"We can rebuild her. We have the technology.
We have the capability to make the world's first Bionic uterus.
This uterus will be that womb. Better than she was before.
Better . . . stronger . . . more fertile."

Fibroid leaving on a metal tray (sung to the tune of Leaving on an Airplane)

So my bag is packed, I'm ready to go
I'm sitting here, making another post
Already I'm looking forward to the change
So cut me and dissect me
Tell me that how much better I'll be
Help me get back on the fertility road

My fibroid is leaving on a metal tray
Don't expect to see it ever again
Oh 'Roid its time to go.

So, anyway... Friday is my big day, I've got gum and granny knickers, a maternity belt, arnice pellets, purple socks of courage etc., etc. -- all courtesy of the generous sharing of info by the fibroid ladies on the NUFF group. I'm feeling pretty relaxed and this will all be over and I'll be on my way to recovery within the next 24 hours.

I don't need to take phosphosoda or any laxative so that is good. And my doc thinks the d&C and myo should only take 2 hours. My RE will be assisted by another RE, a fellow, so I'm in good hands. I check in at the hospital at 1:30 tomorrow and the surgery is scheduled for 3:30.

Please send good thoughts and prayers if you can tomorrow.

Definitions of (girlie) bleeding

In the time I've hung out online with women trying to get pregnant I've had the chance to learn more of the nuances of spotting. I've heard women say that if there is any blood contained in your cervical fluid they they considered it spotting. At the end of your period though it it more residual flow, I have that too. This type of spotting tend to be brownish.

[added in this article link 2/4/06]
Menstrual Mysteries -- more info about determining problems with your menses based on quantity.

Spotting is bleeding outside of your period. I've had spotting this month and it just continued as red coloration to my cervical fluid, this is dysfunctional uterine bleeding related to my miscarriage.

Spotting also is the first sign of an impending period for many women. I'm pretty sure that this is light pinkish, with maybe a little brown as the blood oxidizes.

Heavy menstrual flow is when you need to use more than one pad an hour, though I consider this really heavy, medically referred to as Menorrhagia. Because your body is bleeding so much the chemicals that are supposed to keep the flow fluid can't work as well and you do get some coagulation -- the clots, or liver-like lumps. I find that when I have clotting I tend to get really nauseous kinda intense cramping feelings -- I think this might be the clot passing through the cervix -- when I miscarried there was a similarity to the sensation though the miscarriage was more painful in my opinion.

My previous period was unusual, again it seemed to be related to my body trying to get rid of retained tissue from my miscarriage. I had bleeding for 3-4 days that was bright red and had no clots. On toilet tissue it looked like I was dabbing at a wound, it was plain blood and without the mucus component of a normal menstrual flow. I consider this abnormal for me, though women with fibroids contacting the endometrium might experience this as a frequent event.

"Women lose between 20 and 80 cc's (1-2 ounces) of blood during a normal period." (hah! right)
http://www.fwhc.org/health/moon.htm

This page includes diagrams and links to more information about normal/abnormal menstrual bleeding and includes a reference to fibroids (scroll down the page)
MENSTRUAL ABNORMALITIES

I found a lot of mention of the fact that doctors often underestimate women's blood flows and that there is a pictorial chart (see link below) that women used in one study that was a clearer indictator of blood loss. I'm sure many of us have experienced this underestimate by docs -- perhaps if those of us with heavy periods would catch the blood that pours out of us when we go to the toilet and bring it to the doctor's office they might be able to see what we go through.

The Medical Algorithms Project has a copy of the The Pictorial Blood Loss Assessment Chart (PBAC), an excel spreadsheet that helps calculate blood loss
http://www.medal.org/

So if you have the fibroid out, can you deliver the old-fashioned way?

In all that I've read the horizontal vs. vertical incision hasn't been an issue of health for the most part, it is aesthetic (someone please correct me if I'm wrong about this). It would be great if your doc could do a bikini incision, and maybe to do the ovarian surgery laparoscopically but doctors have to make that call. Since you have been experiencing serious bleeding problems it is pretty certain that your fibroid has contact with the endometrium and your incision will go the full thickness of the uterine wall.

Since I've been researching the possibilities of vaginal delivery post myo I thought I would share some of the other information I've collected related to pregnancy post myo....

