmunereactionresultingininflammation

ClinicalPictureLatentperiod:4-28daysAsymptomatic:25-50%Symptoms：

Main:ProfusevaginaldischargeandpruritusOccasional:odor,pain,dyspareunia,dysuria,infertility

CharacteristicsofthevaginaldischargeCopious(大量的),Purulent(脓性的),Graytoyellowcolor,Malodorous(恶臭的),Frothy(起泡沫的)Strawberrycervix:Tiny,punctatehemorrhages(点状出血)grosslyvisibleonthemucosa

Diagnosis1.Microscopic(wetmount)identificationofthe

trichomonad(60%-70%)2.PrecautionsfortheexaminationAvoid:intercourse1-2daysbeforeexaminationwashingandmedicationlubricantheatpreservation3.Cultureforsuspectedcases4.PCR(Polymerasechainreaction)

Treatment(1)1.Systemictherapy(Firstchoice)Oralmetronidazole(甲硝唑，灭滴灵）

a)2gsingledoseb)400mg,twiceor3timesaday,for7days.2.Topicalapplication(≤50%)a)Effervescenttablets(泡腾片)ofmetronidazole200mg/day,7-10daysb)Metronidazolegelc)Acidificationofvaginawith1%lacticacidor0.5%aceticacidTreatment(2)Criterionforcure:

NegativefindinginpostmenstrualexaminationofthevaginaldischargeforthreetimesFailurerate:5%-10%PoorcomplianceRepeatedinfectionToavoidrepeatedinfection:Sterilizationofunderwear,towels,etcTreatmentofthesexualpartnerMetronidazoleisstilleffectiveinrecurrentcases.CandidalVulvovaginitis假丝酵母菌性外阴阴道炎

(VulvovaginalCandidiasis)

Etiology1.Verycommona)About1/3ofvaginitiscasesarecausedbyfungalinfection.

b)About75%ofwomendevelopcandidiasisat

leastonceinlife.2.TheetiologicagentisCandida(假丝酵母菌/念珠菌).

Candidaalbicans(白假丝酵母菌)isresponsible

for80-90%ofvulvovaginalcandidiasis.3.Candidaalbicansisanopportunisticpathogen.1)Suitableenvironment:acidic(＜4.5),warm,andmoist2)Candidaalbicanscanbeisolatedfrom10-20%nonpregnantand30%pregnantasymptomaticwomen.Treatmentisnotindicatedunlesssymptomsarepresent.

Predisposingfactors1.Pregnancy2.Diabetesmellitus3.Immunosuppressants4.Broad-spectrumantibioticssuppressingthevaginalnormalflora(esp.lactobacillus)5.Others:restrictivesyntheticunderwear,obesity,contraceptivemedication

Transmission1)Endogenousinfection(mostoften)Vagina,oralcavity,intestinaltract2)Sexualcontact3)Contactingfomites(污染物)

PathogenesisTwophasesofcandidaalbicans1)Yeastspores(芽孢相):Asymptomaticparasitism2)Pseudohyphae(菌丝相):

Pathogenic3)Mechanism:a)Candidaatthepseudohyphaphsepenetratevaginalepitheliumfornutrientsb)Growingcandidaalbicansreleaseproteolyticenzymesandtoxinsetc.resultingininflammationreaction

ClinicalPicture1.Vulvovaginalpruritus(main)

usuallyintense,coincidentwithmensesorintercourse2.IncreasedvaginaldischargeTheclassicfindingiswhite,thick,curd-likedischargeformingpatchesadherenttothevaginalwalls.

Diagnosis

1.Wetmountmicroscopicidentificationof

candidaalbicansinthedischarge

Saline:30-50%10%KOH:70-80%2.Gram’sstain:80%3.Culture:highersensitivityanddrugtest4.MeasurementofpHvaluemaybeusefulfordiscoveringcasesofcomplicatedinfection(4.0-4.7).apH<4.5simpleinfectionapH>4.5combinedinfection

Treatment1.Eliminationofpredisposingfactors2.Topicalapplicationofantifungalagents

Vaginalsuppositories(栓剂)：

1)Miconazole(咪康唑/达克宁)a)200mg/dayfor7daysb)400mg/dayfor3days2)Clotrimazole(克霉唑)

a)150mg/dayfor7days

b)150mg,twiceadayfor3daysc)500mgsingledose3)Nystatin(制霉菌素/米可定)

