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. Introduction Uterine Myoma are among the most frequent entities encountered in t h e p r a c t i c e o f g y n e c o l o g y , o c c u r r i n g i n 2 0 4 0 % o f w o m e n d u r i n g t h e i r reproductive years.

. It is the most common pelvic neoplasm of gynecologic origin, as well as the most frequently occurring tumor of the uterus. They are benign and account for the single largest indication for hysterectomy. Myomas range in size from seedlings to large uterine tumors. They are round, firm, benign lumps of the muscular wall of the uterus, composed of s m o o t h m u s c l e a n d c o n n e c t i v e t i s s u e , a n d a r e r a r e l y s o l i t a r y . U s u a l l y a s small as a hen's egg, they commonly grow gradually to the size of an orange or grapefruit. On cutting into such a tumor, its surface is seen to be glistening white color, with characteristic whorl-like trabeculation so that it stands out in sharp contrast to the surrounding muscularies. A d i a g n o s i s o f u t e r i n e m y o m a i s t h e m o s t c o m m o n i n d i c a t i o n f o r hysterectomy . Many surgical procedures other than hysterectomy are also commonly performed because of myomas. Women with symptoms like heavy bleeding and pain may need surgery. If the woman is not planning to have any more children, a hysterectomy may be recommended. This is surgery tor e m o v e t h e u t e r u s . I f t h e w o m a n w o u l d l i k e t o b e c o m e p r e g n a n t i n t h e fut ure, a myomectomy may be done instead. This is surgery to remove only the fibroid. The uterus is left intact. A. Current Trends Young Early Stage Ovarian Cancer Patients Can Preserve Fertility ScienceDaily (Aug. 10, 2009) A n e w s t u d y f i n d s t h a t y o u n g w o m e n w i t h early-stage ovarian cancer can preserve future fertility by keeping at least one ovary or the uterus without increasing the risk of dying from the disease .The study is published in the September 15, 2009 issue of cancer, a peer-reviewed journal of the American Cancer Society. Most cases of ovarian cancer are diagnosed at later stages and in older women. However, up to 17 percent of ovarian tumors occur in women 40years of age or younger, many of whom have early stage disease. Surgery for ovarian cancer usually involves complete removal of the uterus (hysterectomy) and ovaries, which not only results in the loss of fertility, but also subjects young women to the long-term consequences of estrogen deprivation .Researchers led by Jason Wright, M.D., of Columbia University College of Physicians and Surgeons in New York City conducted a study to examine the safety of fertility-conserving surgery in premenopausal women with ovarian cancer. This type of surgery conserves at least one ovary or the uterus. The investigators analyzed data from women 50 years of age or younger who were diagnosed with early stage (stage I) ovarian cancer between 1988 and 2004 and who were registered in the National Cancer Institute's Surveillance, Epidemiology and End Results database, a population-based cancer registry that includes approximately 26 percent of the US population. Patients who had both of their ovaries removed were compared with those who had only the cancerous ovary removed. A second analysis examined uterine conservation vs hysterectomy. For their first analysis, the researchers identified 1,186 ovarian cancer patients. While most had both ovaries removed, about one in three (36percent) had one ovary conserved. They found those in whom one ovary was saved had similar survival for up to at least five years.To examine the effect of uterine preservation, the investigators studied a total of 2,911 women. While most of the women underwent hysterectomy, about one in four (23 percent) had uterine preservation. Uterine preservational so had no effect on survival .Women who were younger, who were diagnosed in more recent years, and who resided in the eastern or western United States were more likely to undergo ovarian or uterine conservation. These results are promising for the many young women who are diagnosed with ovarian cancer each year. An estimated 21,650 women in the United States were diagnosed with the disease in 2008. "Given the potential reproductive and non reproductive benefits of ovarian and uterine preservation, the

