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Wang H, Xue F, Wang W. A combination of laparoscopy and bilateral uterine artery occlusion for the treatment of type II cesarean scar pregnancy: a retrospective analysis. J Int Med Res 2024; 52:3000605241241010. [PMID: 38663910 PMCID: PMC11047230 DOI: 10.1177/03000605241241010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/04/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE We investigated the efficacy of a combination of laparoscopy and bilateral uterine artery occlusion (BUAO) for the treatment of type II cesarean scar pregnancy (CSP). METHODS Patients with type II CSP underwent laparoscopy + bilateral uterine artery embolization (control group) or laparoscopy + BUAO (study group). Data regarding the duration of surgery, intraoperative hemorrhage, postoperative complications, the duration of the hospital stay, and the costs of hospitalization were retrospectively collected. One year later, the time to the return of the β-human chorionic gonadotropin (β-hCG) concentration to normal and to the return of menstruation were compared. RESULTS The duration of surgery, time to the return of menstruation, and incidence of postoperative complications in the study group were significantly less than in the control group, but there was no significant difference in the time for β-hCG to return to normal or the volume of intraoperative hemorrhage. The duration of hospitalization and costs for the control group were higher than those for the study group. CONCLUSION Laparoscopy in combination with BUAO is associated with minimal trauma, rapid recovery, a short duration of surgery, low cost of hospitalization, and a low postoperative complication rate. Thus, it represents a useful new surgical treatment for type II CSP.
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Affiliation(s)
- Hongyan Wang
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Fangfang Xue
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Wenying Wang
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
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Cao G, Liu R, Liu J, Liu J, Liu Y, Li L, Zhao X, Li H, Cao H. Association of menstrual blood volume and reproductive outcomes in patients with caesarean scar pregnancy managed using uterine artery embolization and curettage. HUM FERTIL 2023; 26:1491-1496. [PMID: 37154620 DOI: 10.1080/14647273.2023.2207746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
This study aimed to assess the association of menstrual blood volumes (MBV) and reproductive outcomes in patients after uterine artery embolization (UAE) combined with curettage for caesarean scar pregnancy (CSP). This retrospective observational study enrolled women who underwent UAE plus curettage for CSP at the Interventional Department of Henan Provincial People's Hospital between December 2012 and December 2017. The primary outcome was pregnancy rate and the secondary outcomes were live birth rate (LBR) and interpregnancy interval. This study finally included 37 women (16 women with normal MBV and 21 women with decreased MBV) with pregnancy intention after UAE plus curettage for CSP. The pregnancy rate in women with normal MBV was higher than those with decreased MBV (81.3% vs. 47.6%; P = 0.048). There were no differences between the two groups regarding the interpregnancy interval (18.4 ± 8.7 vs. 22.2 ± 10.0 months, P = 0.233), and LBR (63% vs. 38%, P = 0.191). In conclusion, Women with normal MBV after UAE combined with curettage for CSP management might have a higher pregnancy rate compared with patients with decreased MBV, but there were no differences in LBR between the two groups.
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Affiliation(s)
- Guangshao Cao
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Ruiqing Liu
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Jianwen Liu
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Jian Liu
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Yuyan Liu
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Lupeng Li
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Xiaoyang Zhao
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Hui Li
- Department of Gynaecology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Huicun Cao
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
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Jegaden M, Bleas C, Debras E, Couet D, Pourcelot AG, Capmas P, Fernandez H. Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes. J Minim Invasive Gynecol 2023; 30:494-501. [PMID: 36813132 DOI: 10.1016/j.jmig.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
STUDY OBJECTIVE To study the severity of intrauterine adhesions (IUA) after uterine arterial embolization and to evaluate fertility, pregnancy, and obstetrical outcomes after hysteroscopic treatment. DESIGN Retrospective cohort. SETTING French University Hospital. PATIENTS Thirty-three patients under the age of 40 years who were treated by uterine artery embolization with nonabsorbable microparticles between 2010 and 2020 for symptomatic fibroids or adenomyosis, or postpartum hemorrhage. INTERVENTIONS All patients had a diagnosis of IUA after embolization. All patients desired future fertility. IUA was treated with operative hysteroscopy. MEASUREMENTS AND MAIN RESULTS Severity of IUA, number of operative hysteroscopies performed to obtain a normal cavity shape, pregnancy rate, and obstetrical outcomes. Of our 33 patients, 81.8% had severe IUA (state IV et V according to the European Society of Gynecological Endoscopy or state III according to the American fertility society classification). To restore fertility potential, an average of 3.4 operative hysteroscopies had to be performed [CI 95% (2.56-4.16)]. We reported a very low rate of pregnancy (8/33, 24%). Obstetrical outcomes reported are 50% of premature birth and 62.5% of delivery hemorrhage partly due to 37.5% of placenta accreta. We also reported 2 neonatal deaths. CONCLUSION IUA after uterine embolization is severe, and more difficult to treat than other synechiae, probably related to endometrial necrosis. Pregnancy and obstetrical outcomes have shown a low pregnancy rate, an increased risk of preterm delivery, a high risk of placental disorders, and very severe postpartum hemorrhage. Those results have to alert gynecologists and radiologists to the use of uterine arterial embolization in women who desire future fertility.
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Affiliation(s)
- Margaux Jegaden
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France.
