Pregnancy after uterine artery embolization

doi:10.1016/S0029-7844(02)02347-5

Obstetrics & Gynecology

Volume 100, Issue 5, Part 1, November 2002, Pages 869-872

https://doi.org/10.1016/S0029-7844(02)02347-5 Get rights and content

Abstract

BACKGROUND:

Uterine artery embolization is an increasingly popular alternative to hysterectomy and myomectomy as a treatment for uterine leiomyoma. Whether this procedure is safe for women desiring future fertility is controversial.

CASES:

A primigravida who had previously undergone uterine artery embolization had premature rupture of membranes at 24 weeks. She had a cesarean delivery at 28 weeks, which was followed by uterine atony requiring hysterectomy. A primigravida who had previously undergone uterine artery embolization delivered appropriately grown dichorionic twins at 36 weeks. An analysis of the 50 published cases of pregnancy after uterine artery embolization revealed the following complications: malpresentation (17%), small for gestational age (7%), premature delivery (28%), cesarean delivery (58%), and postpartum hemorrhage (13%).

CONCLUSION:

Women who become pregnant after uterine artery embolization are at risk for malpresentation, preterm birth, cesarean delivery, and postpartum hemorrhage.

Section snippets

Case 1

A 33-year-old primigravida at 24 weeks’ gestation experienced premature rupture of membranes. Her antenatal course was complicated by uterine leiomyomata. She had undergone an abdominal myomectomy 6 years prior because of pain and menometrorrhagia. With continued symptoms and additional leiomyomata documented on ultrasound, a uterine artery embolization was performed the following year, 5 years before the described pregnancy. Her symptoms resolved after the embolization.

At the time of the

Case 2

A 42-year-old primigravida with dichorionic twins presented at 26 weeks with preterm labor and cervical dilation of 2 cm. Her antenatal course was complicated by uterine leiomyomata and infertility. Three years before conception she had undergone uterine artery embolization for symptoms of pain and menometrorrhagia. Later that same year she underwent a myomectomy secondary to persistent symptomatic leiomyomata.

The patient then underwent in vitro fertilization, which resulted in the dichorionic

Comment

Uterine artery embolization has been shown to be an effective treatment for symptomatic uterine leiomyomata, although no long-term studies have been published. Spies2 reported improvement in heavy bleeding in 90% (95% confidence interval [CI] 86%, 95%) and bulk symptoms in 91% (95% CI 86%, 95%) at 1 year. Outcomes data regarding women who desire future fertility are less clear and very limited.

In our case 1, because of contributing factors, such as chorioamnionitis, prior myomectomy, and

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Cited by (164)

