User talk:Michealucheobasi/sandbox

UTERINE FIBROIDS

Fibroids or fibromyoma or leiomyoma or myoma are benign (not cancer) growths of fibrous and muscular tissue arising from the muscles of the uterus. They are spherical masses of tissue that vary from a few millimeters to many centimeters in diameter that grow in the uterus. They grow mainly during a woman’s reproductive age. Most women with symptomatic fibroids are in their 30s and 40s. Fibroids can undergo degenerative changes. Malignant change (fibroid becoming cancer) is very uncommon. Fibroid can be a single growth or many growths in different parts of the uterus. Each fibroid arises from a single muscle cell. They are usually firm, encapsulated grayish white tissues. Sections of a fibroid shows uniform spindle-shaped muscle cells in transverse and longitudinal fashion and arranged in whorls. Some fibroids may show areas of necrosis (death) with hyalinization. Some areas may be fatty or cystic: The following are different types of fibroids depending on their locations •	Subserous fibroid This is fibroid located under the visceral peritoneum of the uterus (skin of the womb) •	Pedunculated subserous fibroid This is a subserous fibroid that has a pedicle which can be long or short. Some pedicles are broad-based or narrow-based. •	Intraligamentous fibroid This is fibroid that grows into the broad ligament. Such fibroids, if large can elongate the fallopian tube or make it tortuous. They can cause the kinking of the fallopian tube. This can be a reason for infertility or ectopic pregnancy Some of them can cause rotation of the uterus to the right or to the left sometimes up to 180ᵒ or more •	Intramural fibroids Such fibroids grow in the uterine muscle layer. Some of them are found surrounded by adenomyotic tissues. Some of such fibroids are quite large •	Submucous fibroids These fibroids lie under the endometrium (inner linning of the uterus) •	Submucous pedunculated fibroids These are submucous fibroids that have a pedicle, long or short Some pedicles are thick and broad-based, while others are thin and narrow-based Some of such fibrous are found extruded out of the external cervical os causing a lot of bleeding •	Parasitic fibroids These are subserous pedunculated fibroids that have detached from their pedicles and are now attached to the intestine or omentum or any other abdominal organ. They can be a reason for constant abdominal pain, intestinal obstruction or constipation “Fibroid or leiomyoma or myoma as it is also called is the commonest trumour in the human body. They can be found in up to 20% to 30% of women above the age of 30years” Fibroids can be a reason for recurrent pregnancy losses such as the following •	Chemical pregnancy that disappeared •	Blighted ovum •	Missed miscarriage •	Inevitable miscarriage •	Intrauterine fetal death •	Ectopic pregnancy •	Preterm delivery leading to the birth of preterm baby that died Instramural and submucous fibroids are the main culprits concerning recurrent pregnancy losses. Fibroids can be a reason for painful episodes and discomfort during pregnancy Fibroids can cause intrauterine growth restriction and fetal death Fibroids cause fetal mal-presentation like breech presentation, transverse lie and hand prolapse Fibroids can cause premature rupture of fetal membranes, and cord prolapse. It can be a forerunner of intrauterine infection and septicaemia. Fibroids is a major reason for intraoperative haemorrhage and post-partum haemorrhage. It increases caesarean section rate among parturient women. Fibroids can cause intestinal obstruction or constipation Fibroids can cause heavy and prolonged menstrual blood losses. Fibroids are major reason for urinary tract obstruction and urinary retention. It can be a reason for prolonged infertility.

FIBROID AND ABDOMINAL SWELLING
Pregnancy is a major reason for abdominal enlargement noticed in women of reproductive age. However, fibroid can swell up the abdomen of women and make people congratulate them for a non-existent pregnancy. This can be quite agonizing for a woman desperate to have her own baby. Some women sincerely believe they are pregnant when only fibroids filled their wombs. It can be quite distressing for them and their caregivers to know there are no gestational sacs in the wombs of these women. An ultrasound scan can settle this matter Sometimes an ultrasound scan can show a missed miscarriage or retained products of conception surrounded by fibroids. It can be quite challenging evacuating such products of conception. Such an effort can be greeted by excessive blood loss due to a coagulation defect. When fibroids are allowed to grow big, a woman who looks emaciated is seen with a protuberant abdomen. Such a woman becomes a concern not only to herself and family but also any community she belongs People allowed fibroids to overgrow because they are afraid they will die if they attempt to remove it. Some are afraid they will become infertile if they try to remove the fibroid. Women with big fibroids may need to make new clothes because they are no longer comfortable in their former dresses. The sizes of the abdomen of women who are pregnant with fibroids are usually far greater than the gestational ages of the pregnancies suggest The fundal height of the uterus is greater than the size expected for a baby of that particular age. This can cause confusion for the non-initiates in obstetrics A protruding abdomen without pregnancy may be the concern that brings such women to the hospital However, some women went for scan on account of infertility or pelvic pain and now discover they have fibroids. Abdominal swelling is an important symptom of fibroids. Women harbouring fibroids for a longtime can be due to a false prophecy. They accepted a prophecy that they will die or become permanently infertile if they do fibroid operation Some of them resort to taking herbal concoctions or nutritional supplements that avail nothing. This leads to delay of action and increasing abdominal girth. — Preceding unsigned comment added by Michealucheobasi (talk • contribs) 13:02, 14 October 2020 (UTC)