benefits of conservative surgical management should be considered in young women with ovarian cancer," the authors concluded. SOURCE: http://www.sciencedaily.com/releases/2009/08/090810024819.htm A. Socio-economic and cultural factors This includes the relationship of people with others, superstitiousbeliefs related to health, religious affiliations, financial status, occupation,inco me and vices. Culture encompasses the set of beliefs, moral values, traditions, language, and laws held in common by a nation, a community, or other defined group of people. Early detection of diseases or any other abnormalities within the body such as myoma uteri is very important to make necessary interventions. In this way there is much chance to prevent further complications to occur. But in reality a lot of people suffer from it without even having doctor consultations due to lack of money to pay their professional fee. In addition, once a person is diagnosed with such, screening tests will be done and its quite expensive as it was expected. F i n a l l y , p a t i e n t s t e n d t o s e e k f o r m o r e g u i d a n c e t o G o d t o e n d u r e myoma that they will be facing. Through the help and guidance of Him, theb e l i e f t h a t H e w i l l b e t h e o n e t o h e a l t h e t u m o r w i t h t h e a i d o f t h e professionals.

ANATOMY AND PHYSIOLOGY

T h e f e m a l e r e p r o d u c t i v e s y s t e m i s d e s i g n e d t o c a r r y o u t s e v e r a l functions. It produces the female egg cells necessary for reproduction, called the ova or oocytes. The system is designed to

transport the ova to the site of f e r t i l i z a t i o n . C o n c e p t i o n , t h e f e r t i l i z a t i o n o f a n e g g b y a s p e r m , n o r m a l l y occurs in the fallopian tubes. The next step for the fertilized egg is to implant i n t o t h e w a l l s o f t h e u t e r u s , b e g i n n i n g t h e i n i t i a l s t a g e s o f p r e g n a n c y . I f fertilization and/or implantation do not take place, the system is designed to m e n s t r u a t e ( t h e m o n t h l y s h e d d i n g o f t h e u t e r i n e l i n i n g ) . I n a d d i t i o n , t h e female reproductive system produces female sex hormones that maintain there productive cycle .During menopause the female reproductive system gradually stops. It makes the female hormones necessary for the reproductive cycle to work. When the body no longer produces these hormones a woman is considered to be menopausal. Female Anatomy

The female reproductive anatomy includes internal and external structures. T h e f u n c t i o n o f the external female reproductive structures (the genital) is twofold: To enable s p e r m t o e n t e r t h e b o d y a n d t o p r o t e c t t h e internal genital organs from infectious organisms. The main external structures of the female reproductive system include

Labia majora: T h e l a b i a m a j o r a e n c l o s e a n d p r o t e c t t h e o t h e r external reproductive organs. Literally translated as "large lips," the labia majora are relatively large and fleshy, and are comparable to thes c r o t u m i n m a l e s . T h e l a b i a m a j o r a c o n t a i n s w e a t a n d o i l - s e c r e t i n g glands. After puberty, the labia majora are covered with hair. Labia minora:

Literally translated as "small lips," the labia minora can b e v e r y s m a l l o r u p t o 2 i n c h e s w i d e . T h e y l i e j u s t i n s i d e t h e l a b i a majora, and surround the openings to the vagina (the canal that joins the lower part of the uterus to the outside of the body) and urethra ( t h e t u b e t h a t c a r r i e s u r i n e f r o m t h e b l a d d e r t o t h e o u t s i d e o f t h e body). Bartholin's glands: T h e s e g l a n d s a r e l o c a t e d n e x t t o t h e v a g i n a l opening and produce a fluid (mucus) secretion. Clitoris: The two labia minora meet at the clitoris, a small, sensitive p r o t r u s i o n t h a t i s c o m p a r a b l e t o t h e p e n i s i n m a l e s . T h e c l i t o r i s i s covered by a fold of skin, called the prepuce, which is similar to the f o r e s k i n a t t h e e n d o f t h e p e n i s . L i k e t h e p e n i s , t h e c l i t o r i s i s v e r y sensitive to stimulation and can become erect. The internal reproductive organs: Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is known as the birth canal. Ovaries: The ovaries are small, oval -shaped glands that are located on either side of the uterus. The ovaries produce eggs and hormones. Fallopian tubes: T h e s e a r e n a r r o w t u b e s t h a t a r e a t t a c h e d t o t h e upper part of the uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The fertilized egg then moves to the uterus, where it implants to the uterine wall. Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a developin g fetus. The uterus is divided into two parts: the cervix, which is the lower part that opens into the vagina, and the main body of the uterus, called the corpus. The corpus can easily expand to hold a developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit. Cervix The cervix is the lower constricted segment of the uterus. It is somewhat conical in shape, with its truncated apex directed downward and b a c k w a r d , b u t i s s l i g h t l y w i d e r i n t h e m i d d l e t h a n e i t h e r a b o v e o r b e l o w . Owing to its relationships, it is less freely movable than the body, so that the latter may bend on it. The long axis of the cervix is therefore seldom in the same straight line as the long axis of the body. The long axis of the uterus asa whole presents the form of a curved line with its concavity forward, or in extreme cases may present an angular bend at the region of the isthmus.T h e c e r v i x p r o j e c t s t h r o u g h t h e a n t e r i o r w a l l o f t h e v a g i n a , w h i c h divides it into an upper, supra vaginal por tion, and a lower, vaginal portion.The supravaginal portion (portio supravaginalis [cervicis]) is separated in front from the bladder by fibrous tissue (parametrium), which extends also onto its sides and lateral ward between the layers of the broad ligam ents. The uterine arteries reach the margins of the cervix in this fibrous tissue, while one either side the ureter runs downward and forward in it at a distance of about2 c m . f r o m t h e c e r v i x . P o s t e r i o r l y , t h e s u p r a v a g i n a l c e r v i x i s c o v e r e d b y peritoneum, which is prolonged below on to the posterior vaginal wall, when it is reflected on to the rectum, forming the recto uterine excavation. It is in relation with the