100,000units/dayfor10-14days4)Methylviolet(龙胆紫)

0.5-1%,3-4times/weekfor2weeks.3.SystemicmedicationOralagentsareusedonlyforcasesthatcannotbetreatedwithtopicalapplicationofantifungaldrugs.Fluconazole(氟康唑/大扶康)150mg,singleuse.2)Itraconazole(伊曲康唑/斯皮仁诺)

a)200mg/dayfor3-5daysb)400mgfor1daydividedintwodoses3)Ketoconazole(酮康唑)200mg,onceortwice/dayuntilcultureresultisnegative

Hepatotoxicitymayoccur.

PointsofnotefortreatingVVCTreatmentshouldbefollowed-upwithapremenstrualexaminationofthevaginaldischarge.Approximately10%ofcaseswillnotrespondtoinitialtherapy.

Prolongationoftreatmentupto14daysmaycuresomepatients.Identificationandeliminationofpredisposingfactorsisimportant.RecurrentVVCshouldbetreatedwithoraltherapyfollowedbyprophylacticdoses.Treatmentofsexualpartner?Notreatmentforasymptomatics.15%shouldbetreatedBacterialVaginosis

细菌性阴道病

Etiology1.ImbalanceofnormalvaginalfloraDiminutionofDoderleinlactobacillusandincreaseinotherbacteria,inparticular,anaerobicbacteria.2.Causativefactorsoftheimbalanceareunknown

Gardnerellavaginalis(加德纳菌)

ClinicalPictureSymptoms:1.10-40%asymptomatic2.Mildpruritusorburningsensation3.IncreasedvaginaldischargeandfishyodorSigns:Discharge:thin,greyish-white,homogenous,butnotsticky

Noinflammationreaction

(Noepithelialedemaorerythema)

DiagnosisIdentificationofcluecells*(wetmountinsaline)togetherwith2ofthefollowing3items

1.Vaginaldischarge:homogenous,thinandwhite2.pH>4.5:invirtuallyallcases,usu.5.0-5.53.PositiveWhifftest(with10%KOH)*Cluecellsaredesquamatedepithelialcellscoveredwithclumpsofcoccobaciliesp.Gardnerellavaginalis(加德纳菌),whichgivesthecellsaspeckled(有小斑点)appearance.Whifftest

Treatment(1)1.Systemictherapy(oral)(80%)1)Metronidazole400mg,2-3timesadayfor7days2)Clindamycin(克林霉素/氯林霉素/氯洁霉素)300mg,twiceadayfor7days2.Topicaltherapy(80%)

1)Effervescenttabletsofmetronidazole200mg/day,for7-10days2)2%Clindamycincream,onceadayfor7days3.Vaginalwashing

1-3%H2O2,1%lacticacid,0.5%aceticacidTreatment(2)1.Systemicortopicaltreatmenthasthesamecurerate(80%).2.Patientswhoareasymptomatic,butscheduledtohaveagynecologicsurgicalprocedureshouldbetreated.3.Patientswhoarepregnantcanbetreatedwithoralmetronidazole.4.Follow-upexaminationshouldbegiven1-2and3-4weeks(postmenstrual)afterthetreatment.Criteriaforcure:Absenceofcluecellswithatleast1ofthefollowingitems:a)Normalvaginaldischarge

b)pH≤4.5c)WhifftestnegativeOtherformsofvulvovaginitis1.Senilevaginitis

(老年性阴道炎)

Atrophicvaginitis(萎缩性阴道炎)Infantilevulvovaginitis

(婴幼儿外阴阴道炎)DifferentialDiagnosisofvaginitisBacterialVaginosis

Candidiasis

TrichomoniasisComplaintsVaginaldischargeVaginalepithelium

VaginalpHWhifftestMicroscopicexaminationdischarge↑mildpruritusseverepruritusburningdischarge↑mildprurituswhitehomogenousfishywhitecurd-likethinpurulentfrothynormaledemaerythemapunctatehemorrhage＞4.5(4.7-5.7)＜4.5＞5(5.6-6.5)

