<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Abstract

Background: Uterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case-control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE. Methods: We retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: We used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01). Conclusion: Our results suggest that previous UAE is a significant risk factor for PAS.

What to learn from a case of short-term pregnancy after uterine artery embolization for acquired uterine arteriovenous malformation

“…In this case UAE was followed by a very short-term spontaneous pregnancy after only three-month interval after treatment. Moreover, UAE for PPH or uterine fibroids could be associated with uterine necrosis, spontaneous abortion, preterm birth, fetal growth restriction, and fetal death [6,13]. Neonatal outcomes of pregnancy here described were excellent.…”

Can uterine artery embolization be an alternative to plastic and reconstructive uterus operation by minimally invasive surgery?

“…A further useful indication of UAE is as a prophylactic method before obstetrical procedures with high risk of massive bleeding such as dilatation and curettage associated with uterine ectopic pregnancy (cervical or caesarean scar) [ 6 ], termination of pregnancy with complete placenta praevia (CPP) [ 32 ], [ 33 ], suspected gestational trophoblastic disease, or retained placenta with vascularity [ 5 ], [ 6 ] (Table 4 (Tab. 4) ).…”

“…The benefits of uterine artery embolization (UAE) in the treatment of different uterine pathologies are demonstrated for women desiring organ preservation, being minimally invasive, even in the treatment of giant fibroids [ 2 ]. Since its introduction in 1995 as conservative therapy for fibroids [ 3 ], the intervention has been developed, being applied for uterine pathologies such as myoma [ 4 ], postpartum haemorrhage (PPH) [ 5 ], or as a prophylactic procedure before obstetrical surgery with a high risk of massive bleeding [ 6 ], adenomyosis [ 7 ], and uterine vascular malformation [ 8 ]. However complications are possible [ 9 ], [ 10 ], which may increase the likelihood of therapy failure eventually leading to future surgical interventions [ 11 ].…”

Analysis of high intensity focused ultrasound in treatment of uterine fibroids on ovarian function and pregnancy outcome

“…Transabdominal or laparoscopic myomectomy may increase the risk of abdominal adhesions, change the pelvic microenvironment, and increase the probability of infertility in patients 15 . Uterine artery embolization is not recommended by the American Society of Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG) for patients with uterine fibroids who have fertility requirements because it may damage the ovarian function endometrial related functions 16,17 . HIFU treatment can block the blood supply of uterine fibroids, reduce the size of fibroids, restore normal contraction of the myometrium, and restore the normal shape of the uterine cavity 18 .…”