With later marriages come later pregnancies. It is not uncommon to see women having their first child in their mid to late thirties today. I had a patient come for a checkup wanting to start her family and an ultrasound scan of her pelvis showed a fairly large fibroid. The previous gynaecologist had told her that it was alright to get pregnant with the fibroid in her uterus so she thought nothing of it. She did not have any symptoms. Fibroids in pregnancy are more and more common nowadays. Whether it affects the pregnancy will depend alot on the position of the fibroid. If it is near the cavity, it may cause a miscarriage, cause the baby to lie in the wrong position or block the passage of the baby at birth. The pregnany is therefore more risky for the baby and mother. The fibroid may grow rapidly due to the sudden surge of pregnancy hormones and this may cause severe pain due to 'degeneration' in the fibroid. The pain would be multiplied if there are several fibroids. Caesarean sections would be more dangerous too because of excessive bleeding or having to cut near the fibroid to get the baby out. The choice for the patient was therefore whether to take out the fibroid first and then try to get pregnant or to get pregnant knowing all the possible problems that it brings. An operation to remove the fibroid meant a wait of a year after before she was able to try for a pregnancy. As she was already in her late thirties, she opted to get pregnant with the fibroid in the uterus.
Monday, 9 April 2012
Everyone above 40 would probably have had at least one one mammogram. And everyone without fail will say that it is painful! Nevetheless it has to be done as only about 8% breast cancers are detectable by manual palpation. The diagnostic accuracy can be improved significantly by adding on an ultrasound scan of the breast. This also helps with picking up breast cysts which would be missed by conventional mammogram alone. In Singapore, polyclinics often will just offer a mammogram. This in my view is inadequate as it will miss a number of breast cancers. Besides, the cost of adding on an ultrasound scan is not much. In those with dense breasts, those who are averse to the pain of mammogram, and those who don't mind the extra cost, an MRI of the breast is an excellent alternative and in fact increases the diagnostic accuracy even more. In time to come perhaps all women will be opting for MRI of their breasts instead of a mammogram.