＋－－CluecellsWBCrareCandidaWBCsomeTrichomonad

WBCmanyInflammationoftheCervix1.Common:50%womenofreproductiveage2.Mayleadtopelvicinfection3.NeedtoidentifyavenerealdiseaseanddifferentiatefrommalignanciesCervicitis:Vaginalportionofthecervix(Ectocervix)

Mucosaofthecervicalcanal(Endocervix)AcuteCervicitis

EtiologyNeisseriagonorrhoeae(淋病奈瑟菌)Chlamydiatrachomatis(沙眼衣原体)

causingsuperficialinfectionofthecervicalcolumnarmucosa2.Staphylococcus(葡萄球菌),

streptococcus(链球菌),

enterococcus(肠球菌)

causinginfectionafteranabortion,puerperium,cervicalinjury,foreignbodies

ClinicalPictureSymptoms1.Asymptomatic2.MucopurulentvaginaldischargeVaginalirritationsymptoms:pruritus,burningsensationLumbosacralpain,Intermenstrualbleeding,postcoitalbleedingSymptomsofthelowerurinarytractSignsInflammationofthecervixwithmucopurulentdischarge(MPCformucopurulentcervicitis)

Diagnosis1.Gram’sstainofthecervicaldischargeforleukocyte≥30/HPor≥10/×1,0002.Testsforgonococcusandchlamydia3.WetmountmicroscopyfortrichomonadsManagementSystemicmedicationChoiceofdrugsdependsonthepathogens.Examples:Gonorrheainfection：ThirdgenerationCephalosporinsCeftriaxoneSodium(头孢曲松钠/头孢三嗪/菌必治/罗氏芬)(头孢克)

Spectinomycin(大观霉素/壮观霉素/淋必治)Chlamydiatrachomatis

Doxycycline(多西环素)

Azithromycin(阿奇霉素)Erythromycin(红霉素)

Ofloxacin(氧氟沙星)ChronicInflammationoftheCervix

CervicalErosionEtiologyWhenthestratifiedepithelium(复层上皮)which

normallycoversthevaginalportionofthecervixisreplacedbycolumnarepitheliumwhichiscontinuouswiththatofthecervicalcanal.2.Mosterosionarenotinfected,northeyaretheresultofinflammation.3.Occursinthenewborns,pregnancy,oralcontracepives

ClinicalFeaturesSymptomsTheonlysymptomisamucoiddischarge.Aslightpostcoitalbleeding(butmalignancyshouldbeexcluded)SignsAredareaisseenaroundtheexternalos.Classification

DependsonthedepthandareaofthelesionTypes:simple,granular,papillaryGrades:I(＜1/3),II(1/3-2/3),III(＞2/3)

TreatmentErosionfoundonroutineexaminationshould

notbetreatedunlessitiscausingtroublesomedischarge.Acervicalsmearisneededbeforethetreatment,andifnecessary,colposcopy(阴道镜)andbiopsy.Cervicalectropion(宫颈外翻)PhysicaltherapyThermalcauterization,Cryotherapy,Lasertherapy

CervicalPolyps

Smallpedunculatedneoplasmsofthecervix

Endocervicalpolyp:Originatingfromtheendocervix

Ectocervicalpolyp:Originatingfromthevaginalportion

PathologyGrossappearance:Endocervicalpolyp:Redorpink,roundedortongue-likeEctoervicalpolyp:Pale,flesh-colored,smooth,rounded

withabroadpedicleMicroscopic:Vascularconnectivetissuestromacoveredwithcolumnarorsquamousepitheliumorboth.Congestion,edemaor

leukocyteinfiltrationmaybepresent.ClinicalFeaturesSomeareasymptomatic.SlightpostcoitalbleedingTreatmentCervicalpolypshouldbetreated.Malignantchange(<1%)PolypoidcervicalcancerTwistingoffapolypwithoutananestheticandcauterizingthebase.Recurrentcasesaretreatedwithcanaldilationandcauterizationofthestalk.

