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    Clinical case of infertility with large uterine fibroid
    (T.C. Maltepe Üniversitesi, 2022) Awais, Momin Mohammed; Ch.A., Stakeeva; G. Zh., Zholdoshbekova; B.D., Toguzbaeva; J.N., Amiraev; R.S., Asakeeva; K.D., Aitbek; Thomas, Pınar Buket; Öner, Çağrı; Avcı Alpar, Demet; Erkut, Zeynep
    Introduction: Uterine leiomyoma is one of the most common benign tumors of the female reproductive system. A special group of patients are women of reproductive age, among whom the incidence of the disease is 40–50% Aim. To present a complex clinical case of large uterine fibroid, complicated by infertility, in the absence of observation in a medical organization. Methods: An analysis was made of the provision of medical care to a patient of reproductive age with uterine myoma complicated by infertility. The authors declare no conflict of interest. Results: Patient T.A., 37 years old, a housewife, was admitted to the gynecology department, for planned surgical treatment with complaints of an enlarged abdomen, aching pain in the lower abdomen, and difficulty urinating. An. morbi: for the first time, small-sized uterine fibroids (d -2 cm) were diagnosed 7 years ago, when examining a patient for infertility. However, over the past 6 years, she was not observed and first applied 4 months ago, when the above complaints began to bother. On USG: a subserous-interstitial node is determined along the posterior wall of the uterus, deforming the outer contour and uterine cavity, reduced echogenicity, rounded shape, clear and even contours, 142 x 141 mm in size. The volume of the body of the uterus is 1110.63 cm3. On CDI moderate intramedullary blood flow is determined. For the purpose of preoperative preparation, to reduce the volume of the myomatous node by reducing its blood supply, agonists of gonadotropin-releasing hormone (GnRH agonists) were prescribed for a period of 3 menstrual cycles. The patient, after outpatient treatment for 2 menstrual cycles, was admitted for planned surgical treatment with diagnosis: Subserous - intramural uterine fibroid of large size. Infertility I. Ultrasound results : a decrease in the volume of the uterine body to 1010.53 cm3, a decrease in the size of the subserous- interstitial node to 132*130 mm. CDI reduction of blood flow in the myomatous node. Given the positive effect of preoperative preparation with GnRH agonists, it was decided to perform a conservative myomectomy by laparotomy . Operative treatment in a planned manner: Laparotomy by Pfannenstiel, conservative myomectomy. Anesthesia - spinal anesthesia. Intraoperative blood loss was 450 ml. The postoperative period was uneventful, the patient received antibacterial, uterotonic, antianemic therapy, adequate pain relief, prevention of thromboembolic complications. Ultrasound data 5 days after the operation: The scar on the uterus is wealthy. Condition after surgery. On the 6th day after the operation, the patient left the hospital with the following recommendations: 1. Continue GnRH agonists for 1 menstrual cycle. 2. Control ultrasound 1 month after the operation. 3. Continue antianemic therapy. 4. Planning for pregnancy after 6 months of the postoperative period. Ultrasound 40 days after surgery: The uterus is of normal size, in the anteflexio position. Length - 66 mm , width - 57mm, front -rear size - 42mm. The contours are even, the echostructure is homogeneous. The cavity is clean. The thickness of the endometrium is 6 mm. The patient began to take dienogest 2 mg according to the scheme. Conclusion: The presented clinical case is an example of the management of patients with uterine myoma in combination with infertility. The use of GnRH agonists preoperative preparation with made it possible to reduce the blood supply to the fibroids, slightly reduce its size and reduce intraoperative blood loss.