​TOP 11 FACTS ABOUT UTERINE FIBROIDS


1. Uterine fibroids are abnormal growths of tissues originating from the muscles of the uterus (womb). They are classified based on the location: just beneath the uterine lining (submucous), within the uterine muscle (intramural) or on the exterior part of the uterus (subserous). 

2. Uterine fibroids are pretty much common, affecting up to 40% of women in any given population and clinically symptomatic in 25% of affected women. The incidence is highest between the ages of 30 – 50 years. 

3. The cause is largely unknown, but researches have shown the role of the excessive female hormones (estrogen and progesterone) in its development. Recognized risk factors for the occurrence of fibroids include:

-Early age at onset of menses

-Advanced age at first pregnancy (>35 years) 

-Absence of pregnancy (in converse, carrying at least one pregnancy beyond 5 months is protective) 

-Obesity 

-Alcohol intake

-Heavy caffeine intake (>500mg/day)

-Black race

-Age 35 – 55 years 

-Family history 

4. The incidence of fibroids reduces drastically after menopause. Pre-existing ones also tend to regress spontaneously. Interestingly, tobacco smoking is associated with reduced risk of having fibroids, but when you weigh in the worse consequences such as lung cancer, you wouldn’t want to smoke, would you?! 

5. Most fibroids are asymptomatic. They just sit there and cause no harm. Most are incidental findings during ultrasound scan for entirely different reasons (like during pregnancy). 

6. The commonest symptom is heavy menstrual bleeding. This can result in severe anaemia, need for hospitalization and/or blood transfusion, poor quality of life and psychological depression. 

7. Other symptoms include:

– Abdominal swelling – massive fibroids can look as big as a full term pregnancy! 

– Abdominal pain

– Pressure on the urinary tract, resulting in infections,  urinary disturbances and kidney damage. 

– Pressure on the bowels, resulting in constipation 

– Problems with fertility: inability to conceive (very rare), miscarriages, preterm labour, difficulty during childbirth, etc. 

8. Treatment depends largely on symptoms:

-Asymptomatic fibroids are best left alone. They will regress after menopause. 

-Heavy bleeding must be corrected early to avoid the complications of chronic blood loss. 

-Conservative management can be employed in younger women with mild symptoms. This includes a wide range of medications to control bleeding and shrink the fibroid. 

– Surgical treatment is aimed at a total (or near total) cure in cases of life threatening symptoms. There are a wide range of options but the ultimate cure is the total removal of the uterus (hysterectomy). 

9. Fibroids can recur. Again, the only sure way to avoid recurrence is to ‘yank’ out the uterus! However, this procedure is reserved for the severe, life threatening ones, in women who have completed their reproductive career. 

10. Fibroids can become malignant (cancer). Fortunately, this only happens to <1% of fibroids. It’s more likely in postmenopausal women with fibroids. 

11. Certain natural remedies can be used to reduce the risk of developing fibroids. Adequate fruits and vegetables intake, green tea, vitamin D are a few examples. Beware of fake herbal products and desperate quack doctors who claim to have some mysterious cure for fibroids!

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​PERINEAL TEAR: THE PRICE OF ‘PUSHING’ 

Vaginal delivery remains the better option than C-section; unless there’s a medical indication for the latter. But nothing comes without its own downside. One of the downsides of vaginal birth is the higher risk of genital tract injuries: ranging from slight bruising to various degrees of tear. 

Episiotomy is the surgical cut made in the vaginal wall and peri-anal (perineal) muscles which is sometimes necessary to widen the space for the passage of the baby and to prevent irregular lacerations during delivery (which are more difficult to treat). 

When a woman is given an episiotomy or she sustained genital laceration during childbirth, a proper repair must be done by a trained personnel (midwife or doctor). Failure to repair promptly and skillfully can result in immediate and longterm complications. 

The steps involved in repairing perineal tear and episiotomy are essentially similar:
*The doctor will examine your vagina and anus to visualize the extent of injury, check if the anus is involved and decide whether the repair should be done in the labour room or operating theater. 

*You will be given an injection at the site of the wound to numb the pain. You shouldn’t feel anything during the stitching and a few hours thereafter. 

*The cut will be stitched layer-by-layer, ie. Vaginal wall, muscles, then skin. Absorbable sutures are widely used nowadays, so need to go back for removal of stitches. 

*If the deep anal sphincters (special muscles controlling the anus) are involved, the procedure should be done in an operating theater, by a specialist doctor, under anesthesia. 

After the repair, care must be taken to ensure proper healing of the wound. Painkillers, antibiotics and stool softening medications must be taken for at least 2 weeks. Sitz bath (immersing the perineum in lukewarm water) should be done twice daily until full healing. Long-term contraception is advised to reduce the risk of wound breakdown during the next delivery. Next pregnancy and childbirth should be hospital-supervised, taking into consideration the past events.
 
If perineal tears are left unattended for a long time after delivery, severe bleeding can occur; necessitating blood transfusion. Other complications include:

*infection 

*poor wound healing 

*constipation 

*chronic pain

*faecal incontinence (inability to control flow of stool) 

*flatulence (uncontrollable farting) 

*fecal fistulae (abnormal connection between anus and vagina – soiling the vagina with feaces) 

*sexual dissatisfaction and other sexual dysfunctions 

*difficulty in subsequent deliveries 

*low self esteem 

Genital tract injuries can be prevented by allowing the baby to descend gradually, with controlled pushing, guarding of the perineum by the midwives, doing episiotomy when needed or planned caesarean section when the fetal weight is estimated to be above 4kg. 

