How to cite:
Wijaya, K, A., Dwistayani, N,M,Y., (2022). Manajemen Beberapa Fibroid Rahim Pada Kehamilan. Jurnal
Health Sains, 3(11). https://doi.org/ 10.46799/jhs.v3i11.645
E-ISSN:
2722-5356
Published by:
Ridwan Institute
MANAJEMEN BEBERAPA FIBROID RAHIM PADA KEHAMILAN
Kadek Agus wijaya, Ni Made Youthma Dwistayani
Tabanan Regional General Hospital, Tabanan, Bali, Indonesia
Email: dyouthma@gmail.com, lotuslaundrybyheart@gmail.com
Jurnal Health Sains: p–ISSN: 2723-4339 e-ISSN: 2548-1398
Vol. 3, No.11, November 2022
INFO ARTIKEL
ABSTRAK
Diterima
29 Oktober 2022
Direvisi
15 November 2022
Disetujui
25 November 2022
Fibroid Rahim adalah tumor jinak yang berasal dari otot polos
rahim. Pada umumnya mioma uteri tidak menunjukkan gejala
dan ditemukan secara kebetulan pada pemeriksaan USG
kehamilan. Kami melaporkan bahwa seorang wanita 39 tahun
dengan G2P1001 yang mengaku hamil 40 minggu datang
dengan keluhan nyeri perut intermiten sejak pukul 04.00 pagi,
yang semakin memburuk 2 jam sebelum masuk rumah sakit.
Keluhan disertai keluarnya lendir darah melalui vagina. Pasien
menikah 2 kali dan jarak antara anak pertama dan kedua adalah
19 tahun. Tanda-tanda vital pasien dalam batas normal. Pada
pemeriksaan fisik, teraba massa dengan permukaan halus yang
tampak menempel pada uterus. Pemeriksaan obstetri
didapatkan: tinggi fundus uteri: 32cm, HIS+ adekuat, denyut
jantung janin 140 denyut/menit, kinerja; posisi kepala. Saat
dilakukan vaginal touch didapatkan adanya bukaan sebesar 1
cm dengan penipisan 25%, selaput ketuban masih utuh. Pasien
didiagnosis dengan G2P10001 usia kehamilan 40-41 minggu +
intra uterin hidup tunggal + primer sekunder lama + fibroid
uteri. Pasien menjalani operasi caesar, hasil bayi dan ibu baik.
Temuan intraoperatif ditemukan 2 mioma uteri berukuran lebih
dari 5 cm yang terletak di subserosa dan intramural sehingga
pasien menjalani histerektomi supravaginal. Usia pasien di atas
35 tahun merupakan salah satu pertimbangan untuk tubektomi
Kata Kunci:
Kehamilan; Fibroid
Rahim; Histerektomi
Supravaginal; Tubektomi
Keywords:
Pregnancy, uterine fibroids,
Supravaginal Hysterectomy,
Tubectomy.
ABSTRACT
Uterine Fibroids is a benign tumors originating from the
smooth muscle of the uterus. In general, uterine myomas are
asymptomatic and are found incidentally during ultrasound
examination of pregnancy. We report that a 39-year-old
woman with G2P1001 who admitted she was 40 weeks
pregnant came with complaints of intermittent abdominal pain
since 04.00 in the morning, which was getting worse 2 hours
before being admitted to the hospital. Complaints are
accompanied by the discharge of blood mucus through the
vagina. The patient was married 2 times and the distance
between the first child and the second was 19 years. The
patient's vital signs were within normal limits. On physical
examination, there was a palpable mass with a smooth surface
that seemed to stick to the uterus. Obstetrical examination
revealed: uterine fundal height: 32cm, HIS + adequate, fetal
heart rate 140 beats/minute, performance; head position. When
Manajemen Beberapa Fibroid Rahim Pada Kehamilan
Syntax Health Sains: Vol. 3, No. 11 November 2022 1635
Introduction
Uterine Fibroids is a benign tumors
originating from the smooth muscle of the
uterus (Robboy et al., 2000). The
prevalence of uterine myomas is 40-60% in
women of childbearing age. It is said that
the incidence of pregnancy with myoma is
1.2 – 10.7%.(Nurmansyah et al.,
2019);(Yadav et al, 2019)
In general, uterine Fibroids are
asymptomatic and are found incidentally
during an ultrasound examination of
pregnancy (Egbe et al., 2018). In 42% of
cases, uterine fibroids can be found on
physical examination if they are large
(>5cm) (Lee et al., 2010).
