#Grand Rounds

High-Intensity Ultrasound for Fibroids – What are the Pregnancy Outcomes?

BACKGROUND AND PURPOSE:

Ultrasound guided high-intensity focused ultrasound (HIFU) is an effective, non-invasive treatment for fibroids, but fertility and pregnancy effects are not well characterized
Zou et al. (BJOG, 2017) evaluated the effect of high-intensity focused ultrasound (HIFU) ablation for uterine fibroids on pregnancy

Retrospective Observational study (2011-2016)
Cohort: Patients with uterine fibroids who wished to become pregnant and subsequently underwent a HIFU procedure

Data from 78 women were evaluated
Total pregnancy rate was 19.2% (78/406) and average time to pregnancy was 5.6 months
- Out of 80 pregnancies, 4 were IVF
Of 78 patients who became pregnant
- 9 had complicated primary or secondary infertility before the HIFU treatment
- 13 had at least two miscarriages
After the HIFU treatment, the average time to pregnancy was 5.6 ± 2.7 months
There were 15 vaginal deliveries and 56 cesarean sections
- Majority of cesarean sections were for social reasons
- No evidence that HIFU affects mode of delivery
68 pregnancies were term and 3 cases were preterm (uncertain fetal status, PROM and decreased AFV), with an average gestational age of 38.1 weeks.
There were 3 miscarriages (1 with low progesterone and 2 unexplained)
There were no cases of fetal anomalies or perinatal/postpartum complications
There were no cases of abnormal placentation or uterine rupture

The researchers did not find increase pregnancy complications with HIFU
HIFU may be an approach to treat fibroids in women who are still interested in pregnancy, including those who have a history of infertility

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