Clinical, Imaging and Procedural Risk Factors for Intrauterine Infective Complications After Uterine Fibroid Embolisation: A Retrospective Case Control Study

Abstract

Introduction This was a retrospective case–control study at a single tertiary centre investigating all UFE procedures between January 2013 and December 2018 for symptomatic fibroids. The aim was to determine the clinical, imaging and procedural risk factors which impact upon the risk of post-uterine fibroid embolisation (UFE) intrauterine infection. Cases were patients which developed intrauterine infection post-procedure, and controls were the background UFE population without infection. Methods Clinical demographics, presenting symptoms, uterine and fibroid characteristics on imaging and procedural variants were analysed. A p value of less than 0.05 was considered statistically significant. The main outcome measures were presence of infection and requirement of emergency hysterectomy. Results 333 technically successful UFE procedures were performed in 330 patients. Infection occurred after 25 procedures (7.5%). 3 of these patients progressed to overwhelming sepsis and required emergency hysterectomy. Clinical obesity (BMI > 30) (OR 1.53 [1.18–1.99]) and uterine volume > 1000cm3 (2.94 [1.15–7.54]) were found to increase the risk of infection Conclusions UFE is generally safe in patients with symptomatic fibroids. Obese patients (BMI > 30) and those with large volume uteri (> 1000cm3) are at slight increased risk of developing infection and require appropriate pre-procedural counselling, as well as careful post-UFE follow-up. BMI and uterine volume may be useful to assess before the procedure to help to determine post-UFE infection risk.

Isorhynchophylline alleviates cartilage degeneration in osteoarthritis by activating autophagy of chondrocytes

“…Based on the previous researches, we hypothesized that Isorhy could promote autophagy in OA cells via the PI3K/AKT/mTOR pathway. To confirm this hypothesis, we divided the cells into four groups, in order of normal chondrocytes (control), OA chondrocytes [ 1 ], OA cells + 50 μM Isorhy (OA + Isorhy) and OA cells + 50 μM Isorhy + MHY1485 (mTOR activator) (OA + Isorhy + MHY1485), respectively. For the above four groups of cells, RT-PCR analysis was performed, and the results showed (Fig.…”

“…Osteoarthritis [ 1 ] is a familiar chronic joint disease that manifests itself as degenerative changes in articular cartilage (changes similar to aging of machine parts) and secondary osteophytes [ 2 – 4 ]. According to statistics, OA has become one of the most common chronic diseases in the world, affecting about ten percent of men and eighteen percent of women more than the age of 60, and recent studies have shown a trend toward younger onset of OA [ 5 , 6 ].…”

Uterine artery embolisation: fertility, adenomyosis and size – what is the evidence?

“…Interestingly, the two most recent studies on fibroid size suggest an increased risk of complications in women with greater fibroid burden. A large retrospective case control study reviewed 333 patients with respect to intra-uterine infection post UAE and identified large uterine volume > 1000 cm 3 to be a risk factor for infective complications although the statistically significance was relatively low ( p = 0.049, OR 2.94 [1.15–7.54] (Mollier et al 2020 ). A systematic review and meta-analysis of four retrospective cohort studies (Katsumori et al 2003 ; Prollius et al 2004 ; Choi et al 2013 ; Bérczi et al 2015 ) was carried out incorporating total of 839 total patients.…”

“…Similarly, a study of 61 patients showed that larger uterine volume (> 780 cm 3 ) is not associated with reduced symptomatic improvement or higher rate Table 3 Studies of UAE for adenomyosis where the primary outcome was assessed using a validated QOL questionnaire (Froeling et al 2012;Smeets et al 2012;Nijenhuis et al 2015;de Bruijn et al 2017a;de Bruijn et al, 2017b;Siskin et al 2001;Millo et al 2010) NR not reported, AUB abnormal uterine bleeding, HRQOL health related quality of life, UFS-QOL Uterine fibroid symptom and quality of life a same patient cohort with outcomes reported at 3 years and 7 years. The De Bruijn article was not included in the systematic review (Parthipun et al, 2010;Katsumori et al, 2003;Prollius et al, 2004;Firouznia et al, 2008;Choi et al, 2013;Bérczi et al, 2015;Mollier et al, 2020) UAE uterine artery embolisation, NR not reported (Prollius et al 2004). Furthermore, a retrospective analysis of 101 patients found no correlation between size of the dominant fibroid and clinical effectiveness or complication rate at 1 year (Firouznia et al 2008).…”