PREGNANT WOMEN WITH FIBROIDS, HUSBANDS, MENTORS AND FRIENDS
PREGNANT WOMEN WITH FIBROIDS, HUSBANDS, MENTORS AND FRIENDS Abdominal pains that come and go can be the first signal of fibroid co-existing with pregnancy in a young woman. It is due to degeneration of the interior of the fibroid with a relatively poor blood supply. As a fibroid grows, it can outgrow its blood supply especially in its interior. The dying fibroid tissue produces pain. The pain can be excruciating in some people requiring hospitalization, infusions, analgesia and antibiotics for there to be relief. Occasionally. There is no relief requiring myomectomy even in pregnancy. Read our account of a case like that in our recommended book of the week FIBROID CO-EXISTING WITH PREGNANCY Part of premarital checkup should be a pelvic scan for all prospective wives. Fibroids should be removed prior to pregnancy to prevent pregnancy-related challenges due to fibroids. Prospective husbands and fathers should insist that a diagnosis of fibroids is ruled out. They can support their would-be wives to get the fibroids removed. This will spare them the challenges of fibroids co-existing with pregnancy. KNOW YOUR EXPECTED DATE OF DELIVERY The abdomen of a pregnant women with fibroids can appear bigger than what the age and size of the baby suggests. Ultrasound reports especially early scans can help care givers avoid overrating the size and age of the baby. The early scan can help date the pregnancy. If the woman is sure of the date of her last menstrual period it can also assist care givers calculate the actual age of the pregnancy. Women in their reproductive years can keep a diary where their menstrual dates are clearly written, each month to assist midwives and doctors calculate their expected dates of delivery or gestational ages of their babies when they conceive. They can also mark the dates on a calendar or link it with important events so as to be sure of it. Babies have been delivered prematurely because of wrong dates. PREMATURE BABIES Babies born prematurely can die from challenges of low sugar level, infection or lack of control of body temperature. They need specialist paediatric care which can be expensive. Every effort should be made to ensure babies are matured before delivery. Palpating the abdomen of a woman with fibroid who is pregnant can present some difficulties. Some hard or firm masses co-exist with fetal parts. Sometimes it is difficult to palpate the baby or the baby’s head can be mistake for a huge fibroid. Sometimes a huge fibroid is mistaken for the baby’s head. A good ultrasound scan can come to the rescue. FETAL DEVELOPMENTAL ANOMALIES Fetal development anomalies are common in babies whose mothers harbour fibroids in the womb. They can have flat face-one-sided or both sided. They can have short lower limbs. Some have club feet (talipes equinovarus). All these are due to the restrictive uterine space where these babies were growing. It is good to remove fibroids before conception to minimize the challenges associated with pregnancy which are heightened by fibroids. PREGNANT WOMEN WITH FIBROIDS All pregnant women with fibroids should go for skilled childbirth care by the most senior members of the delivery team. Such pregnancies are high-risk pregnancies. Women with fibroids should not be handled by unskilled childbirth attendants. They need specialized care. Their haemoglobin levels must be high because the women with fibroids generally bleed more than others. They bleed more than others during caesarean section. They also bleed more than others following vaginal birth. CAESAREAN SECTION WITH FIBROIDS IN-SITU Delivery of the baby during caesarean section with fibroids in-situ is more difficult than if fibroids are absent. The baby may develop birth asphyxia (reduced oxygen level in the blood and brain). There can also be prolongation of labour in women with fibroids who deliver vaginally. Some of their babies can also have birth asphyxia or die. There can be damage to the baby’s brain when birth asphyxia is not well managed. The baby can fail to thrive (fail to grow) or become mentally retarded. This can pose a serious challenge to families and society who have to support children that can never have an independent existence. Removing fibroids before pregnancy by specialist surgeons who care for women will obviate these difficulties.