| | - Cécile Bleas
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Elodie Debras
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France
| | - Déborah Couet
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Anne-Gaëlle Pourcelot
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Perrine Capmas
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP (Drs. Capmas, Fernandez), Villejuif, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP (Drs. Capmas, Fernandez), Villejuif, France
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Mailli L, Patel S, Das R, Chun JY, Renani S, Das S, Ratnam L. Uterine artery embolisation: fertility, adenomyosis and size - what is the evidence? CVIR Endovasc 2023; 6:8. [PMID: 36847951 PMCID: PMC9971423 DOI: 10.1186/s42155-023-00353-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Uterine artery embolisation is well established as a treatment for symptomatic fibroids, however, there remain some uncertainties. We have carried out a focused literature review on three particularly challenging aspects - post-procedure fertility, symptomatic adenomyosis and large volume fibroids and uteri, to enable operators to utilise evidence-based guidance in patient selection, consent, and management. REVIEW Literature searches were performed of the PubMed/Medline, Google scholar, EMBASE and Cochrane databases. The outcomes of our analysis of studies which recorded fertility rates in women desiring pregnancy following UAE for symptomatic fibroids found an overall mean pregnancy rate of 39.4%, live birth rate of 69.2% and miscarriage rate of 22%. The major confounding factor was patient age with many studies including women over 40 years who already have lower fertility compared to younger cohorts. Miscarriage rates and pregnancy rates in the studies analysed were comparable to the age matched population. Treatment of pure adenomyosis and adenomyosis with co-existing uterine fibroids with UAE has been shown to produce symptomatic improvement with better outcomes in those with combined disease. Although the effectiveness is not as high as it is in pure fibroid disease, UAE provides a viable and safe alternative for patients seeking symptom relief and uterine preservation. Our analysis of studies assessing the outcomes of UAE in patients with large volume uteri and giant fibroids (> 10 cm) demonstrate no significant difference in major complication rates demonstrating that fibroid size should not be a contraindication to UAE. CONCLUSION Our findings suggest uterine artery embolisation can be offered to women desiring pregnancy with fertility and miscarriage rates comparable to that of the age-matched general population. It is also an effective therapeutic option for symptomatic adenomyosis as well as for the treatment of large fibroids > 10 cm in diameter. Caution is advised in those with uterine volumes greater than 1000cm3. It is however clear that the quality of evidence needs to be improved on with an emphasis on well-designed randomised controlled trials addressing all three areas and the consistent use of validated quality of life questionnaires for outcome assessment to enable effective comparison of outcomes in different studies.
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Affiliation(s)
- Leto Mailli
- grid.451349.eDepartment of Interventional Radiology, St George’s University Hospital, London, UK
| | - Shyamal Patel
- grid.451349.eDepartment of Interventional Radiology, St George’s University Hospital, London, UK
| | - Raj Das
- grid.451349.eDepartment of Interventional Radiology, St George’s University Hospital, London, UK
| | - Joo Young Chun
- grid.451349.eDepartment of Interventional Radiology, St George’s University Hospital, London, UK
| | - Seyed Renani
- grid.451349.eDepartment of Interventional Radiology, St George’s University Hospital, London, UK
| | - Sourav Das
- grid.451349.eDepartment of Obstetrics and Gynaecology, St George’s University Hospital, London, UK
| | - Lakshmi Ratnam
- Department of Interventional Radiology, St George's University Hospital, London, UK.
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Dai Y, Peng Y, Shi Q, Jin P, Wang Z. Comparison of menstruation recovery after ultrasound-guided suction curettage in patients with cesarean scar pregnancy pretreated using high-intensity focused ultrasound and uterine artery embolization. Int J Hyperthermia 2023; 40:2241686. [PMID: 37698065 DOI: 10.1080/02656736.2023.2241686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES To investigate the menstruation recovery after two therapeutic regimens, high-intensity focused ultrasound (HIFU) or uterine artery embolization (UAE) combined with ultrasound-guided suction curettage, for premenopausal women with cesarean scar pregnancy (CSP). MATERIALS AND METHODS Seventy patients with CSP treated with HIFU followed by ultrasound-guided suction curettage and 63 patients with CSP treated with UAE followed by ultrasound-guided suction curettage in our hospital were retrospectively reviewed. The treatment parameters and the menstrual blood loss (MBL) volume at 6 months after the two therapeutic regimens were compared between the two groups. RESULTS There was no significant difference in treatment results between the two groups. With regard to postoperative MBL volume, 5 out of 70 patients in the HIFU group and 22 out of 63 patients in UAE group exhibited a reduction in MBL, respectively. Multivariate logistic regression revealed that hypomenorrhea was more likely to occur in the UAE group than in the HIFU group (UAE group vs. HIFU group; OR 11.328, 95% CI 3.158-55.871; p < 0.001). CONCLUSION Compared to UAE, HIFU has less influence on postoperative MBL volume, which may be a fertility-sparing option for patients with CSP.
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Affiliation(s)
- Yu Dai
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, P.R. China
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Yan Peng
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, P.R. China
- School of Public Health and Management, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ping Jin
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, P.R. China
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, P.R. China
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6
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Tan KL, Chen YM, Zeng W, Meng Y, Jiang L. Local Methotrexate Injection Followed by Dilation and Curettage for Cesarean Scar Pregnancy: A Prospective Non-randomized Study. Front Med (Lausanne) 2022; 8:800610. [PMID: 35127758 PMCID: PMC8815728 DOI: 10.3389/fmed.2021.800610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the clinical effects and outcomes of local intra-gestational sac methotrexate injection followed by dilation and curettage for treatment of cesarean scar pregnancies (CSP).MethodThis prospective non-randomized study was conducted on patients diagnosed with CSP between 2018 and 2020 at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Patients were categorized into two groups according to the treatments, i.e., local intra-gestational sac methotrexate injection followed by dilation and curettage (group A), and uterine artery embolization in combination with dilation and curettage (group B). The choices of treatment reflect the patients' decision after they thoroughly understood the benefits and risks of the two therapies. Clinical data were then collected and compared between these two alternatives.ResultsSeventy-seven patients with CSP were enrolled in the study. Of this total, 41 vs. 36 were respectively categorized into group A and group B. Similar success rates were observed between these two groups (92.7 vs. 97.2%; RR = 27.362, 95% CI: 0.496–1.51E3, p = 0.106). However, the overall occurrence of complications in group A was significant lower when compared with group B (17.1 vs. 52.8%; RR = 0.236, 95% CI: 0.077–0.728, p = 0.012). Lower abdominal pain (unrelated to infection) and intrauterine adhesions were the two primary complications exhibited in group B of the present study, with rates of 38.9 and 22.2% respectively.ConclusionsLocal intra-gestational sac methotrexate injection followed by dilation and curettage is an effective and safe treatment for CSP that also drastically reduces the risks of complications. Further multiple center randomized trials with large series are warranted to confirm these findings.