rectum, from which it may be separated by coils of small intestine. The vaginal portion (portio vaginalis [cervicis]) of the cervix projects free into the anterior wall of the vagina between the anterior and posterior fornices. On its rounded extremity is a small, depressed, somewhat circular aperture, the external orifice of the uterus, through which the cavity of the cervix communicates with that of the vagina. The external orifice is bounded by two lips, an anterior and a posterior, of which the anterior is the shorter and thicker, although, on account of the slope of the cervix, it projects lower t h a n t h e p o s t e r i o r . N o r m a l l y , b o t h l i p s a r e i n c o n t a c t w i t h t h e p o s t e r i o r vaginal wall . Interior of the Uterus T h e c a v i t y o f t h e u t e r u s i s s m a l l i n c o m p a r i s o n w i t h t h e s i z e o f t h e organ. The Cavity of the Body (cavum uteri) is a mere slit, flattened antero-posteriorly. It is triangular in shape, the base being formed by the internal surface of the fundus between the orifices of the uterine tubes, the apex byt h e i n t e r n a l o r i f i c e o f t h e u t e r u s t h r o u g h w h i c h t h e c a v i t y o f t h e b o d y co mmunicates with the canal of the cervix. The Canal of the Cervix (canaliscervicis uteri) is somewhat fusiform, flattened from before backward, andb r o a d e r a t t h e m i d d l e t h a n a t e i t h e r e x t r e m i t y . I t c o m m u n i c a t e s a b o v e through the internal orifice with the cavity of the body, and below through the external orifice with the vaginal cavity. The wall of the canal presents an a n t e r i o r a n d a p o s t e r i o r l o n g i t u d i n a l r i d g e , f r o m e a c h o f w h i c h p r o c e e d a number of small oblique columns, the palmate folds, giving the appearance of branches from the stem of a tree; to this arrangement the name arbor vitae uterina is applied. The folds on the two walls are not exactly opposed, but fit between one another so as to close the cervical canal. The total length of the uterine cavity from the external orifice to the fundusis about 6.25 cm. Ligaments T h e l i g a m e n t s o f t h e u t e r u s a r e e i g h t i n n u m b e r : o n e a n t e r i o r ; o n e posterior; two lateral or broad; two uterosacral; and two round ligaments. T h e anterior ligament consists of the vesicouterine fold of peritoneum,which is reflected on to the bladder from the front of the uterus, at the junction of the cervix and body.The posterior ligament consists of therectovaginal f old of peritoneum, which is reflected from the back of theposterior fornix of the v a g i n a o n t o t h e f r o n t o f t h e r e c t u m . I t f o r m s t h e bottom of a deep pouch called the recto uterine excavation, which is bounded in front by the posterior wall of the uterus, the supra vaginal cervix, and the posterior fornix of the vagina; behind, by the rectum; and laterally by two crescentic folds of peritoneum which pass backward from the cervix uteri on either side of the rectum to the posterior wall of the pelvis. These folds are named the sacrogenital or recto uterine folds. They contain a considerable amount of fibrous tissue and non -striped Muscularrf i b e r s w h i c h a r e a t t a c h e d t o t h e f r o n t o f t h e s a c r u m a n d c o n s t i t u t e t h e uterosacral ligaments.The two lateral or broad ligaments (ligamentum latum uteri) pass from the sides of the uterus to the lateral walls of the pelvis, dividing that cavity into two portions. In the anterior part is contained the bladder; in the posterior part the rectum, and in certain conditions some coils of the small intestine and a part of the sigmoid colon. Between the two layers of each broad ligament are contained: (1) the uterine tube superiorly; (2) the round ligament of the uterus; (3) the ovary and its ligament; (4) the epophoron and parophoron; (5) connective tissue;(6) unstriped muscular fibers; and (7) blood vessels and nerves. The portion of the broad ligament which stretches from the uterine tube to the level of the ovary is known by the name of the mesosalpinx. Between the fimbriated extremity of the tube and the lower attachment of the broad ligament is a concave rounded margin, called the in fundibulopelvic ligament. The round ligaments (ligamentum teres uteri) are two flattened bands between 10 and 12 cm. in length, situated between the layers of the broad ligament in front of and below the uterine tubes. Commencing on either side at the lateral angle of the uterus, this ligament is directed forward, upward, and lateral ward over the

