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Grand Rounds

Uterine Artery Embolization and Pregnancy: What Are the Outcomes?

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BACKGROUND AND PURPOSE:

  • Serres-Cousine et al. (AJOG, 2021) characterized the clinical, anatomic, and obstetrical results of uterine artery embolization (UAE) in patients of childbearing age not eligible for myomectomy

METHODS:

  • Retrospective cohort study
  • Participants
    • Women <43 who were treated for symptomatic fibroids and/or adenomyosis between 2003 and 2017
  • Exposure
    • Uterine artery embolization (UAE) using fertility-sparing uterine artery embolization technique | Right femoral artery puncture, allowing for successive superselective catheterization of the uterine arteries
    • Ovarian protection in the event of dangerous utero-ovarian anastomosis using a microcoil to protect the ovary or larger particles
  • Study design
    • UAE indications: Occurrence of a single fibroid measuring >5 cm and/or several fibroids and/or adenomyosis
    • MRI and pelvic ultrasounds were performed before and after uterine artery embolization
    • Predictors of clinical and obstetric success were determined by logistic regression
  • Primary outcome
    • Overall clinical success rate with resolution of preembolization symptoms
      • Heavy menstrual bleeding | Iron-deficiency anemia | Pelvic pressure

RESULTS:

  • 398 patients
    • Presented with dangerous utero-ovarian anastomosis: 49.3%
  • Overall clinical success rate: 91.2%
  • Reduction in myoma volume one year after UAE
    • Mean 73% reduction
  • Pregnancy and birth outcomes
    • 158 women desired a pregnancy
      • 65% started at least 1 pregnancy
    • Overall pregnancies: 148
      • 109 Live Births | 23 Preterm
    • Mean gestational age at delivery: 35.12±2.78 weeks
    • Mean birthweight and birth length were within normal limits
  • Mode of delivery
    • Rate of cesarean delivery: 46.8% vs 21% in the normal population
  • Main predictive factors for obstetrical success
    • Restoration of uterine anatomy with no intracavity distortion (also a major predictive factor for clinical success and was associated with a lower rate of miscarriage)

CONCLUSION:

  • The clinical success rate of UAE for this population was 91.2%
  • 74% of pregnancies resulted in a live birth
    • 68% of births occurred at term
    • High cesarean rate may be due to obstetricians treating UAE similar to myomectomy scar
  • Obstetrical success was mainly predicted by restoration of uterine anatomy and ovarian protection
  • The authors state

This study adds to the growing body of literature investigating the effects of UAE on fertility

Further research—notably prospective cohorts and controlled randomized trials — is needed to refine the indications of UAE as a possible therapeutic option based on anatomic and clinical parameters

Learn More – Primary Sources:

Clinical investigation of fertility after uterine artery embolization

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Related ObG Topics:

Uterine Artery Embolization or MRI-guided Focused Ultrasound for Uterine Leiomyoma Treatment?
FEMME RCT Results: Myomectomy or Uterine Artery Embolization for Uterine Fibroids?
What Uterine-Sparing Treatment for Fibroids Has the Best Outcomes?

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