WOMEN WITH RECURRENT PREGNANCY LOSSES DUE TO FIBROIDS Submucous fibroids occurring beneath the inner lining of the womb and large intramural (inside womb muscle) fibroids can lead to recurrent miscarriages. These are frustrating events for any couple expecting a baby and getting none, despite several pregnancies. This is reproductive failure. The inner lining of the womb over a submucous fibroid is usually thin with poor blood supply. Poor growth and development of an embryo implanted into such a decidua (inner lining of the pregnant womb) are difficult or impossible. MISCARRIAGE IN DUE TO FIBROIDS The miscarriage can occur early if the space available to the baby to implant is small. It can also occur later in the course of pregnancy. Some babies are known to grow into the fourth month of gestation before death and miscarriage. FIBROIDS AND THE PLACENTA Fibroids can hamper the proper development of the placenta which is the source of oxygen and nutrients to the baby. Recurrent incidence of Blighted ovum which is failure of a blastocyst (very early pregnancy) from further development can be due to fibroids in the uterine cavity. Rapid growth or degeneration of fibroids during pregnancy causes uterine irritability which can force the baby out. There can be difficulty in the enlargement of the uterine cavity due to the presence of fibroids. This can force enlarging fetus out. The growth of a baby implanted in a good part of the uterus can be hampered by fibroid subjacent to it increasing the chances of death and miscarriage of the pregnancy. BLEEDING ASSOCIATED WITH PREGNANCY Bleeding associated with pregnancy loss can be excessive especially in the face of multiple fibroids. The womb finds it difficult to contract and retract to close up open bleeding vessels. The response of the uterus to uterine stimulants such as oxytocin or misoprostol (Cytotec) is poor. Uterus harbouring fibroids is less supple than normal uterus. Submucous fibroids make the uterine cavity irregular making complete evacuation of retained products of conception challenging.

WOMEN WITH FIBROIDS WHO HAVE RECURRENT MISCARRIAGES Retained products of conception due to difficulty in completely evacuating a uterus riddled with fibroids can be a source of misery. It can lead to secondary bleeding after the initial bleeding. It can be a reason for infection of the endometrial cavity (endometritis). This can lead to Asherman’s syndrome (uterine synechia). In this syndrome the endometrial (uterine) cavity can be closed up by fibrous tissue that followed healing of the infected endometrium (inner lining of the uterus). This is a common reason for secondary infertility. The woman can have several miscarriages. She can also have amenorrhoea (absence of menstrual flow for six months or more) and secondary infertility.

WOMEN WITH FIBROIDS WHO HAVE MENORRHAGIA Menorrhagia – heavy menstrual flow is a major reason for women with fibroids to present to the doctor. The menses can be heavy and prolonged. Sometimes it is not heavy but prolonged. Occasionally there may not be any dry moments without vaginal bleeding. It is so serious in some women that they will need blood transfusion to survive to the next menstrual cycle. Some women with menorrhagia have normal regular menstrual cycles, although the periods are heavy accompanied by blood clots. They use more sanitary pads than usual. Fibroids causing menorrhagia are major reasons for iron deficiency anaemia in young black women. It can make women unable to attend to their chores or duties. It is also a reason for infertility as most men usually avoid women who are menstruating. There is poor coital exposure. PEDUNCULATED SUBMUCOUS FIBROIDS Pedunculated submucous fibroids trying to extrude from the cervical os (mouth of the womb) can lead to frustrating prolonged menstrual flow or inter menstrual bleeding. They can easily be missed by a surgeon except he inspects the cervix before surgery. Some of them can be removed though the vagina without necessarily doing an abdominal procedure.

Fibroids that are located under the inner lining of the uterus (submucous myomas) are the usual culprits in causing menorrhagia. The endometrial cavity should be opened during myomectomy for inspection and possible removal of fibroids responsible for menorrhagia. No surgeon should finish carrying out myomectomy without removing the fibroids responsible for the excessive bleeding. He must satisfy himself that menorrhagia will not occur again after the operation. WOMEN WITH ADENOMYOSIS Debulking of the uterus invaded by adenomyotic tissues and removal of redundant endometrial tissue can stop menorrhagia in women with adenomyosis. In adenomyosis, the endometrial tissue that shed every month as menses, invades the uterine muscle converting it to a non- supple, plastic-like tissue that bleeds easily. Such debulking procedures are done by surgeons who have the experience to do so. Sometimes some submucous myonas co-exist with adenonyotic tissues. Such fibroids should be removed and some adenomyotic tissues also removed.