ChronicEndocervicitis(宫颈粘膜炎)(Infection)

EtiologyPathogens:

Normalcervicalandvaginalflora

PathologyThickenedendocervixthatproducesawhitishpusAcervicalossurroundedbyareddishareaHypertrophyofthelaceratedcervix

ClinicalFeatures1.Persistentleukohrreausu.mucopurulent2.Slightpostcoitalstaining3.Painslowerabdominaldiscomfort,lumbosacralbackache,dysmenorrhea,dyspareunia4.Infertility5.Urinarysymptomsfrequency,urgency,dysuriadueto

subvesicallymphangitisnottocystitis

DiagnosisThecharacteristicdischargefromexternalosofthecervix.Cytologicandcolposcopicstudiesarehelpful,but

onlybiopsyisdefinitive.Culturesarenotsohelpful.

TreatmentEvenifchronicendocervicitisisasymptomatic,itshouldbetreated.1.MedicaltreatmentSystemicratherthantopicalBasedoncultureandsensitivitytest2.Surgicaltreatment

Anoteofcaution:postoperativebleeding,infection,strictureformation,infertility.Methods:thermaltherapy,cryotherapy,lasertherapyconization,hysterectomy.

NabothianCystsRetentioncystsofthecervicalglandscausedbyobstructionoftheglandorificesbythegrowthofsquamousepithelium.Thecystsmaybeinfectedandcontainpus.CervicalHypertrophy

CervicalHypertrophyPelvicInflammatoryDisease(PID)InfectionoftheuppergenitaltractTerms:

Endometritis(子宫内膜炎)

Salpingitis(输卵管炎)

Oophoritis(卵巢炎)

Myometritis(子宫肌炎)

Pyosalpinx(输卵管积脓)

Hydrosalpinx(输卵管积水)

Peritonitis(腹膜炎)

Tubalovarianabscess(TOA)(输卵管卵巢脓肿)

EpidemiologySexualactivityAdiseaseofsexuallyactive,menstruatingwomen.AcutePIDoccursin1-2%ofyoungsexuallyactivewomenannually.AgeThepeakincidenceoccursintheirlateteensandearlytwenties.Themostcommonseriousinfectioninwomenof16-25yearsofageContraceptivepractices

ContraceptivemethodsNo.ofPID/woman-yearsSexuallyactive,usingnocontraception:3.42

Oralcontraceptives:0.91Barriermethods1.39Intrauterinedevices(IUD)5.21FinancialcostInUSA,$3.5billionannuallyin1990sMedicalsequelae

Ectopicpregnancy:6-10foldincrease

PIDaccountsfor50%Chronicpain:

4foldincreaseInfertility:

acutePIDaccountfor5-60%ofcasesTubalobstruction:

11.4%,23.1%,54.3%from1,2,3

episodesofinfectionMortality:

septicshockanddeath

EtiologyPathogensthataresexuallytransmitted1)Neisseriagonorrhoeae:inUSA,40-50%casesofPID2)Chlamydiatrachomatis:inUSA,10-40%casesofPIDThetwopathogensmayaccountfor2/3ofthePID3)Mycoplasma(支原体)Recoveredfromthepusin2-20%casesofsalpingitisEndogenousbacteria1)Aerobic:streptococci,staphylococci,Escherichiacoli2)Anaerobic:Bacteroidesfragilis(脆弱类杆菌),

peptococcus(消化球菌)，

peptostreptococcus(消化链球菌)SpreadingRouteofInfection1.AscendingalongthereproductivetractFornon-pregnantandnon-puerperalwomenGonococcus,C.trachomatis,staphylococcus2.LymphaticvesselsInpuerperalinfection,post-abortioninfectionandIUDassociatedinfectionStreptococcus,E.coli,anaerobicbacteria3.BloodvesselsTuberculosis4.DirectspreadingInfectionfromothervisceralorgans.AcutePID

PredisposingFactors1.Intrauterinemanipulatione.g.artificialabortion,IUD,etc.2.Infectioninthelowerreproductivetract,esp.STD3.Sexualactivity4.Badhygiene4.Directspreadingfromadjacentviscera6.AcuteonsetofachronicPID

Pathology1.Acuteendometritisandmyometritis2.Acutesalpingitis,pyosalpinxandtubo-ovarianabscess(TOA)3.Acutepelvicperitonitis4.Acuteinflammationoftheperitonealconnectivetissue(parametritis)(宫旁结缔组织炎)5.Septicemia(败血症)andpyemia(脓毒血症)6.Fitz-Hugh-Curtissyndrome