The location, type, and size of the
uterine fibroids that are suffered determine
the symptoms experienced by the patient
(Yoon et al., 2008). Symptoms experienced
can be; Abnormal uterine bleeding which
can occur in 30% of patients, and
abdominal pain, if there is pressure on
surrounding organs, it can cause symptoms
such as polyuria, leg edema, and pelvic pain
(Mise et al., 2020).
Based on the location Uterine
Fibroids can be divided into three, namely
submucosal, intramural, and subseros
(Nurmansyah et al., 2019). Complications
that may occur in pregnancy with Uterine
Fibroids can be spontaneous abortion,
antepartum bleeding, postpartum bleeding,
premature labor, malpresentation, and
malposition (Sultana et al., 2012).
Research Methods
A 39-year-old mother with G2P1001
admitted that she was 40 weeks pregnant
and came with complaints of intermittent
abdominal pain since 04.00 in the morning,
which was getting worse 2 hours before
being admitted to the hospital. Complaints
are accompanied by the discharge of blood
mucus through the vagina. The patient was
married twice and the distance between the
first and second child was 19 years. The
patient's first child was born by normal
delivery. During pregnancy the patient.
Performed ANC 3 times at the
obstetrics and gynecology specialist.Before
this pregnancy, the patient had never
complained of bleeding or abdominal pain.
On general examination, the patient's
general condition was good, blood
pressure: 120/80 mmHg, pulse 80
times/minute, respiratory rate 20
times/minute.
The results of laboratory
examinations showed hemoglobin levels of
12.1 g/dL, hematocrit 35.6%, leukocytes 8
x 103 uL, and platelets 268 x 103 uL (Nazer
et al., 2022).
The patient also underwent an
ultrasound examination, it was found that
there was a single fetus living in the uterus
a vaginal touch was performed, it was found that there was an
opening of 1 cm with 25% thinning, and the membranes were
still intact. The patient was diagnosed with G2P10001 40-41
weeks of gestation + single alive Intra uterine + old secondary
primary + uterine fibroids. The patient underwent a cesarean
section, and the outcome of the baby and mother was good.
Intraoperative findings found that 2 uterine myomas were
measuring more than 5 cm located in the subserosa and
intramural so the patient underwent a supravaginal
hysterectomy. The age of the patient above 35 years is one of
the considerations for tubectomy.
Kadek Agus wijaya, Ni Made Youthma Dwistayani
1638 Syntax Health Sains: Vol 3 No. 11 November 2022
and a solid mass that looked like uterine
fibroids.
Figure 1
Ultrasound of Pregnancy
Based on the history, physical
examination, and supporting examinations,
the patient was diagnosed with G2P10001,
40-41 weeks of gestation + single
intrauterine life + secondary old primary +
uterine fibroids. Then a cesarean section
was performed followed by a supravaginal
hysterectomy and tubectomy.
Figure 2
Post Supravaginal Hysterectomy
After the cesarean section in this
patient, the baby was born women
weighing 3750 grams, body length of 50
cm, and Apgar score of 8/10.
During surgery, two uterine fibroids
were found, subserosa and intramural.
After surgery, the patient was diagnosed to
be G2P10001 40-41 weeks gestation +
single living intra uterine + primary aged
secondary + multiple uterine fibroids. After
surgery the patient's hemodynamic
condition was stable, and the patient was
discharged from the hospital after 2 days of
hospitalization.
Figure 3
Intramural Uterine Fibroids with
hyaline degeneration
From the results of the surgery above,
another follow-up examination was carried
out, namely the anatomical pathology
examination. The results of anatomical
pathology examination readings: benign
hyperplastic smooth muscle cells that form
a bundle arrangement and whorled
appearance, necrosis, and mitoses do not
appear.
Manajemen Beberapa Fibroid Rahim Pada Kehamilan
Syntax Health Sains: Vol. 3, No. 11 November 2022 1639
Figure 4
Subserous Uterine Myoma.
Results And Discussion
Uterine Fibroids is a benign tumors
originating from the smooth muscle of the
uterus. The incidence of pregnancy with
Uterine Fibroids is 1: 100,000 pregnancies.
