This reflective report is based on a condition called leiomyoma also known as fibroid myoma. Which is the development of fibroins on the uterus and is a major problem in women who are between the ages of 40-60 during the menopause phase? They end up having a Total Abdominal Hysterectomy Operation (removal of the uterus from the womb.
On the 5th August 2009, I treated a patient complaining of abdominal pain and constantly having period pains. The patient's vital signs were as follows BP-137/82, HR- 70, RR- 18, SpO2- 100, and the rhythm on the electro cardio gram was a normal sinus rhythm, pupils were equal and reacting to light. The patient was diagnosed with leiomyoma and had to undergo a total abdominal hysterectomy.
Before the operation takes place everything must be explained to the patient, be informed about complication that can occur during the operation and be given a chance to choose which form of sedation does the patient prefer either gas or medication (drugs). The patient needs to sign legal documentation that proves that the patient agreed to terms and conditions of this procedure and grant the surgeons consent to perform the procedure.
Definition of Hysterectomy is the surgical removal of a woman's womb. It may also involve the removal of the fallopian tube and ovaries. Once a hysterectomy is performed, a woman can no longer have children or menstrual period. (1) www.hysterectomy-surgical procedure- better health channel
Definition of leiomyoma they are the firm masses of smooth muscle encapsulated in compressed muscle fibers and they vary greatly in size. Large tumors may undergo degenerative changes if they outgrow their blood supply, leading to necrosis, fibrosis and calcification. They develop during the reproductive period and may be hormone dependent, enlarging during pregnancy and when oral contraceptives are used. They tend to regress after the menopause. Large tumors may cause pelvic discomfort, frequency of micturation, menorrhagia, irregular bleeding, and dysmenorrhoea and reduce fertility. It usually happens to women who have babies over age e.g. 40-60 years of age. (2) Book: anatomy and physiology (Ross and Wilson)
: I read that they are usually due to genetic abnormalities; hormones due to over stimulation of estrogen and progesterone to prepare the uterus for pregnancy and these hormones can aggravate the growth of fibrins. Chemicals such as oral contraception that contain estrogen that is biosynthesized not produced by the body. (3) www.mayoclinic.com/health/uterine-fibroid/Dsection=causes
Patient presented with these signs and symptoms
- Vaginal bleeding
- Abdominal pain
- Prolonged menstrual period
- Period pains
Complications that can occur in this condition
- Internal bleeding post operation
This experience has taught me to the perfect age to have a child is between the 20-25 years of age or even late twenties.
The effective treatment you can give to this patient pre-hospitaly is supportive treatment oxygen administration, monitor vital signs, fluid replacement depending on BP, and stop bleeding with sanitary pads and do not plug the vagina besides that the is absolutely nothing you can do for this patient. The effective treatment that the patient can get is in hospital. Surgeons will perform a total abdominal hysterectomy. Personal values are that each an every patient deserves a chance to decision making as it states in the patient rights.
If it happens that you find such a patient on the rode transport the patient rapidly to hospital because these patients can bleed to death if not treated properly and the proper treatment being in hospital.
Always strive to give my patient the best medical care besides other things that are out or beyond my scope of practice. Always give 100% of medical care.
1. www.hysterectomy-surgical procedure-better health channel
2. Waugh and grant, book: anatomy and physiology tenth edition published 2006 page 459