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The effect of prophylactic uterine artery embolization on reproductive outcomes in patients with cesarean scar pregnancy: a propensity score-matched study. Arch Gynecol Obstet 2021; 305:651-659. [DOI: 10.1007/s00404-021-06347-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
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8
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Gubbini G, Bertapelle G, Bosco M, Zorzato PC, Uccella S, Favilli A. Asherman's Syndrome after Uterine Artery Embolization: A Case of Embolic Spheres Displacement inside the Uterine Cavity. J Minim Invasive Gynecol 2021; 28:1436-1437. [PMID: 33744406 DOI: 10.1016/j.jmig.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Giampietro Gubbini
- Department of Gynecology, Madre Fortunata Toniolo Clinic, Bologna (Dr. Gubbini)
| | - Giulia Bertapelle
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona (Drs. Bertapelle, Bosco, Zorzato, Uccella, and Favilli), Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona (Drs. Bertapelle, Bosco, Zorzato, Uccella, and Favilli), Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona (Drs. Bertapelle, Bosco, Zorzato, Uccella, and Favilli), Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona (Drs. Bertapelle, Bosco, Zorzato, Uccella, and Favilli), Italy
| | - Alessandro Favilli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona (Drs. Bertapelle, Bosco, Zorzato, Uccella, and Favilli), Italy.
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Li X, Musoba PM, Zhou X, Lai S, Yang W, Wang LN, Chantholleng DD, Zhao J. Recovery of uterine and ovarian function in patients with complete placenta previa after caesarean delivery: A retrospective study. Medicine (Baltimore) 2021; 100:e24196. [PMID: 33466195 PMCID: PMC7808485 DOI: 10.1097/md.0000000000024196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023] Open
Abstract
This retrospective study was designed to explore the recovery of uterine and ovarian function in patients with complete placenta previa (PP) after caesarean delivery (CD). 136 complete placenta previa patients (group completed placenta previa) and 140 patients without complete PP (group non-PP, control group) were included in this study from Jan 2016 to Dec 2018. Subgroup analysis of patients with complete PP was made to determine the impact of different hemostatic methods used during CD on the recovery of uterine function. There were no statistically significant differences between the 2 groups in postpartum menstrual cycle changes, ovarian hormone, and uterine vascular supply as measured by pulsatility index and systolic/diastolic ratio (P > .05). However, the group with complete PP had a reduced endometrial thickness (0.47 ± 0.11 vs 0.50 ± 0.12, P < .001), a lower uterine resistance index at 42nd days (0.84 ± 0.03 vs 0.90 ± 0.03, P < .001), and a delayed resumption menstruation (7.07 ± 2.61 vs 5.31 ± 2.16, P < .001) when compared with control group. Subgroup analysis showed that RI index of all subgroups in completed PP group was lower, endometrial thickness was thinner and the time to menstrual recovery was longer than that of non-PP group. In conclusion, the endometrial thickness and blood supply at 42nd days, not ovarian function, maybe affected after CD in patients with complete PP.
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Affiliation(s)
- Xiaoxue Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Rd, Haidian District
- National Clinical Research Center for Obstetrics and Gynecology
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education
- Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing
| | - Paul M. Musoba
- The Department of Obstetrics &Gynecology, Tongji Hospital, Tongji Medical college of Huazhong University of Science &technology, 1095#Jiefang Avenue, Wuhan 430030, Hubei province, China
| | - Xuan Zhou
- The Department of Obstetrics &Gynecology, Tongji Hospital, Tongji Medical college of Huazhong University of Science &technology, 1095#Jiefang Avenue, Wuhan 430030, Hubei province, China
| | - ShaoYang Lai
- The Department of Obstetrics &Gynecology, Tongji Hospital, Tongji Medical college of Huazhong University of Science &technology, 1095#Jiefang Avenue, Wuhan 430030, Hubei province, China
| | - Wan Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Rd, Haidian District
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education
- Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing
| | - Li Na Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Rd, Haidian District
- National Clinical Research Center for Obstetrics and Gynecology
- Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing
| | - Dara D. Chantholleng
- The Department of Obstetrics &Gynecology, Tongji Hospital, Tongji Medical college of Huazhong University of Science &technology, 1095#Jiefang Avenue, Wuhan 430030, Hubei province, China
| | - Jie Zhao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Rd, Haidian District
- National Clinical Research Center for Obstetrics and Gynecology
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education
- Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing
- The Department of Obstetrics &Gynecology, Tongji Hospital, Tongji Medical college of Huazhong University of Science &technology, 1095#Jiefang Avenue, Wuhan 430030, Hubei province, China
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Kim MD. Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases. Korean J Radiol 2020; 20:1462-1473. [PMID: 31544371 PMCID: PMC6757003 DOI: 10.3348/kjr.2019.0205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/14/2019] [Indexed: 12/04/2022] Open
Abstract
Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.
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Affiliation(s)
- Man Deuk Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Li X, Niu H, Li J, Zhang L, Qu Q. Clinical assessment of uterine artery embolization combined with curettage when treating patients with cesarean scar pregnancy: A retrospective study of 169 cases. J Obstet Gynaecol Res 2020; 46:1110-1116. [PMID: 32307813 DOI: 10.1111/jog.14258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 12/28/2019] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaolin Li
- Department of Gynecology Tianjin First Central Hospital Tianjin China
| | - Haiying Niu
- Department of Gynecology Tianjin First Central Hospital Tianjin China
| | - Jing Li
- Department of Gynecology Tianjin First Central Hospital Tianjin China
| | - Lizhi Zhang
- Department of Gynecology Tianjin First Central Hospital Tianjin China
| | - Quanxin Qu
- Department of Gynecology Tianjin First Central Hospital Tianjin China
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Khaw SC, Anderson RA, Lui MW. Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids. Reprod Biomed Online 2020; 40:429-444. [DOI: 10.1016/j.rbmo.2020.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
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13
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Xiao Z, Cheng D, Chen J, Yang J, Xu W, Xie Q. The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy: A retrospective case-control study. Medicine (Baltimore) 2019; 98:e14913. [PMID: 30882712 PMCID: PMC6426622 DOI: 10.1097/md.0000000000014913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In this study, we explored the optimal treatment for cesarean scar pregnancy (CSP). One hundred three women diagnosed with CSP received 1 of the 3 treatments: local or systemic methotrexate (MTX) injection and surgery (MTX + Surg), uterine arterial embolization (UAE) and surgery (UAE + Surg) or surgery only (Surg only). We compared their therapeutic effects and their follow-up results. There was no significant difference between the groups in the baseline of clinical characteristic except for the initial β human chorionic gonadotropin levels, which was highest in the MTX + Surg group (median, [interquartile range]), (120,004 [16,720-181,727] mIU/mL), compared to the UAE + Surg group (38,219 [23,194-100,029] mIU/mL) and Surg only group (22,557 [9113-49,573] mIU/mL). There was no significant difference between groups in the sonographic characteristic of patients. The intraoperative hemorrhage was highest in the Surg-only group (7/42, 16.67%), compared to the MTX + Surg group (4/26, 15.38%) and the UAE + Surg group (0/35, 0%). The incidence of intrauterine adhesions was highest in the UAE + Surg group (20%), compared to the MTX + Surg group (0%) and the Surg only group (0%). The incidence of embryo residue was highest in Surg-only group (21.43%), compared to the MTX + Surg group (0%) and the UAE + Surg group (2.86%). To conclude, MTX injection plus surgery might be the best treatment for CSP patients.