The formation of Uterine Fibroids is caused
by the influence of genetic, hormonal, and
growth factors (Kim, 2018);(Eyong &
Okon, 2020).
In 40-50% of cases of Uterine
Fibroids, there are tumor-specific
chromosomal irregularities that can affect
extracellular matrix remodeling and
estrogen-progesterone receptor status
(Kim, 2018),(Eyong & Okon, 2020).
The hormones estrogen and
progesterone are said to influence the
growth of uterine fibroids. Uterine fibroids
are often encountered during the
reproductive phase and are rarely seen at
the age before menarche and after
menopause (Giuliani et al., 2020).
Compared with normal myometrial
conditions, the levels of estrogen and
progesterone in Uterine Fibroids cases were
found to be higher (Nurmansyah et al.,
2019);(Egbe et al., 2018).
Growth factors produced by smooth
muscle and fibroblasts can increase the
extracellular matrix to stimulate the growth
of uterine fibroids (Nurmansyah et al.,
2019);(Sultana et al., 2012).
The size of uterine fibroids in
pregnancy increased in 31% of cases
occurring significantly before 10 weeks of
gestation. The remaining 69% did not
change in myoma size (Rusnaidi &
Raynaldi, 2021).
Uterine fibroids that are less than 5
cm in size generally do not enlarge during
pregnancy, whereas uterine fibroids larger
than 5 cm will often enlarge during
pregnancy (Poovathi & Ramalingam,
2016).
The incidence of Uterine Fibroids
during pregnancy is mostly asymptomatic.
But pregnancy with Uterine Fibroids can
worsen the pregnancy prognosis. In 10-
30% of cases, Uterine Fibroids can cause
complications during pregnancy, delivery,
or after delivery (Sparić et al.,
2017);(Ginting & Rasmaliah, 2012).
Complications experienced can be in
the form of abortion, placental abruption,
placenta previa, IUGR, prematurity,
malpresentation, postpartum bleeding
caused by uterine atony, and retained
placenta (Egbe et al., 2018);(Lee et al.,
2010).
Based on the location of Uterine
Fibroids are divided into 3; Submucosal,
intramural, and subserous uterine myomas.
Uterine myomas located in the submucosa
most often require intense treatment
because they have severe symptomatic
manifestations such as menorrhagia,
metrorrhagia, dysmenorrhea, infertility,
and repeated abortions (Egbe et al.,
2018);(Chiaffarino et al., 2016).
In this case, the patient did not
complain of symptoms that generally occur
in uterine fibroids, this could be because the
location of the myoma in this patient is
intramural and subserosa. Both locations
rarely cause symptoms unless there is
pressure on surrounding organs
(Nurmansyah et al., 2019).
The gap between the patient's first
pregnancy and the current pregnancy is
more than 10 years, so it is referred to as
secondary primary. The age of patient is
over 35 years ago with a high risk so the
patient undergoes a tubectomy intending to
prevent re-pregnancy (Nurmansyah et al.,
2019).
Kadek Agus wijaya, Ni Made Youthma Dwistayani
1640 Syntax Health Sains: Vol 3 No. 11 November 2022
The management of this patient was
operative supravaginal hysterectomy
because the myoma size was more than 5
cm and the number was more than 1. A
hysterectomy was performed because of
uterine atony caused by multiple uterine
fibroids.
Conclusion
Uterine Fibroids is a benign tumors
originating from the smooth muscle of the
uterus. Uterine Fibroids often occur in
women of reproductive age. Pregnant
patients with Uterine Fibroids are often
asymptomatic and are found incidentally
during routine pregnancy examinations.
Uterine Fibroids in pregnancy can worsen
the prognosis of pregnancy. The
complications that can occur: are abortion,
placental abruption, placenta previa, IUGR,
prematurity, malpresentation, postpartum
bleeding caused by uterine atony, and
retained placenta. Based on the location
Uterine Fibroids are divided into 3, namely:
submucosal, intramural, and subserosa.
Uterine fibroids are the submucosal type
that most often show symptoms such as
menorrhagia, metrorrhagia, repeated
abortions, and infertility.
Manajemen Beberapa Fibroid Rahim Pada Kehamilan
Syntax Health Sains: Vol. 3, No. 11 November 2022 1641
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Kadek Agus wijaya, Ni Made Youthma Dwistayani
(2022)
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Jurnal Health Sains
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