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Re: AdenomyomaFrom: Marco A. Pelosi, III, MD (marcop@agoron.com)Sat Jan 27 11:31:03 2001
At Thu, 25 Jan 2001, Peter V. Weston, M.D. wrote: > >Hi Everyone, >This is a voice from the past that is making an enquiry for a colleague. > >Very brief history. > >35 year old patient with a bad obstetric history - 2 mid pregnancy losses. >U/S showed a large anterior submucous and intramural "leiomyoma". At >surgery it did not shell out and the path report showed that it was an >adenomyoma. > >Does anyone know of references on post surgical management of such a case, >recommendations re future pregnancy and if she should become pregnant >obstetrical management? > >She is currently on Lupron > >Regards to all > >Peter >Cap'n Pete > I see no indication for GnRH agonist therapy in this setting. "Suppressing" residual adenomyosis is pointless unless you're treating DUB-related anemia. Any significant incursion of the myometrium, regardless of whether the cavity was entered, weakens the uterine wall and increases the potential for obstetric uterine rupture. Labor is contraindicated. The patient must be informed that she remains at high risk for uterine rupture throughout the pregnancy whether or not she labors. A history of mid-trimester losses also warrants an evaluation for cervical incompetence. Her problem may be multifactorial.
-- M.A. Pelosi, III, MD
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