With incisions into the uterine wall (especially those that go the full thickness) there is a greater risk of uterine rupture during pregnancy it seems, even if you don't go through labor, but it is a very RARE event. I will add the exception in cases of laparoscopic removal of fibroids because they often don't suture the uterus as well through that procedure -- though this is likely dependant on the size, type and position of the fibroids being removed as well as the skill of the surgeon. You should ask your doctor to try to preserve as much of the myometrium (muscular wall of the uterus) outside of the endometrium as possible and also to make sure that they are going to stitch up the uterus wall in more than one layer -- to help retain integrity of the wall and to reduce the risk of adhesions as well.

"The chance of postoperative uterine rupture increases with pregnancy; the rate reported is five percent."
http://www.uterine-fibroid-treatment.com/html/myomectomy.php3
(note this is across all types of myos - lap and abdominal)

Discuss rupture risk with myomectomy patients - Uterine Rupture in
Pregnancy
http://www.findarticles.com/p/articles/mi_m0CYD/is_20_37/ai_93531937

Pregnancy outcome and deliveries following laparoscopic myomectomy
http://humrep.oupjournals.org/cgi/content/abstract/15/4/869

Other risks in pregnancy post myo include placenta acreta and of course growth of new fibroids (boo hiss!):

"Placenta accreta is a disorder in which all or part of the placental villi are in direct contact with the myometrium and are anchored to the muscle fibers rather than to decidual cells. It is attributed to lack of decidua beneath the placenta, which allows placental villi to invade the uterine wall. Risk factors include old cesarean section scars, fibroids, prior myomectomy, and uterine malformations. Clinically, placenta accreta presents as a failure of the placenta to separate spontaneously from the uterus after the birth of the child."
From: http://www.neonatology.org/syllabus/placenta.html (scroll down for reference)

Many women undergoing laparotomy (abdominal myo surgery) will be advised against attempting labor and will be steered towards c-section due to a greater change of uterine rupture at the scar site. Here are some quotes and links you might find informative, related to VBAC (vaginal birth after cesarian, being a close cousin to delivery post myo) and pregnancy delivery post- myo.

"The type of uterine incision made at the previous cesarean section is important in evaluating suitability for a VBAC. The scar visible on the skin does not necessarily predict what type of uterine incision might be found underneath. Where in the uterus the incision was made affects its strength and integrity after healing. The upper part of the uterus is composed of a different type of tissue than the lower uterine segment and cervix. The fundus, together with the upper three-quarters of the uterus, is composed of a thick, muscular tissue that does not heal with a very durable scar, while the lower uterine segment is composed of a fibroelastic tissue that heals quite well and is more flexible and elastic when stretched after healing. Virtually any scar is weaker than the surrounding native tissue (like the old episiotomy scar that springs open during the most gentle birth). Usually the forces of labor will dilate a ripe cervix but labor will open the path of least resistance, which in a few cases will be the previous uterine incision. In addition, any incision that extends into the muscular portion of the uterus is much more vulnerable to disruption in a subsequent pregnancy and labor because of the poorer integrity of scars in the muscle. A low transverse, or low cervical, incision is the preferred uterine incision in any VBAC"
from: A VBAC Primer: Technical Issues for Midwives
http://www.midwiferytoday.com/articles/vbacprimer.asp

"Among the 21 pregnancies which resulted in live births, 8 (38%) were delivered by Caesarean Section (one case because of fetal distress, two cases because of delay in progress of labour, three cases because the uterine incision involved the whole thickness of the uterine wall, and two cases due to patient request), and the remaining 13 (62%) had vaginal delivery. There were no instances of premature labour (<37 weeks), preterm rupture of membranes, placental abruption, intrauterine growth retardation, scar rupture or post-partum haemorrhage."
from: Myomectomy: a retrospective study to examine reproductive performance before and after surgery
T.C. Li1, R. Mortimer and I.D. Cooke
http://humrep.oupjournals.org/cgi/content/full/14/7/1735

Doppler Sonographic Evaluation of the Vascularity of the Myomectomy
Authors: Alfonso Rossetti M.D., Ornella Sizzi M.D., Giuseppe Florio M.D., Giulietta Tancredi M.D., Pierluigi Paparella M.D., Salvatore Mancuso M.D.
http://www.thetrocar.net/view.asp?ID=2
(Talks in more detail about how the uterus heals and why there is a risk of rupture sometimes)

UTERINE RUPTURE AND VBAC
http://hometown.aol.com/melissaem1/myhomepage/baby.html
(VBAC stands for vaginal birth after caesarean)