external iliac vessels. It then passes through the abdominal inguinal ring and along the inguinal canal to the labium majus, in which it becomes lost. The round ligaments consists principally of muscular tissue, prolonged from the uterus; also of some fibrous and areolar tissue, besides blood vessels, lymphatics; and nerves, enclosed in a duplicature of peritoneum, which, in the fetus, is prolonged in the form of a tubular process sfor a short distance into the inguinal canal. This process is called the canal of Nuck. It is generally obliterated in the adult, but sometimes remains perviouseven in advanced life. It is analogous to the saccus vaginalis, which precedes the descent of the testis. In addition to the ligaments just described, there is a band named the ligamentum transversalis colli (Mackenrodt) on either side of the cervix uteri. It is attached to the side of the cervix uteri and to the vault and lateralf o r n i x o f t h e v a g i n a , a n d i s c o n t i n u o u s e x t e r n a l l y w i t h t h e f i b r o u s t i s s u e which surrounds the pelvic blood vessels. The form, size, and situation of the uterus vary at different periods of life and under different circumstances. RECOMMENDATION The following information was prepared to provide background information on fibroid tumors and some of the treatment options available, including a relatively new procedure that allows women to avoid surgery. Methods of treatment depend on the severity of symptoms, the patient's age, her pregnancy status, her possible desire for future pregnancies, her general health, and characteristics of the fibroids. Treatment may consist of simply monitoring the rate of growth of the fibroids with periodic pelvic exams or ultrasound. Nonsteroidal antiinflammatory medications like ibuprofen or naprosyn may be recommended for lower abdominal cramping or pain with menses.Iron supplementation will help to prevent anemia in women with heavy periods. These methods are usually sufficient in premenopausal women. Hormonal treatment, involving drugs such as injectable Depo Leuprolide, causes fibroids to shrink, but can also cause significant side effects. This method is sometimes used for short treatment periods before surgical procedures or when menopause is imminent. Learning derived Handling this kind of patient is interesting. Although its quite difficult for the researchers, but it has a purpose to the researching to gain more experience in the field of nursing. At first the researchers did not know what to do in this case, because we have no background about it. But when there searchers did this case study about myoma we were challenge to do it. Such a wonderful opportunity to be exposed in the ward of ob-gyne. And there searchers are thankful of C.I maam for being supportive and having a long patience with group 50 whenever a mistake is done

VIII. BIBLIOGRAPHY Internet resources :http://www.sciencenews.org/search/seek?for=uterine+myomahttp://www.sciencedaily.com/releases/2009/0 8/090810024819.htm