Long-term outcome and pre-interventional predictors for late intervention after uterine fibroid embolization
2020, European Journal of Obstetrics and Gynecology and Reproductive Biology
To assess the long-term freedom of surgical conversion after uterine fibroid embolization (UFE) and to define predictors for better clinical outcome. Additionally, the potential of pregnancy after UFE is assessed.
Study design: Single-center retrospective cohort study including 190 patients who underwent UFE between 2001 and 2016. Data were obtained by postal questionnaire including symptom severity, late reintervention rate and post procedural fertility. Patient characteristics were extracted from the patients' electronic medical records. The cumulative rate of freedom from treatment failure was determined by Kaplan-Meier analysis. Cox regression models were used for univariate analyses of the association between patient preinterventional characteristics and late surgical conversion. Secondary outcome measures were patient specific predictors of treatment failure and evaluation of post-procedural fertility.
Long-term follow-up was available for a median of 6.1 years (range 1.2–15.2 y) in 95 out of 190 patients (50 %). Freedom from treatment failure showed a cumulative rate of 72.9 % after 10 years and stable until end of follow-up. A 63.8 % reduction in symptoms and a 23.3% increase in quality of life was found. Significant increase of treatment failure was found in patients with increasing pre-interventional uterine volume (p = 0.0003) or dominant fibroid volume (p = 0.0042); 9 out of 23 patients (39.13 %) with child-bearing wish became pregnant and conceived one or more children after UFE.
UFE is associated with sustained long-term symptom control. Larger size uterus or dominant fibroma are correlated with higher late surgical conversion rate. Last, women can become pregnant and deliver after UFE.
Fertility, Pregnancy, and Clinical Outcomes after Uterine Arteriovenous Malformation Management
2019, Journal of Minimally Invasive Gynecology
To evaluate fertility, pregnancy, and clinical outcomes after uterine arteriovenous malformation (UAVM) management.
Single-center retrospective study (Canadian Task Force classification III).
One referral center.
Twenty-two patients with a UAVM diagnosed by magnetic resonance angiography or computed tomography angiography and managed by expectant management (EM) or uterine arterial embolization (UAE) during the study period were included.
Nine of 22 patients underwent first-intention EM and 13 first-line UAE. Three of 9 EM patients (33.3%) required emergency second-intention UAE for nonresolution of the UAVM and severe genital bleeding.
To analyze fertility according to management approach, we defined 2 groups: EM only group (n = 6) and UAE group (n = 16; women who underwent first- or second-intention UAE). Overall, the median age was 29 years (range, 17–43). The mean follow-up after UAVM management was 39 months (range, 1–116). The success rate of the UAE procedure was 87.5% (14/16). Eight of 12 women (66.7%) who wished to conceive became pregnant: 2 of 5 (33.3%) in the EM group and 6 of 7 (85.7%) in the UAE group (p = 1). Overall, 11 patients (50%) conceived: 3 in the EM group (50%) and 8 in the UAE group (50%) (p = .9). The live birth rate was 36.4% (8/22) for the whole population. There were no miscarriages or ectopic pregnancies. The 8 women (72.7%) wishing to conceive who became pregnant all delivered: 1 by cesarean section and 7 by vaginal delivery. Median duration of pregnancy was 39 weeks and 5 days. The remaining 3 women (i.e., women who conceived but did not wish to become pregnant) had therapeutic abortions. One complication was experienced in the EM group (small for gestational age newborn) and none in the UAE group (p = .3). Limitations include retrospective design and small sample size.
UAE for UAVM is an effective and safe technique. It does not impair fertility, and obstetric prognosis is good.
Acquired uterine arteriovenous malformation in caesarean scar after a previous ectopic pregnancy: A case report
2018, European Journal of Obstetrics and Gynecology and Reproductive Biology
Extensive uterine arteriovenous malformation with hemodynamic instability: Embolization for whole myometrium affection
2018, European Journal of Obstetrics and Gynecology and Reproductive Biology
Uterine arteriovenous malformation is abnormal and nonfunctional connections between the uterine arteries and veins. Patients typically present with vaginal bleeding which may be life-threatening. Treatment depends on the symptoms, age, desire for future fertility, localization and size of the lesion. Embolization of the uterine artery is the first choice in symptomatic AVM in patients in the reproductive age. We report a case of acquired AVM with an extensive lesion on ultrasound and MRI, which was successfully treated with uterine artery embolization for severe bleeding (UAE).
Uterine artery embolization: A review of current concepts
2018, Best Practice and Research: Clinical Obstetrics and Gynaecology
Uterine artery embolization (UAE) has gained traction as a safe and effective treatment modality for symptomatic uterine leiomyomata since its introduction nearly two decades ago. This review includes an overview of current concepts with regard to patient selection, technique, and outcomes following UAE. Specific topics also include the impact of this procedure on fertility and pregnancy, the emerging role of UAE in the treatment of adenomyosis, and how UAE compares with surgical intervention for the treatment of symptomatic leiomyomata.
Nonsurgical Alternatives for Uterine Fibroids
2016, Best Practice and Research: Clinical Obstetrics and Gynaecology
Uterine leiomyomata are the direct cause of a significant health-care burden for women, their families, and society as a whole.
Because of the long experience with the mode of treatment, surgical myomectomy remains the gold standard for treating reproductive-age women; however, in the recent years, the wide evolution of less invasive approaches led to a change in the options used by the clinician to treat symptomatic fibroids.
Minimally invasive procedures such as uterine artery embolization (UAE) are increasingly used to treat symptomatic fibroids. Other alternative treatments are becoming more diffuse, such as magnetic resonance–guided high-frequency focused ultrasound surgery (MRgFUS), cryomyolysis, vaginal occlusion, and laparoscopic closure of the uterine arteries. Both advantages and limitations of these techniques under development must be taken into account, but this wider range of choices is being increasingly considered for a tailored treatment.
This article aims to enable health-care providers with the tools to provide the latest evidence-based care in the minimally invasive or noninvasive management of this common problem.

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Case reportPregnancy after uterine artery embolization

Abstract

Section snippets

Case 1

Case 2

Comment

Lancet

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Fertil Steril

Fertil Steril

Int J Gynaecol Obstet

Conservative treatment of uterine arteriovenous fistula

Acta Obstet Gynecol Scand

Successful pregnancy after selective embolization of a post-molar vascular malformation

Br J Obstet Gynaecol

Case report
Pregnancy after uterine artery embolization