FIBROID WITH A HAEMORRHAGIC SPOT It has been noticed that heavy menstrual flow can be due to loss of blood from one bleeding point on a fibroid in the endometrial space. It is usually a pedunculated submucous fibroid with an area of conspicuous redness (usually at its tip. It is the haemorrhagic spot. Such fibroid may not be big, but can cause tremendous loss of blood. The endometrial plate must be opened and such haemorrhaging fibroids removed, if one is to expect a satisfactory outcome of the surgery.                                                                                           UTERINE RUPTURE Uterine rupture can be said to have occurred when there is a total disruption of uterine wall with or without the extrusion of the baby or the placenta. It is usually accompanied by bleeding into the peritoneal (abdominal) cavity. The extent of blood loss depends on the part of the uterus and the vessels that were disrupted. It is a monumental disaster that can kill the baby or the mother due to ignorance of the grave danger unskilled childbirth practice pose. Cessation of uterine contractions can be the first signal of uterine rupture. A woman shouting from time to time from the pains of strong uterine contractions suddenly feels relief from such contractions. However, such relief is temporary as she is greeted by constant abdominal pain. She can also feel like fainting. Some women notice vaginal bleeding following uterine rupture. Many may not see any blood in their private parts because a deeply impacted fetal presenting part has effectively walled off the blood in the peritoneal cavity from egress to the vagina. The doctor can notice that it is easy to palpate fetal parts in a woman whose uterus has ruptured especially when the baby was forcefully extruded from the uterine cavity. The womb can be found contracted down in the abdominal cavity. In such cases the peritoneal covering of the womb (the serosa), the muscle layer, the decidua (inner layer) and the fetal membranes (amnion and chorion) are all disrupted. Blood can be found in the urine following uterine rupture. This is evidence of the disruption (rupture) of the urinary bladder. However, in obstructed labour, blood can also be found in the urine without uterine rupture because of compression of the bladder by an impacted fetal presenting part. There is interruption of blood flow from the bladder. Some blood vessels can break and release blood into the urine. Outflow of urine is also interrupted and bladder can become swollen from retained urine or oedema Epigastric pain accompanied by respiratory embarrassment can occur following uterine rupture. It can be due to extrusion of the baby or placenta into the epigastric area (area over the stomach or gaster). The baby impinges on the diaphragm restricting respiratory movements. Blood, liquor or urine that piled up in the paracolic gutters can also flow to the diaphragm restricting respiratory movements PRAYERS FOR SAFE SURGERY AND SAFE DELIVERY ARE HINDERED BY SIN Sin is lawlessness. Prayers are hindered by sin. Solution – say “I am sorry” to God and to those you hurt. Sprinkle yourself and all yours the blood of our Lord Jesus Christ for your cleansing. Your access to God will be open. Sin is rebellion against the government of God. God, the creator of heaven and earth has a righteous government that oversees the affairs of the universe. Sin must be punished, except the sinner repents. Even if sin is done secretly, punishment is sure. Sin opens the doors to complications of pregnancy and childbirth. Sin may not necessarily be rebellion to the Nigerian government or any other government for that matter. For example, the evil that one speaks against the government in secret may not receive punishment from the government. Evil speaking against righteous people and institutions draws blood and can open the door of excessive blood loss following delivery Sin is an act fueled by evil spirits. Speaking what we know or what we don’t know that brings down others is evil speaking. It is like stabbing the person and spilling blood. It can be a reason for placenta praevia. This can make a woman bleed to death. Speaking against drugs can bring about adverse reactions when such drugs are taken. Say “I am sorry” to drugs which are God’s mercy to save lives. Sprinkle yourself and the drugs you want to take the blood of our Lord Jesus Christ to sanctify yourself and the drugs for your safety. When you speak evil against anything you cut yourself off the grace that thing carries. Speaking against an injection can make a woman not to benefit from the work of the injection. Don’t speak against caesarean section. Surgeons should redeem all women going for caesarean section from complications that can take lives. Complications can arise because of evil such women spoke against this life – saving procedure.