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Guida M, Maffucci D, Iannuzzi G, Giordano M, Luciano G, Di Benedetto L, Cantarella R, Rescigno A, Giugliano L. Successful pregnancy after uterine artery embolization for uterine arterovenous malformation: a rare case report. Int J Womens Health 2018; 10:745-750. [PMID: 30538584 PMCID: PMC6254590 DOI: 10.2147/ijwh.s182131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective This paper reports on a rare case of pregnancy after uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM). Debate exists about persistence of fertility in women after UAE. Adverse effects of this technique can modify both uterine echostructure, inducing necrosis and infarction, endometrial atrophy and uterine artery rupture, and ovarian reserve, causing persistent amenorrhea. Ovarian reserve appears to be affected by UAE in pre-menopausal women. However, younger ovaries (according to biological ovarian age) exhibit a greater capacity for recovery after ovarian damage. Therefore, larger studies are needed for more conclusive results. Case report A 28-year-old woman was admitted to our department due to life-threatening uterine bleeding, resulting in tachycardia, pallor, and sweating. The patient came with a history of two spontaneous miscarriages. After sonography and computed tomography, AVMs were identified at uterine fundus and anterior wall. Conclusion The pathogenesis of infertility after UAE is not yet known. The peculiarity of this case was that, only few months later, the patient became pregnant and gave birth to a live fetus at 37 weeks with cesarean delivery.
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Affiliation(s)
- M Guida
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - D Maffucci
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - G Iannuzzi
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - M Giordano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - G Luciano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - L Di Benedetto
- Università degli studi di Roma "La Sapienza" - Dipartimento di Scienze Medico-Chirurgiche e di Medicina Traslazionale - Facoltà di Medicina e Psicologia Azienda Ospedaliera Sant' Andrea, Rome, Italy
| | - R Cantarella
- Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - A Rescigno
- Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - L Giugliano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
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Regarding "Multidisciplinary Approach in Large-Sized Submucous Myoma: Hysteroscopic Myomectomy after Uterine Artery Embolization". J Minim Invasive Gynecol 2018; 26:369-370. [PMID: 30165186 DOI: 10.1016/j.jmig.2018.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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Cao GS, Liu RQ, Liu YY, Liu JW, Li LP, Zhang Q, Cao HC, Li TX. Menstruation recovery in scar pregnancy patients undergoing UAE and curettage and its influencing factors. Medicine (Baltimore) 2018; 97:e9584. [PMID: 29538216 PMCID: PMC5882401 DOI: 10.1097/md.0000000000009584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 12/19/2022] Open
Abstract
This study aims to investigate the menstrual recovery outcome of scar pregnancy patients who received uterine artery embolization combined with curettage, and its influencing factors.The data of 119 patients with scar pregnancy, who received uterine artery embolization combined with curettage between December 2012 and December 2016 in Henan Provincival People's Hospital, were collected. The menstruation recovery of these patients was followed up, and factors that have influence on menstrual blood volume were analyzed using SPSS V.17.0.Follow-up data were available in 101/119 (84.9%) women. The median follow-up time was 22.7 months (range: 1.6-50.6 months); 58 (57.4%) patients had reduced menstrual blood volume, and 2 patients (2%) had amenorrhea. The proportion of patients with reduced menstrual blood volume, who were embolized with polyvinyl alcohol (PVA), PVA combined with gelatin sponge, and gelatin sponge between < and ≥33 years old was 41.7% versus 66.7%, 40% versus 57.1% and 60.6% versus 68.0%. The average age of patients with reduced menstrual blood volume (34.3 years) was greater than patients with normal menstrual blood volume (31.4 years), but the difference was not statistically significant (P = .07).Reduced menstrual blood volume can occur in scar pregnancy patients who received uterine artery embolization combined with curettage. The influence of the embolic agent PVA on menstrual blood volume depends on age, but the difference was not statistically significant.
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Uterine fibroid embolization efficacy and safety: 15 years experience in an elevated turnout rate center. Radiol Med 2018; 123:385-397. [PMID: 29357038 DOI: 10.1007/s11547-017-0843-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate effectiveness and safety of UFE as alternative to surgery, in treatment of uterine fibromatosis. METHODS/MATERIALS 255 patients (aged 26-55) with symptomatic UF, indication for surgery, followed in our center (2000-2014), single or multiple fibroids, pain and/or functional/compressive disorders, underwent embolization: injection of PVA particles (150-900 μm) from distal portion of uterine arteries (ascending section). Primary end-point: flow-stop distally to injection site, disappearance of lesion design, preservation of flow in main trunk of UA. Secondary end-point: control of pain and functional/compressive disorders during follow-up (2-7 years). RESULTS Procedure was performed bilaterally in 250 patients (98%). Mean duration: 47 min (average fluoroscopy: 10:50 min). Post-embolization pelvic pain (according with VAS score) was on average 2.2 at discharge (24 h). Follow-up at 2 years: resolution of menstrual disorders in 78% of patients and improvement in 14%; pain disappeared in 66%; significant improvement of menstrual flow and HCT/HB levels, decrease in total uterine (57.7%)/dominant fibroid (76.1%) volume. Recurrence in 18 patients. CONCLUSIONS UFE represents an excellent alternative to surgical treatment: it is safe, tolerable and effective both in short and long term, with evident advantages in economic and social terms.