Fitz-Hugh-CurtissyndromePerihepatitis:inflammationofGlisson’scapsulewithoutinvolvementoftheliverparenchyma.Suppurative(脓性)andfibrousexudationofthecapsuleoccurscausingadhesionbetweenthecapsuleandtheanteriorperitoneum.Ithappensin5-10%casesofsalpingitis.ItiscausedbygonococcusorChlamydiatrachomatis.Edemaandadhesionofthecapsulemayleadtopain

intheupperabdominalregion.ClinicalFeaturesSymptoms

VarydependingonseverityandextentoftheinfectionandtypesofpathogensMostcommon:lowerabdominalpain,fever,increaseinvaginaldischarge.Gonorrhea/ChlamydiaTrichomatisSignsVariableTypical:Bimanualexamination:

DiagnosisCriteriaforthediagnosisofPIDMinimum:Painoncompressionofuterinebodyortheadnexalregion2)TendernessofthecervixSpecific:1)Biopsyoftheendometriumshowingendometritis2)Ultrasound/MRIidentificationofliquid-filledenlargedoviductsorTOA3)LaparoscopicexaminationAdditional:

DifferentialDiagnosisAppendicitisRuptureorabortionoftubalpregnancyTorsionorruptureofanovariantumor

Treatment(1)1.Systemicmedication(Ideal)Basedondrugsensitivitytest(Empirical)CombinationuseofdrugsPatient’sconditionandpossiblepathogens1)Oral:Ofloxacin(氧氟沙星)Metronidazolefor14days2)Intravenous:PenicillinorErythromycin(红霉素)

Gentamycin(庆大霉素)orAmikacin(阿米卡星/丁胺卡那霉素)

Metronidazoleforendogenousbacteria3)Cefuroximesodium(头孢呋辛钠/西力欣)forgonococcus4)Doxycycline(多西环素/强力霉素)orAzithromycin(阿奇霉素)

forchlamydiaormycoplasma5)Clindamycin(克林/氯林/氯洁霉素)foranaerobicbacteria

Treatment(2)2.SurgicaltreatmentforTOAorperitonealabscessesthatcannotbecontrolledbydrugs(2-3days)

Indications:1)Failureofdrugtherapy2)Persistentexistenceofabscesses(2-3weeks)3)Ruptureoftheabscess3.TraditionalChinesemedicineChronicPID

Etiology1.IncompletetreatmentoftheacutePID2.InfectionfromcertainpathogenssuchasChlamydiatrachomatis3.ResiduallesionsfrompreviousacutePIDCharacteristicsofchronicPID:

1.Persistenceofthecondition2.Difficulttoidentifythepathogens

Pathology1.Chronicendometritis2.Chronicsalpingitisandhydrosalpinx3.Salpingo-oophoritisandtubo-ovariancyst4.ChronicinflammationofpelvicconnectivetissueClinicalFeatures1.Chronicpelvicpain2.Infertility(20-30%)andectopicpregnancy3.Abnormalmenstrualcycle4.Systemicsymptoms5.SignsPelviccongestionorvaricosity(静脉曲张)EndometriosisTumorsUltrasoundandlaparoscopicexaminationishelpfulDiagnosisBasedonhistoryofacutePID,symptomsandsigns

DifferentialdiagnosisTreatmentAccordingtoplaceofthelesionandthepatient’scomplaintUsu.comprehensivetreatmentisrequired.1.Physical2.TraditionalChinesemedicine(赤丹丸)3.Antibiotics(抗炎II号栓)4.Drugsthatdissolveandabsorbinflammatorylesions5.Surgicaltreatment子宫肌瘤

Myomaofuterus

BenignneoplasmcomposedprimarilyofsmoothmusclePresentin20-25%ofreproductive-agewomenUsuallyasymptomaticmostcommonbenigntumoroffemalereproductivesystem.AndthemostcommonbenigntumorinhumanbodyIntroductionTheexactcauseisnotveryclear,Probablyrelatestofemalehormones.Evidence:Notdetectablebeforepubertyandaftermenopause,estrogenandE-Rarehigherinmyomathanthatinnormalmyometrium.PmaypromotemitosisofmyomaEtiology1.Accordingtothelocation,myomaisdividedinto:Uterinebodymyoma(92%)Cervicalmyoma(8%).Classification2.accordingtotherelationshipbetweenmyomaanduterinemyometrium,myomaisdividedinto:Submucousmyoma(10%~15%):liejustbeneaththeendometriumandgrowtowardtheuterinelumenIntramuralmyoma(60%~70%):liewithintheuterinewallSubserousmyoma(20%):liejustbeneaththeserosalsurfaceoftheuterusSubmucousmyomaSubmucousmyomabyhysteroscopeSubserousmyomaIntramuralmyomaPathology