PASTORS, SPIRITUAL OVERSEERS, PROPHETS, IMAMS, CLERICS WHO PRAY FOR WOMEN WITH FIBROIDS Fibroid is a tumor (swelling) of the womb. It is not cancer. However, symptomatic fibroid can be a reason for excessive bleeding and death. It can impinge on the ureters and prevent urine from reaching the bladder, causing renal failure and death. Fibroid can cause constipation or urinary obstruction. Women who are pregnant with fibroids can die from excessive bleeding. Fibroid is a very challenging condition. Handling of fibroid is war. To win the war against fibroids many battles are to be fought on several fronts. Some people think fibroid is a purely spiritual problem that should be handled by men or women of God. Men and women of God and husbands and mentors of women with fibroids need a working knowledge of fibroid and the spiritual challenges associated with it. Book of the week: “Winning the battles against fibroids”. The women with fibroids are bombarded with information about fibroids from everywhere. The words of men and women of God and mentors are respected by people including women with fibroids. A lot of women are suffering from the complications of fibroids who have been enslaved by the fear of surgery due to misinformation about fibroids. Priests and those who pray for women with fibroids should know that there are physical and spiritual aspects to the challenge of fibroids. The women with fibroid can need medical or surgical attention apart from prayers. There is need for a holistic approach to the challenge of fibroids. Intercessors have a responsibility to unearth the iniquity behind the challenge called fibroids and the complications that accompany them, otherwise the problem can never be destroyed from its roots. Lamentations 2 v 14 Your prophets have seen for you false and deceptive visions. THEY HAVE NOT UNCOVERED YOUR INIQUITY. To bring BACK YOUR CAPTIVIES. But have envisioned for you false prophecies and delusions.

Any prophecy that removes the responsibility of addressing the iniquity that opened the doors of affliction to fibroids to other people beside the patient is a false prophecy. Books: Winning the battles against fibroids. Hidden Reasons for maternal mortality. For demonic forces that cause fibroids or its complications to reach a woman, she must have opened the door to them through sin. One sin that does that well is the sin of voluntary abortion. It is shedding of innocent blood. It defiles a woman, family and land. Defilement opens the door of afflictions like fibroids, so that the woman’s blood can also be shed Hosea 6 v 8 Gilead is a city of evil doers. And defiled with blood.

The womb like Gilead mentioned in the scripture is defiled when pregnancies are forcefully removed thereby shedding innocent blood. The devil has access to a defiled womb. The devil sows his evil seed such as fibroids in a defiled womb. Every intercessor must address this issue of defilement through quality repentance and the sprinkling of the blood of our Lord Jesus Christ Blaming witches, wizards, occultic people or evil forces for the complications of fibroids such as prolonged pregnancy, transverse lie of the baby, excessive menstrual flow or recurrent pregnancy losses will not solve the problem. Before the forces of destruction can gain access to the woman, the hedge has been broken through sin. Such sin must be discovered and repented off before we can successively expel demonic forces causing challenges who were released from Satanic altars and works. The axe must be laid to the root of every evil tree through the ministry of the Holy Spirit as He reveals the root of the challenge of fibroids and its complications. Matt 3 v 10 “And even now the axe is laid to the root of the tree. Therefore every tree which does not bear good fruits is cut down and thrown into the fire. Expending scarce spiritual energy dealing with witches, wizards, occultic people and other sons and daughters of the devil and their works can be an effort in futility if we don’t address the sin that gave them access to the lives of women with fibroids. It is spiritual ignorance for any intercessory ministry to engage itself in cutting down the branches of an evil tree instead of destroying the tree from its roots. Hosea 4 v 6 My people are destroyed for lack of knowledge. Because you have rejected knowledge, I also will reject you from being priest for me.

Many prayers of priests or intercessors are not answered because we are going about it ignorantly- the wrong way. We must know the way God operates if we are to successfully engage Him to help women with fibroids out. Hosea 4 v 1 Hear the word of the Lord, You children of Israel for the Lord brings a charge against the inhabitants of the land. “There is no truth or mercy or KNOWLEDGE of God in the land”.

Hosea 12 v 6 So you, by the help of your God, RETURN; observe mercy and justice. And wait on your Lord continually.

We intercessors must help women with fibroids, their spouses, husbands, and relations to repent of their sins and help them to become cleansed by the blood of our lord Jesus Christ. They must be sanctified by the anointing and helped to receive their liberty from God through surgery or medical treatment or prayers.