Leiomyoma uteri in Ethiopian women: a clinical study

A retrospective review of 588 patients with myoma surgically managed at Tikur Anbessa teaching hospital, Addis Ababa, Ethiopia, from February 1992-October 2000 is presented. The objectives of the study were to describe the sociodemographic profile, clinical parameters, indications for operation and outcome of management of myoma cases surgically managed at the hospital. Data was collected on sociodemographic, obstetric, gynecological and other relevant clinical variables from the patient's records. Mean age of patients was 35.8 (SD 7.5) years with a median parity of 1. Median uterine size was of 16 weeks pregnant uterus. Number of myomas removed at myomectomy ranged from 1-50 (Median 2). 98% of myomas were fundal and 2% cervical. 40 (6.8%) of the myomas were "delivered" myomas. The median duration of the presenting complaints reported by the patients was 1 year. Abnormal bleeding was the major presenting complaint (69.2%). In 101 (17.2%) of the patients other pelvic pathologies were identified, the majority being ovarian tumours. Three hundred sixteen (53.7%) of the patients had an additional medical condition encountered mainly anemia and hypertension. Intraoperative and postoperative complications were much higher following hysterectomy than myomectomy, but duration of operation, intraoperative blood loss and uterine size were not much different in the two operations. Reasons for the delay in presentation should be addressed by studies so that interventions leading to early presentation of patients can be sought. It is proposed that in all situations where it is feasible to do so, myomectomy should be performed in preference to hysterectomy irrespective of the need for future fertility.