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Karlsen K, Hrobjartsson A, Korsholm M, Mogensen O, Humaidan P, Ravn P. Fertility after uterine artery embolization of fibroids: a systematic review. Arch Gynecol Obstet 2017; 297:13-25. [PMID: 29052017 DOI: 10.1007/s00404-017-4566-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE. MATERIALS AND METHODS We searched for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before-after trials, cohort studies, case-control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control intervention was included. The PRISMA guideline was used to do a systematic review using the main outcomes pregnancy rate and miscarriage rate. Risk of bias was assessed by the Cochrane risk of bias tool or by ROBINS-I. The quality of evidence was assessed by the GRADE approach. RESULTS We included 17 studies (989 patients): 1 RCT, 2 cohort studies, and 14 case series. Pregnancy rates after UAE were 50% in the RCT and 51 and 69% in the cohort studies. Among the case series median pregnancy rate was 29%. Miscarriage rates were 64% in the RCT. Miscarriage rates at 56 and 34% were found in the cohort studies after UAE. The median miscarriage rate was 25% in the case series. CONCLUSION Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base. Systematic review registration number: CRD42016036661.
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Affiliation(s)
- K Karlsen
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kløvervænget 10, 10.sal, 5000, Odense C, Denmark.
| | - A Hrobjartsson
- Center for Evidence-Based Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - M Korsholm
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kløvervænget 10, 10.sal, 5000, Odense C, Denmark
| | - O Mogensen
- Department of Gynaecology, Karolinska Institute Stockholm and the University of Southern Denmark, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - P Humaidan
- Faculty of Health, The Fertility Clinic, Skive Regional Hospital, Aarhus University, Skive, Denmark
| | - P Ravn
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kløvervænget 10, 10.sal, 5000, Odense C, Denmark
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Özcan HÇ, Uğur MG, Balat Ö, Sucu S, Mustafa A, Bayramoğlu Tepe N, Uğur BK. Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study. J Matern Fetal Neonatal Med 2017; 31:2953-2958. [DOI: 10.1080/14767058.2017.1359827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hüseyin Çağlayan Özcan
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mete Gurol Uğur
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Özcan Balat
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Seyhun Sucu
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Aynur Mustafa
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Neslihan Bayramoğlu Tepe
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Berna Kaya Uğur
- Department of Anesthesiology and Reanimation, School of Medicine, Gaziantep University, Gaziantep, Turkey
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Tsikouras P, Manav B, Koukouli Z, Trypsiannis G, Galazios G, Souftas D, Souftas V. Ovarian reserve after fibroid embolization in premenopausal women. MINIM INVASIV THER 2017. [DOI: 10.1080/13645706.2017.1292919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynaecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Bachar Manav
- Department of Obstetrics and Gynaecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zacharoula Koukouli
- Department of Obstetrics and Gynaecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Grigorios Trypsiannis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Galazios
- Department of Obstetrics and Gynaecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Souftas
- Department of Social Administration, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasileios Souftas
- Department of Radiology and Medical Imaging, Democritus University of Thrace, Alexandroupolis, Greece
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Torre A, Fauconnier A, Kahn V, Limot O, Bussierres L, Pelage JP. Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors. Eur Radiol 2016; 27:2850-2859. [DOI: 10.1007/s00330-016-4681-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/02/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
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Liu S, Sun J, Cai B, Xi X, Yang L, Sun Y. Management of Cesarean Scar Pregnancy Using Ultrasound-Guided Dilation and Curettage. J Minim Invasive Gynecol 2016; 23:707-11. [DOI: 10.1016/j.jmig.2016.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 11/28/2022]
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Xiao J, Zhang S, Wang F, Wang Y, Shi Z, Zhou X, Zhou J, Huang J. Cesarean scar pregnancy: noninvasive and effective treatment with high-intensity focused ultrasound. Am J Obstet Gynecol 2014; 211:356.e1-7. [PMID: 24769010 DOI: 10.1016/j.ajog.2014.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/13/2014] [Accepted: 04/17/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this preliminary study was to investigate whether ultrasound-guided high-intensity focused ultrasound (HIFU) can play a role in treating cesarean scar pregnancy (CSP). STUDY DESIGN Between November 2011 and December 2012, 16 patients with CSP were treated with ultrasound-guided HIFU ablation. Successful treatment was defined as disappearance of CSP mass, undetectable serum beta human chorionic gonadotropin, and no serious complications such as severe bleeding, uterine rupture, or hysterectomy. RESULTS All patients were successfully treated in the outpatient department and none required readmission. After 2-5 treatment sessions, the mean time for achieving undetectable serum beta human chorionic gonadotropin was 4.94 ± 2.32 weeks, and the mean time for CSP mass disappearance was 6.69 ± 3.36 weeks. Three patients experienced moderate abdominal pain that subsided in 1-2 days, and nine patients experienced mild vaginal bleeding (<30 mL) that resolved within 2-3 days. All 16 patients had recovered their normal menstruation function at follow-up. CONCLUSION These preliminary results suggest that ultrasound-guided HIFU ablation is a noninvasive, feasible, and effective method for the treatment of CSP.
