Fibroid Embolization and Pregnancy

1
Fibroid Embolization and Pregnancy

• Simon McDowell
• Wellington Womens Hospital

2
Background

• Uterine Artery Embolization (UAE)
• Fertility and Infertility

3
Royal Surrey County Hospital

• Prospective observational study
• Established December 1996
• 1200 UAE performed
• Single interventional radiologist

4
Aim

• To evaluate the incidence, outcomes and
  complication rates of pregnancies following UAE

5
Methods

• Informed consent
• Questionnaires, telephonic follow-up and hospital
  records

6
Results

• 56 completed pregnancies
• 4 ongoing pregnancies

7
Successful outcomes

• 33 (58.9) live births
• In 27 women

8
Other

• 17 (30.4) Miscarriages
• 3 (5.4) Terminations
• 2 (3.6) Stillbirths
• 1 (1.8) Ectopic

9
Results - Miscarriages

• 13/17 - first trimester
• 1/17 - 19 weeks gestation
• 3/17 - not obtained

10
Results - Stillbirths

• 33/40 True knot in cord
• 37/40 Ruptured uterus antepartum

11
Results Complications

• Placenta praevia 1 (3.0)
• Proteinuric hypertension 2 (6.1)
• PROM 3 (9.1)
• IUGR 1 (3.0)
• Preterm delivery 6 (18.2)
• Postpartum hge 6 (18.2)

12
Results Live births

• 9/33 (27.3) Vaginal deliveries
• 24/33 (72.7) Caesarean
• Indication 9/13 term elective caesareans was
  fibroids

13
Discussion

• Atypical population
• Mean age 37.44 yrs
• Fibroids
• First conceptions (58)

14
Literature review

• 2004 - UAE vs Laparoscopic Myomectomy
• 2005 Ontario Multicentre Trial

15
Conclusion

• Higher rates
• Miscarriage
• Preterm delivery
• Postpartum haemorrhage
• Caesarean section
• Possibly partly explained by the demographics of
  the study population