Uterine artery embolisation (UAE) was first described as a treatment for symptomatic leiomyomas in 1995 by Ravina et al. 1 and has since become established as a valid nonsurgical management option for a woman wishing to conserve her uterus. It involves targeted disruption to the blood supply of the uterus using embolic material such as polyvinyl alcohol particles and subsequent necrosis of the fibroids. However, although there has been great interest in the use of this technique in women wishing to preserve their fertility, it is unclear whether subsequent pregnancy is safe. This uncertainty relates to the relative dearth of published data compounded by the lack of adequate controls; women undergoing UAE tend to have larger, more symptomatic fibroids in comparison with the usual control groups, who are frequently derived from series of women with infertility. 2 To date, over 200 pregnancies following UAE have been reported in the literature. 3 Early pregnancy, in particular, appears to be adversely affected with an increased spontaneous miscarriage rate over the general population (38.5 versus 10-15%) 3 and over other women with uterine fibroids matched for age and fibroid location (35.2 versus 16.5%). 2 A recent systematic review compared pregnancies after UAE with pregnancies in women with untreated fibroids, data informing the review were generally from small retrospective, uncontrolled series. The meta-analysis reported that women who had previously had UAE were more likely to be delivered by caesarean section (66 versus 48.5%; odds ratio [OR] 2.1; 95% CI 1.4-2.9) and were six times more likely to experience postpartum haemorrhage (PPH) (13.9 versus 2.5%; OR 6.4; 95% CI 3.5-11.7). Rates of preterm delivery (14 versus 16%; OR 0.9; 95% CI 0.5-1.5), fetal growth restriction (7.3 versus 11.7%; OR 0.6; 95% CI 0.3-1.3) and malpresentation (10.4 versus 13%; OR 0.8; 95% CI 0.4-1.5) were similar. 2 Despite the lack of large, controlled prospective series or randomised studies, the observed increase in caesarean delivery and, more notably, in PPH raises concerns over the safety of pregnancy after UAE.The cause of increased blood loss after delivery is unclear from the reported data. However, it has been suggested that this is related to the higher caesarean section rate or to inherent impaired contraction of the fibroid uterus. 2 Of note, however, are the increasing number of case reports in the literature of placenta accreta complicating these pregnancies. [4][5][6][7] We have recently experienced an incident of placenta accreta in a 34-year-old general practitioner who underwent UAE of a 15 · 6-cm posterior wall leiomyoma in 2007, which was subsequently passed per vaginam. At hysteroscopy, performed for the investigation of primary infertility, a large crater was noted in the posterior uterine wall. It was felt that this was likely to prevent spontaneous conception. She later presented with a positive pregnancy test and ultrasound showed a singleton intrauterine pregnancy. She was monitored closely throughout the pr...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.