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Verret V, Pelage JP, Wassef M, Louguet S, Servais E, Bédouet L, Beaulieu T, Moine L, Laurent A. A novel resorbable embolization microsphere for transient uterine artery occlusion: a comparative study with trisacryl-gelatin microspheres in the sheep model. J Vasc Interv Radiol 2014; 25:1759-66. [PMID: 25194456 DOI: 10.1016/j.jvir.2014.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/11/2014] [Accepted: 06/25/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate angiographic recanalization, inflammatory reaction, and uterine damage after sheep uterine artery embolization (UAE) with a novel calibrated resorbable embolization microsphere (REM) and compare the results with control nonresorbable microspheres. MATERIALS AND METHODS Six hormonally artificially cycled sheep underwent bilateral UAE until stasis with either REM or trisacryl-gelatin microspheres (TGMS). At 7 days, control angiograms were obtained to assess the residual vascularization at arterial and parenchymal phases. The animals were then sacrificed for analysis of the presence of microspheres, inflammatory foreign body reaction, and surface areas of uterine damage. RESULTS Mean volume of microspheres injected per uterine artery (UA) or per animal did not differ between groups. At day 7, the flow was normal for six of six UAs that received embolization with REM versus only three of six UAs with TGMS (P = .0455, χ(2) test). Uterine parenchymography showed no defects in six UAs in the REM group versus five defects in six UAs in the TGMS group (P = .0060, χ(2) test). No REM or residual fragments of microspheres were observed on histologic analysis. TGMS were observed in tissues and accompanied by a mild inflammatory response. Necrosis rates were not significantly different between the two products, either in endometrium (REM 23.5% ± 28.8% [median 8.1%] vs TGMS 21.8% ± 23.7% [median 14.6%]) or in myometrium (REM 8.2% ± 22.7% [median 0.0%] vs TGMS 8.8% ± 20.8% [median 0.9%]). Endometrium alteration rate was lower with REM than with TGMS (39.7% ± 25.7% [median 34%] vs 60.6% ± 27.1% [median 71%]; P = .0060, Mann-Whitney test). Myometrium alteration rates were not significantly different between REM (45.7% ± 37.1% [median 63.0%]) and TGMS (37.8% ± 34.0% [median 19.1%]). CONCLUSIONS At 1 week after sheep UAE with REM, the recanalization was complete, the microspheres were completely degraded, and there was no remnant inflammatory response.
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Affiliation(s)
| | | | - Michel Wassef
- Department of Pathology, APHP, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; Université René Diderot, Paris
| | | | | | | | | | - Laurence Moine
- UMR CNRS 8612 Institut Galien Paris-Sud, Chatenay Malabry
| | - Alexandre Laurent
- Department of Interventional Neuroradiology, APHP, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; Université René Diderot, Paris; Laboratoire MSC, Paris, France..
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Tropeano G, Amoroso S, Di Stasi C, Di Bidino R, Monterisi A, Petrillo M, Scambia G. Incidence and predictive factors for complications after uterine leiomyoma embolization. Hum Reprod 2014; 29:1918-24. [PMID: 25006204 DOI: 10.1093/humrep/deu166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the risk of complications after uterine leiomyoma embolization and what are the factors associated with complications? SUMMARY ANSWER The cumulative risk of complications after embolization is relatively low even in the long term, but submucosal leiomyoma location may increase the risk. WHAT IS KNOWN ALREADY A broad spectrum of complications after leiomyoma embolization have been described with widely varying rates. There is uncertainty over the actual risk of complications and the factors associated with this risk. STUDY DESIGN, SIZE, DURATION This was a prospective cohort study of 288 consecutive women undergoing leiomyoma embolization in the general gynaecology clinic of a university teaching hospital between January 2001 and December 2010. PARTICIPANTS/MATERIALS, SETTING, METHODS Complications occurring after embolization were categorized as major or minor according to the severity of their impact on health, the level of care required and the outcome. Cumulative complication rates were estimated by survival analysis and log-rank tests according to baseline variables. Multivariable Cox proportional hazards analysis was performed to adjust for confounders. MAIN RESULTS AND THE ROLE OF CHANCE There were 48 patients who experienced a complication at a median of 5 months (95% confidence interval, 4.1-11.4) after embolization. Complications were minor in 38 patients and major in 10 patients. The cumulative overall complication rate was 13% (95% CI, 9.0-17.0) at 6 months, 16% (95% CI, 11.0-20.0) at 1 year, 17% (95% CI, 12.0-22.0) at 3 years and 18% (95% CI, 12.9-22.8) at 5 years. The most frequent complication (19/48, 39.6%) was leiomyoma expulsion, which occurred spontaneously in 13 (68.4%) of these cases and required assistance in 6 (31.6%) cases. Eight (2.8%) patients underwent re-intervention, including six hysteroscopic myomectomies, one laparoscopic myomectomy and one hysteroscopic adhesiolysis, as a result of a complication. Submucosal leiomyoma location was the only baseline variable associated with an increased risk for complications [Hazard ratio (HR), 2.28, 95% CI, 1.24-4.18, P = 0.008]. LIMITATIONS, REASONS FOR CAUTION Our population did not include women of African descent, who have been reported to be at higher risk of post-procedural complications compared with Causcasian women. If such women were involved in the study, higher morbidity rates might have been observed. WIDER IMPLICATIONS OF THE FINDINGS Women with submucosal leiomyomas at the time of embolization are more likely to have post-procedural complications. This is important new information for counselling patients contemplating this therapeutic approach. STUDY FUNDING/COMPETING INTERESTS The authors have no competing interests to declare. The study was not supported by any external grant.
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Affiliation(s)
- G Tropeano
- Department of Obstetrics & Gynaecology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy
| | - S Amoroso
- Department of Obstetrics & Gynaecology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy
| | - C Di Stasi
- Department of Radiology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - R Di Bidino
- Health Technology Unit, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - A Monterisi
- Department of Obstetrics & Gynaecology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy
| | - M Petrillo
- Department of Obstetrics & Gynaecology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy
| | - G Scambia
- Department of Obstetrics & Gynaecology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy
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Mara M, Kubinova K. Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons. Int J Womens Health 2014; 6:623-9. [PMID: 25018653 PMCID: PMC4074023 DOI: 10.2147/ijwh.s43591] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Uterine artery embolization (UAE) is a minimally invasive procedure with large symptomatic potential in treatment of women with uterine leiomyomas. Due to specificities of this method and possible complications the appropriate indication is crucial. Patient’ symptoms, age, plans for pregnancy, and surgical and reproductive history play a major role in decision-making regarding appropriate subjects for UAE. Close cooperation between the gynecologist and the interventional radiologist is necessary. UAE is usually offered as an alternative to surgical treatment. In patients with no fertility plans, it is a less invasive option than abdominal hysterectomy, with a comparable effect on fibroid-related symptoms and quality of life. The need for reintervention is markedly greater in patients after UAE (up to 35% within 5 years) than after hysterectomy. Women with large symptomatic fibroids wishing to retain the uterus and ineligible for minimally invasive (laparoscopic or vaginal) hysterectomy are good candidates for UAE. However, studies comparing UAE with minimally invasive hysterectomy are lacking. Use of UAE in younger women desiring pregnancy is more controversial, mainly because of the significant risk of miscarriage (as high as 64% in some studies) as well as the increased risk of other complications of pregnancy, such as preterm delivery, abnormal placentation, and post-partum hemorrhage. The risk of infertility or subfertility following UAE is unknown. Even poor candidates for myomectomy should be carefully selected for UAE after counseling about all possible adverse effects on fertility. Good prospective studies focused on fertility comparing UAE with no treatment or with myomectomy are needed but would be ethically questionable. This review summarizes the current knowledge regarding the benefits and potential risks of UAE from the point of view of the gynecologist, who should be responsible for proper indication of this treatment.
