30 years old female presents in gynaec OPD with complaints of recurrent aboions and menorahagia. Her USG showed 2 sub-serosal fibroids of 3 x 4 cm on anterior wall of uterus and fundus, which is best line of management:-
Laparoscopic myomectomy is best treatment for such young infeile patients, but it requires subserosal pedunculated fibroids and surgical expeise. Hysterectomy is advisable in patients who had completed their family. Myolysis is myoma coagulation with laparoscopic lasers. (Nd- YAG) or bipolar needle & used in perimenopausal patients. UAE is newer intervention for fibroid management in surgically unfit high risk patients, but it causes decreased feility & carries risk of placental insufficiency and uterus rupture in subsequent pregnancy.
TAH with BSO
Myolysis
Myomectomy
Uterine aery embolisation (UAE)