Pregnancy outcomes following treatment for fibromyomata:

1
Pregnancy outcomes following treatment for
fibromyomata uterine artery embolization versus
laparoscopic myomectomy Jay Goldberg, MD1,
Leonardo Pereira, MD1, Vincenzo Berghella, MD1,
James Diamond, PhD1, Emile Daraï, MD2, Piero
Seinera, MD3, Renato Seracchioli, MD4 Jefferson
Medical College, Philadelphia, PA, USA 1, Tenon
Hospital, Paris, France2, S. Anna Hospital,
Turin, Italy3, S. Orsola Hospital, Bologna,
Italy4
Materials Methods
Table 1. Comparison of characteristics of
pregnant women with prior uterine artery
embolizations (UAE) and laparoscopic myomectomies
(LM).

• The MeSH terms uterine artery embolization,
  embolization, laparoscopic myomectomy,
  myomectomy and pregnancy were used to check
  for all published reports of pregnancies
  following UAE or LM. We identified three of the
  largest series of pregnancies following LM.2,3,4
  We attempted to contact all authors to verify
  data, collect additional information, and add
  recent cases. Only cases in which UAE was
  performed for fibroids were included. A total of
  53 pregnancies following UAE and 139 pregnancies
  following LM were included in this study.
• The rates of six different pregnancy
  complications spontaneous abortion, postpartum
  hemorrhage, preterm delivery (weeks), cesarean delivery, small for gestational
  age, and malpresentation, were determined.
  Outcome data was obtained for 98 of cases.
• SAS statistical software version 8.1 was used for
  data management and descriptive analyses.
  Fishers Exact Test was used for statistical
  analysis. Confidence intervals were set at 0.95.
  Type I error was set at 0.05 (two-sided).
• The rates of pregnancy complications following
  UAE and LM were compared.

Introduction Pregnancies following uterine
artery embolization (UAE), an increasingly
popular alternative to hysterectomy and
myomectomy as a treatment for uterine fibroids,
have been reported to be at higher risk than the
general population. The objective of this study
was to compare pregnancy outcomes in women with
fibromyomata treated by UAE to those treated by
laparoscopic myomectomy (LM). Methods Data
from pregnancies following UAE and LM were
compiled from the largest accessible previously
published series. Rates were calculated for six
pregnancy complications spontaneous abortion,
postpartum hemorrhage, preterm delivery, cesarean
delivery, small for gestational age, and
malpresentation. Fishers Exact Test was used
for statistical analysis. Type I error was set
at 0.05 (two-sided). The rates of pregnancy
complications following UAE and LM were
compared. Results Pregnancies following UAE
had higher rates of preterm delivery (OR 6.2, 95
CI 1.4, 27.7) and malpresentation (OR 4.3, 95 CI
1.0, 20.5) than pregnancies following LM. The
risks of postpartum hemorrhage (OR 6.3, 95 CI
0.6-71.8) and spontaneous abortion (OR 1.7, 95
CI 0.8-3.9) following UAE were similarly higher
than the risks following LM, however, they did
not reach statistical significance. Conclusion
In this study, pregnancies in women with
fibromyomata treated by UAE, compared to those
following LM, were at increased risk for preterm
delivery and malpresentation.
Table 2. Complications in pregnancies following
uterine artery embolization (UAE) and
laparoscopic myomectomy (LM).
 

• Patients receiving UAE had a higher mean age and
  parity and larger fibroid size than those
  undergoing LM (see Table I).
• Pregnancy complication rates following UAE,
  following LM, and in the general population were
  compared (see Table II). Odds ratios refer to
  complication rates following UAE compared to LM.
  The rate of spontaneous abortion was calculated
  by dividing the number of spontaneous abortions
  over total pregnancies excluding 3 ectopics, 4
  therapeutic abortions, and 1 pregnancy in which
  no outcome data was available. This left 51
  cases in the UAE group and 133 in the LM group.
• For the remaining 5 complications, the
  denominator was based on the total number of
  singleton pregnancies, excluding 8 multiple
  gestations, 32 spontaneous abortions, and 5
  ongoing pregnancies. This left 35 cases in the
  UAE group and 104 cases in the LM group. For the
  preterm birth rate, 3 additional cases with
  unknown gestational age at delivery were excluded
  from the UAE group. For the calculation of small
  for gestational age, an additional 22 cases were
  excluded due to lack of birth weight data (13
  from the UAE group and 9 from the LM group).
• Compared to pregnancies following LM, those
  following UAE were at greater risk of preterm
  delivery and malpresentation. The rate of
  postpartum hemorrhage following UAE compared to
  LM was 6 times higher, but this was not
  statistically significant (see Table II). Both
  groups had a higher rate of CD compared to the
  general population.

Background

• Uterine artery embolization (UAE) is an
  increasingly popular alternative to hysterectomy
  and myomectomy as a treatment for uterine
  fibroids.
• Women becoming pregnant after uterine artery
  embolization may be at significantly increased
  risk for postpartum hemorrhage, preterm delivery,
  cesarean delivery, and malpresentation. 1
• Many large series have reported pregnancy
  outcomes following laparoscopic myomectomy
  (LM).2-4 How these pregnancies compare to those
  following uterine artery embolization is unknown.
• 1. Goldberg J, Pereira L, Berghella V. Pregnancy
  after uterine artery embolization. Obstet Gynecol
  2002100869-72.
• 2. Daraï E, Dechaud H, Benifla JL, Renolleau C,
  Panel P, Madelenat P. Fertility after
  laparoscopic myomectomy preliminary results. Hum
  Reprod 1997121931-4.
• 3. Seinera P, Farina C, Todros T. Laparoscopic
  myomectomy and subsequent pregnancy results in
  54 patients. Hum Reprod 2000151993-6.
• 4. Seracchioli R, Rossi S, Govoni F, Venturoli
  S, Bulletti C, Flamigni C. Fertility and
  obstetric outcome after laparoscopic myomectomy
  of large myomata a randomized comparison with
  abdominal myomectomy. Hum Reprod152663-8.

Pregnancies in women with fibromyomata treated by
uterine artery embolization, compared to those
following laparoscopic myomectomy, may be at
significantly increased risk for preterm delivery
and malpresentation.
jay.goldberg_at_jefferson.edu