Reducing the risk of bleeding after myomectomy: is preemptive embolization a valuable tool?

Abstract

Purpose Abdominal myomectomy can be a challenging procedure, with elevated intraoperative blood loss and post-operative complications such as the need for blood transfusion and hemostasis with sometimes hysterectomy. Previous studies suggested that preemptive uterine artery embolization (PUAE) might reduce intraoperative blood loss. Materials and methods We reviewed all cases of abdominal myomectomy in our institution between January 2016 and June 2018. Out of 119 cases, 16 patients had PUAE and 103 did not. The objective of our study was to determine whereas PUAE reduced blood loss and post-operative complication rate. Results In our study, there was no difference between the two groups in regard to average blood loss (128 vs 192 mL, OR 1,00 [0.99;1,01], p = 0,73), difference between pre- and post-operative hemoglobin level (− 1,15 g/dL vs − 1,32 g/dL, OR 0,91 [0.47;1,73], p = 0,79), and post-operative complications (need for transfusion, surgical revision, post-operative embolization, hysterectomy). Conclusion Our findings could not conclude that PUAE is effective in reducing intraoperative blood loss during abdominal myomectomy, but it should still be considered an option for patients with large or multiple myomas, with a specific situation or previously operated, who wish to preserve their uterus.

World Federation for Ultrasound in Medicine Review Paper: Incidental Findings during Obstetrical Ultrasound

“…UAE is a therapeutic modality whose efficacy has been indicated especially for large or multiple myomas. UAE may also be an efficient treatment approach to reduce the size of myomas, simplifying their surgical removal (Abrahami et al 2021). However, to date, there are few published data regarding UAE during pregnancy; therefore, the decision to use such a therapeutic modality should be made with caution, in specific cases by centers with relative experience and in which a High-Risk Pregnancy Unit is available.…”