Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution

Abstract

Objective: To assess the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids on fertility. Material and methods: A retrospective observational study was conducted of 560 reproductive-age women with symptomatic uterine fibroids who underwent USgHIFU therapy at M utua Terrassa University Hospital, Spain, between February 2008 and February 2018. We analyzed pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes and complications during pregnancy and delivery. Results: After USgHIFU treatment, 71 pregnancies were obtained in 55 patients. Of these, 58 (82%) cases were natural pregnancies and 13 (18%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 12 (range 1-72) months. There were 43 (61%) successful deliveries, including a twin gestation, 22 (31%) spontaneous abortions and 6 (8%) therapeutic abortions. The rate of fullterm deliveries was 91% (39/43) and the remaining 9% (4/43) were preterm deliveries. Of the 44 live births, 25 (57%) were born vaginally and 19 (43%) by cesarean section. The complications reported included 3 women with retained placenta (7%), 2 with placenta previa (5%) and 1 with severe preeclampsia (2%). The mean birth weight was 3.1 (range: 1.4-4.3) kg, and except for a baby born with a tetralogy of Fallot, all newborns developed well without complications during postpartum and breastfeeding. Conclusion:Patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postpartum complications. More studies are required to compare fertility and perinatal outcomes between patients who underwent or not USgHIFU.

Third-Trimester Spontaneous Uterine Rupture After Ultrasound-Guided High-Intensity Focused Ultrasound Therapy

“…1 Although some pregnant patients that underwent USgHIFU-based treatment experienced a few obstetric complications, there is still insufficient clinical evidence relating to the real impact of USgHIFU. 2 Here, we report a case of spontaneous rupture of the anterior uterine wall at 36 weeks of gestational weeks in a patient who had previously received USgHIFU therapy. The patient has given her consent to publish the clinical information in the journal.…”

“…Over the past few decades, ultrasound-guided high-intensity focused ultrasound (USgHIFU) has emerged as a non-invasive therapeutic tool and has found wide application for the safe and effective management strategy of uterine fibroids and adenomyosis 1 . Although some pregnant patients that underwent USgHIFU-based treatment experienced a few obstetric complications, there is still insufficient clinical evidence relating to the real impact of USgHIFU 2 . Here, we report a case of spontaneous rupture of the anterior uterine wall at 36 weeks of gestational weeks in a patient who had previously received USgHIFU therapy.…”

New treatment options for nonsurgical management of uterine fibroids

“…A systematic review suggests reproductive outcomes are noninferior to conventional fibroid treatments [38 ▪ ]. Case series were reported regarding pregnancy outcomes in patients after treatment with MRgFUS and HIFU and demonstrated high-term delivery rates with few pregnancy complications [39,40]. Ovarian reserve after HIFU or MRgFUS as measured by hormonal levels before and after focused ultrasound treatment is also reassuring [34 ▪ ,41 ▪ ].…”

High-intensity Focused Ultrasound is a Better Choice for Women with Fertility Desire: A Systematic Review and Meta-analysis of the Comparison between High-intensity Focused Ultrasound and Laparoscopic Treatment of Uterine Fibroids

“…These studies were retrospective. [ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ] It was a comparative study between the HIFU and laparoscopic myomectomy groups. [ 12 13 14 ] The only data for the HIFU group were from these studies,[ 15 16 17 ] whereas data for the laparoscopic myomectomy group were from these studies only.…”