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Affiliation(s)
- Michal Mara
- Department of Obstetrics and Gynecology, General Faculty Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
| | - Kristyna Kubinova
- Department of Obstetrics and Gynecology, General Faculty Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
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Yan JY, Zhou ZM, Xu X, Huang XY, Xu RL, Lin SH. Risk factors and surgical interventions associated with primary postpartum haemorrhage unresponsive to first-line therapies. J OBSTET GYNAECOL 2014; 34:588-92. [DOI: 10.3109/01443615.2014.920310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Song D, Liu Y, Xiao Y, Li TC, Zhou F, Xia E. A matched cohort study comparing the outcome of intrauterine adhesiolysis for Asherman's syndrome after uterine artery embolization or surgical trauma. J Minim Invasive Gynecol 2014; 21:1022-8. [PMID: 24842805 DOI: 10.1016/j.jmig.2014.04.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To compare the outcome of hysteroscopic adhesiolysis in women who had Asherman's syndrome after uterine artery embolization (UAE) with those who had Asherman's syndrome caused by surgical trauma. DESIGN A retrospective cohort study matched for age and intrauterine adhesion score (Canadian Task Force classification II-2). SETTING A tertiary hysteroscopic center in a teaching hospital. PATIENTS Nineteen women with Asherman's syndrome after UAE and 57 women with Asherman's syndrome caused by surgical trauma. INTERVENTIONS Hysteroscopic adhesiolysis was followed by a second-look hysteroscopy 1 month later. The scoring system proposed by the American Fertility Society was used to evaluate intrauterine adhesion during hysteroscopy. MEASUREMENTS AND MAIN RESULTS In the UAE group, only 42.1% of women experienced improvement in menstruation defined as a subjective increase in menstrual flow after surgery, which was significantly lower than that of 86.0% observed in the non-UAE group. In the UAE group, the reduction of the American Fertility Society (AFS) score after intrauterine adhesiolysis was 30%, which was significantly lower than that of 80% in the non-UAE group. The pregnancy rate and live birth rate in the UAE group (5% and 0%, respectively) were significantly lower than the corresponding rates in the non-UAE group (33% and 25%, respectively). CONCLUSION The outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome after UAE was worse than in women with Asherman's syndrome caused by surgical trauma.
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Affiliation(s)
- Dongmei Song
- Department of Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China; Department of Reproductive Medicine and Surgery, Jessop Wing, Royal Hallamshire Hospital, University of Sheffield, UK
| | - Yuhuan Liu
- Department of Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yu Xiao
- Department of Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Tin-Chiu Li
- Department of Reproductive Medicine and Surgery, Jessop Wing, Royal Hallamshire Hospital, University of Sheffield, UK; Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong, China
| | - Fengqiong Zhou
- Department of Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Enlan Xia
- Department of Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China.
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Torre A, Paillusson B, Fain V, Labauge P, Pelage JP, Fauconnier A. Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms. Hum Reprod 2014; 29:490-501. [DOI: 10.1093/humrep/det459] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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David M, Kröncke T. Uterine Fibroid Embolisation - Potential Impact on Fertility and Pregnancy Outcome. Geburtshilfe Frauenheilkd 2013; 73:247-255. [PMID: 26633901 PMCID: PMC4647484 DOI: 10.1055/s-0032-1328318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The current standard therapy to treat myomas in women wishing to have children consists of minimally invasive surgical myomectomy. Uterine artery embolisation (UAE) has also been discussed as another minimally invasive treatment option to treat myomas. This review evaluates the literature of the past 10 years on fibroid embolisation and its impact on fertility and pregnancy. Potential problems associated with UAE such as radiation exposure of the ovaries, impairment of ovarian function and the impact on pregnancy and child birth are discussed in detail. Previously published reports of at least 337 pregnancies after UAE were evaluated. The review concludes that UAE to treat myomas can only be recommended in women with fertility problems due to myomas who refuse surgery or women with an unacceptably high surgical risk, because the evaluated case reports and studies show that UAE significantly increases the risk of spontaneous abortion; there is also evidence of pathologically increased levels for other obstetric outcome parameters. There are still very few prospective studies which provide sufficient evidence for a definitive statement on the impact of UAE therapy on fertility rates and pregnancy outcomes.
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Affiliation(s)
- M David
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - T Kröncke
- Klinik für Radiologie, Charité Universitätsmedizin Berlin, Berlin, Germany
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31
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Levy G, Hill MJ, Beall S, Zarek SM, Segars JH, Catherino WH. Leiomyoma: genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet 2012; 29:703-12. [PMID: 22584729 DOI: 10.1007/s10815-012-9784-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/24/2012] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Uterine leiomyomas are common, benign, reproductive tract tumors affecting a majority of reproductive aged women. They are associated with gynecologic morbidity and detrimentally affect reproductive potential. The etiology of leiomyomas is poorly understood and their diagnosis prior to treatment with Assisted Reproductive Technologies (ART) represents a management dilemma. The purpose of this paper is to review known genetic and molecular contributions to the etiologies of leiomyomas, describe their impact on ART outcomes and reproductive potential, and review alternative therapies and future directions in management. METHODS A critical review of the literature pertaining to genetic component of uterine leiomyomas, their impact on ART and pregnancy and leiomyoma therapeutics was performed. RESULTS Uterine leiomyomas are characterized by complex molecular mechanisms. Their location and size determines their potential detriment to ART and reproductive function and novel therapeutic modalities are being developed. CONCLUSION The high prevalence of uterine leiomyomas and their potential detrimental influence on ART and reproductive function warrants continued well-designed studies to ascertain their etiology, optimal treatment and novel less morbid therapies.
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Affiliation(s)
- Gary Levy
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Bethesda, MD, USA.