PAIN RELIEF DURING LABOUR 

If you ask women who have been through labour how the pain feels like, majority will tell you that it is the most excruciating and indescribable pain ever. Some would liken it to having the most severe menstrual cramps… multiplied by 10! Most women will be able to tolerate the pain without any medical intervention; it depends on the threshold for pain and prior mindset and experience. 

The good news is that labour does not have to be painful. It can in fact, be painless or at least, less painful. Women should not shy away from asking the doctor or midwife for the options available (and applicable) to them. 
Let’s discuss some of the methods of pain relief in labour… 

*EPIDURAL. This is the most effective method of pain relief. A tiny catheter is inserted into the space between the backbone and the spinal cord, and then an anesthetic drug is injected. Epidural blocks the pain almost 100 percent. It can also be connected to a device which is controlled by the woman herself (PCA: patient-controlled analgesia), such that she only administers it to herself when she feels severe pain. This form of analgesia can be combined with spinal anesthesia and easily topped up in case an emergency cesarean section needs to be done. It is also beneficial for hypertensive women as it decreases blood pressure. The major downside of epidural is that it increases the duration of labour because the woman would not feel the urge to push effectively. She will have to rely on the midwife to tell her when to push. Epidural also increases the incidence of assisted (instrumental) vaginal delivery and perineal injuries. 

*ENTONOX. A combination of nitrous oxide and oxygen given by face mask during labour is also very effective in relieving the pain. It may cause drowsiness, nausea or vomiting. 


*TRANSCUTANEOUS ELECTRIC NERVE STIMULATION. (TENS) As the name implies, TENS is a device that stimulates the nerves responsible for the perception of pain. It can be used to mask the effect of the uterine contractions during labour. 

*ANALGESIC INJECTIONS. Examples are pethidine, pantazocine. These are related to morphine and they create a feeling of euphoria or “high”, in addition to pain relief. The main side effect is respiratory depression in the newborn but the effect can easily be reversed with an antidote (naloxone) given to the baby after birth. Weaker analgesics (like paracetamol) can be used in early labour but they tend to have little or no effect. NSAIDS are avoided because of side effects on the newborn. 

*WATER BIRTH. Yeah, water is a powerful painkiller too. You read that right! Many hospitals in developed countries now have the option of delivering the baby inside a birth pool. This can also be achieved at home in selected low-risk pregnant women. Floating in the warmth of a pool of water helps to relieve the pain and pressure associated with labour. 

*HERBAL PRODUCTS. I am not an herbalist, but I know there are several mixtures and concoctions that have been used and proven to be effective; though most have not gone through scientific trials. Care should be taken in using these products as they may contain substances that may be harmful to the baby, and there is a high risk of aspiration in case the woman vomits. 

*RELAXATION TECHNIQUES. Non-medical methods of pain relief remain more popular and preferred by most women; mainly because of the fear of side effects of medications. Relaxation can be achieved through deep breathing exercises, massage, aromatherapy, acupuncture and of course, moral support from husbands or other close relatives.

SAVE A SOUL SERIES: PART 4 – CONVULSIONS! 

Epilepsy (also called seizure disorder) is a wide topic which includes abnormal and involuntary movements, gestures, speech and behaviors caused by abnormal firing of the neurons in the brain.

This article is mainly based on the generalized (tonic-clonic or grand mal) convulsions; when there is jerking of part or whole of the body, with or without loss of consciousness. 
If you find someone having seizures, there are a few things you can do to help them:
*Don’t panic. Remain calm and confident, while you help. Stay with the patient all through and offer gentle reassurance. 
*Note the time the convulsion starts. The duration is an important information that can help the physicians in determining the mode of treatment. 
*Remove any dangerous object on, or around the patient (like furniture, sharps, etc.) to avoid injury
*Remove anything in the patient’s mouth, such as food and dental prosthetics, to prevent blockage of the airway. 
*Secure the patient’s head on a pillow or any other soft material to prevent him from hitting his head on a hard surface and causing head injury. 
*Don’t try to move the patient while he is convulsing, rather, wait until he becomes calm or conscious. 
*Also, don’t try to restrain the patient. Let him be; except for the head that needs to be secured. 
*Don’t put anything in the patient’s mouth. It is common practice for people to insert a finger, spoon and other items in order to separate the gnashing teeth. This is very wrong. 
*Don’t give the patient anything to eat or drink while he is convulsing. He may aspirate and die from that. 
*If the convulsion lasts longer than 5 minutes or the patient is having multiple convulsions without regaining consciousness fully in-between the convulsions, then you need to call for urgent medical help or move the patient to the nearest emergency room. 
*Once the convulsion stops, place the patient in recovery position (see picture below) to prevent the tongue from falling backwards, thereby blocking the airway. This posture is especially important if the patient becomes unconscious after the convulsion. 

*Check the breathing and heartbeat, and commence CPR as needed.