Ongrossexaminationtheyarewhite-colored,round,smooth,andusuallyfirm.Leiomyomashaveapseudocapsule,sotheycanbeeasilyandcleanlyenucleatedfromthesurroundingmyometrialtissue.Onmicroscopicexamination

Myomaoriginatesfromuterinesmoothmusclecellsorfromvascularsmoothmusclecells.Undermicroscope,itiswhorledappearanceanditssmoothmusclefibersarearrangedininterlacingbundlesofvaryingsizerunningindifferentdirections.PathologyDegeneration:losetheoriginaltypicalstructure.Thefollowingtypes:HyalinedegenerationCysticdegenerationReddegenerationSarcomatouschangeDegenerationwithcalcificationDegenerationHyalinedegenerationHyalinedegeneration

Themostcommondegeneration.itswhorledstructuredisappearsandisreplacedbyclearsubstance,whitecolor.Undermicroscope,thecellsinthedegenerationareadisappear,Cysticdegeneration

Itisasecondarychangefollowinghyline

degeneration.ThereistissuenecrosisandliquefactionandformsmutiplecystsCysticdegenerationDegenerationwithcalcification

Majorityoccurinthemyomaswiththin

pedecleoraftermenopause,forthecircu-lationisinsufficient,whichcausesprecipitationofcalciumcarbonateandphosphatewithinthetumor.Oftensecon-darytothefattydegeneration

DegenerationwithcalcificationReddegenerationVenousthrombosisandcongestionwithinterstitialhemorrhageareresponsibleforthedarkredcolorofaleiomyomaundergoingreddegeneration.Itswhorledstructuredisappearsandhasbadsmell.ReddegenerationismostcommonDuringpregnancyandpuerperium.Itisaspecialtypenecrosis,thecauseisnotclear.Theprocessisusuallyaccompaniedbypainandfeverandrapidlyenlargedmyoma.SarcomatouschangeSarcomatouschangeismalignanttransformationofleiomyoma.Thefrequencyis0.4-0.8%,oftenoccursinoldwomen.Themyomaenlargesrapidlyinshorttermwithirregularvaginalbleed-ing.SarcomatouschangeSymptomsUsuallynosymptoms.Oncetherearesymptoms,thesymptomsfromleiomysmasdependontheirlocation,thespeedofgrowthanddegenerations,andnotassociatewiththesizeandthenumberofmyomas.1.

menstruationchange2.

abdominalmass3.

leucorrhea4.

Abdominal

pain5.

compresssymptom6.

infertility7.

anemiaMainsymptomsMainsymptomsAbnormaluterinebleedingItisthemostcommonandmostimportantclinicalmanifestationofmyomaThemostcommonsymptom:largeintrmural

myoma,sub-mucousmyoma,necrosisorinfectionofmyoma,subserousorsmallmyoma.MassoflowerabdomenMasscouldbefoundwhenpalpatethepatients,lowerabdomen.Leukorrhagia:myomaincreasethesizeofuterinecavity,infectionofsubmucousmyoma

MainsymptomsMainsymptomsPainPainmayresultfromReddegenerationInfectiontorsionofapendunculated

subserousmyoma3.

myometrialcontractionstoexpelasubmucousmyomafromtheuterinecavity.PressureeffectsLargetumorsmayfillthetruepelvisandcompresstheureters,bladder,orrectum.CervicaltumorsmaycausedyspareuniaandinfertilityParasitictumorsmaycauseintestinalobstructioniftheyarelargelyinvolvedinbowel.MainsymptomsMainsymptomsInfertilityandSpontaneousabortionTherelationshipbetweenmyomaandinfertilityremainsuncertain.Between25%and40%ofwomenwithmultipleleiomyomasarereportedtobeinfertile.Cause.TheincidenceofspontaneousabortionsecondarytoleiomyomaisunknownAnemiaSignsThephysicalsignsareass