<Uterine myoma>

*Pathophysiology

Leiomyomas arise from the overgrowth of smooth muscle and connective tissue in the uterus. A genetic predisposition exists. Histologically, a monoclonal proliferation of smooth muscle cells occurs.

Evidence of an apparent hormonal dependency includes the following:

Both estrogen and progestin receptors are present in fibroids. Elevated estrogen levels may cause fibroid enlargement. During the first trimester of pregnancy, 15-30% of fibroids may enlarge then shrink in puerperium. Some fibroids may decrease in size during pregnancy.

Fibroids shrink after menopause. Some regrowth may occur with hormonal therapy.

*Complication

spontaneous abortion, intrauterine growth retardation, preterm labor, uterine dyskinesia or inertia during labor, obstruction of the birth canal, postpartum hemorrhage, and hydronephrosis.

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What are the symptoms of fibroids during pregnancy?

Heavy vaginal bleeding
Abdominal pain
Pelvic pressure
Frequent urination
Constipation

Always report abdominal pain or vaginal bleeding to your doctor immediately.

Will a fibroid tumor complicate my pregnancy?
Fibroids usually develop prior to pregnancy, though many women don't know they have one until they have an ultrasound or the fibroid is discovered during a pelvic exam. If you know prior to pregnancy that you have fibroids, ask your doctor whether their size or position could cause problems, and which symptoms to watch for.

Most women who have one or more of these noncancerous growths experience no pregnancy complications because of them. For the 10 to 30 percent of pregnant women with fibroids who do end up having complications, the most common is abdominal pain, which occasionally may be accompanied by light vaginal bleeding. The baby is rarely affected unless the bleeding is substantial.

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<Adenomyosis>

Adenomyosis may be present and cause no symptoms. When this condition presents with symptoms the typical triad is uterine enlargement, pelvic pain and heavy and abnormal menstrual bleeding. Pain, which is most common during menses (dysmenorrhea), may be severe cramping or knifelike. However, pain may be present any time during the cycle and not only during the period. Uterine enlargement may be generalized with a large globular uterus or it may present as localized "tumors". Periods may be very heavy and prolonged, with passage of clots. Heavy bleeding may lead to anemia. Later, abnormal bleeding may be present any time during the cycle besides the heavy periods.

The effect of adenomyosis on fertility and pregnancy is not clear. Adenomyosis may well lower fertility. The information available suggests that adenomyosis may be present in up to 17% of pregnant women over the age of 35. It is infrequently associated with obstetric or surgical complications. In most of these cases adenomyosis was an incidental finding at cesarean section or hysterectomy. Complications reported during pregnancy include uterine rupture or perforation, placenta accreta or increta, uterine atony or hemorrhage. A few cases of ectopic pregnancy inside the uterine wall or within an adenomyoma have been reported. Further studies are needed to determine the correlation between uterine size, extent of adenomyosis and the occurrence of infertility and obstetric complications. However, there is little doubt that adenomyosis is the cause of infertility in many women, especially when the condition is advanced.

On the basis of the only large study of adenomyosis in pregnancy, an analysis of 151 uteri obtained at cesarean hysterectomy, it appears that the incidence of this condition is 17.2% (Sandbert and Cohn, 1962)
Although 50 years ago it was suggested that adenomyosis in pregnancy markedly increased the risk of obstetric complications-specifically, postpartum hemorrhage, uterine atomy, and uterine rupture-that has not proved to be the case (Haydon,1942). In his excellent review of this subject, Azziz noted only 29 cases of complications in more than 80 years' worth of literature, a surprisingly low figure in light of the incidence of this entity. (Azziz,1986)

*Complication
uterine rupture or perforation, placenta accreta or increta, uterine atony or hemorrhage

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  태반 분리가 일어나는 해면탈락막이 없거나 부족한 부위에 태반이 착상되어서 하나 이상의 태반엽(cotyledon)이, 결함이 있는 기저 탈락막이나 자궁근층과 단단히 붙어 있는 경우를 말한다.
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