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32
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Mara M, Horak P, Kubinova K, Dundr P, Belsan T, Kuzel D. Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 2012; 38:823-31. [PMID: 22413922 DOI: 10.1111/j.1447-0756.2011.01782.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Several atypical hysteroscopy findings have been described in association with uterine artery embolization (UAE). The purpose of this study was to evaluate the types and frequency of these findings in the largest published series of patients. MATERIAL AND METHODS Premenopausal patients after bilateral UAE for symptomatic intramural fibroid underwent subsequent hysteroscopic examination 3-9 months following UAE. The uterine cavity was examined with focus on specific post-embolization changes. Biopsy of endometrium was obtained and evaluated together with a biopsy of abnormal foci if present. RESULTS UAE was performed in a total of 127 women with an average size of dominant fibroid 63.1 mm in diameter and an average patient age of 35.1 years. Even though the majority of patients were asymptomatic at the time of hysteroscopy (78.0%), the post-embolization hysteroscopic examination was normal in only 51 patients (40.2%). The most frequent abnormalities included tissue necrosis (52 women, 40.9%), intracavitary myoma protrusion (45 women, 35.4%), endometrium 'spots' (22.1%), intrauterine synechiae (10.2%) and 'fistula' between the uterine cavity and intramural fibroid (6.3%). Histopathological examination showed normal, secretory or proliferative endometrium in 83.5% patients. Necrosis and/or hyalinization prevailed in the results of biopsy of abnormal loci (45 cases, 35.4%). CONCLUSION Frequency of abnormal hysteroscopic findings several months after UAE for primary intramural myomas is high. Alarmingly high is the percentage of patients with a histopathologically verified necrosis. Performing hysteroscopy in selected patients after UAE is necessary before eventual surgical re-intervention, especially in women with reproductive plans.
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Affiliation(s)
- Michal Mara
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
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33
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Maegawa M, Mitani R, Miyatani Y, Ueta S, Endo S, Senuma M, Sakamoto Y, Kamada M, Irahara M. A case of placental polyp treated with an intraoperative injection of prostaglandin F 2α followed by hysteroscopic resection. Reprod Med Biol 2011; 11:105-108. [PMID: 29699115 DOI: 10.1007/s12522-011-0116-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 11/24/2011] [Indexed: 11/25/2022] Open
Abstract
A 27-year-old woman had massive genital bleeding after an artificial abortion. Color Doppler ultrasonography showed a hypervascular mass. Hysteroscopy revealed a placental polyp. Serum hemoglobin level was decreased to 7.7 g/dl. Although uterine artery embolization (UAE) followed by hysteroscopic resection has been used for treatment of a placental polyp, UAE may not be an ideal option for patients with intent for future pregnancy because of the risk of ovarian function failure. This report presents a case of a placental polyp managed successfully with intracervical injection of prostaglandin F2α, as an alternative UAE, followed by hysteroscopic resection.
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Affiliation(s)
- Masahiko Maegawa
- Department of Obstetrics and Gynecology Tokushima Prefectural Central Hospital 1-10-3 Kuramoto-cho 770-8539 Tokushima Japan
| | - Ryuji Mitani
- Department of Obstetrics and Gynecology Tokushima Prefectural Central Hospital 1-10-3 Kuramoto-cho 770-8539 Tokushima Japan
| | - Yuka Miyatani
- Department of Obstetrics and Gynecology Tokushima Prefectural Central Hospital 1-10-3 Kuramoto-cho 770-8539 Tokushima Japan
| | - Saki Ueta
- Department of Obstetrics and Gynecology Institute of Health Biosciences, The University of Tokushima Graduate School 770-8503 Tokushima Japan
| | - Satoko Endo
- Endo's Clinic for Women 779-3233 Tokushima Japan
| | | | | | - Masaharu Kamada
- Department of Obstetrics and Gynecology Health Insurance Naruto Hospital 772-8503 Tokushima Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology Institute of Health Biosciences, The University of Tokushima Graduate School 770-8503 Tokushima Japan
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34
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Uteroenteric fistula resulting from fibroid expulsion after uterine fibroid embolization: case report and review of the literature. Cardiovasc Intervent Radiol 2011; 35:1231-6. [PMID: 22159908 DOI: 10.1007/s00270-011-0318-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
Abstract
A 44-year-old woman underwent uncomplicated uterine fibroid embolization (UFE) for menstrual and bulk-related symptoms in an enlarged, myomatous uterus. After surgery, she spontaneously sloughed a large mass of fibroids that arrested in the cervical canal during passage. Four days after gynecological extraction, she developed copious vaginal discharge that contained enteric contents. Contrast-enhanced computed tomography (CT) demonstrated a fistula between the small bowel and the uterus. She subsequently underwent hysterectomy, left oophorectomy, and small-bowel resection. Her postoperative recovery was uneventful.
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35
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Wu CC, Lee MH. Transcatheter arterial embolotherapy: a therapeutic alternative in obstetrics and gynecologic emergencies. Semin Intervent Radiol 2011; 23:240-8. [PMID: 21326770 DOI: 10.1055/s-2006-948761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Transcatheter arterial embolization has become a major treatment modality in a variety of clinical applications, including management of bleeding related to a broad spectrum of obstetric and gynecologic disorders. Embolotherapy has a well-documented role in the management of pelvic and genital tract hemorrhage in the postpartum and postoperative/postcesarean setting. It is also an integral part in the treatment armamentarium of abdominal and cervical ectopic pregnancy, arteriovenous malformation, and gynecologic neoplasms, including more recently, uterine leiomyomata. Based on experiences accumulated over the past decades, embolotherapy has been proven to be highly effective with success rate in the 90 to 100% range in the appropriate clinical settings. It provides visualization of the bleeding site and enables targeted, minimally invasive therapy to achieve hemostasis, which allows preservation of the uterus and hence fertility. In hospitals where experienced personnel and technology is available, transcatheter arterial embolization should be considered in the emergent management of obstetric and gynecologic hemorrhage, particularly when local and conservative measures fail to attain hemostasis.
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Affiliation(s)
- Carol C Wu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
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36
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Schirf BE, Vogelzang RL, Chrisman HB. Complications of uterine fibroid embolization. Semin Intervent Radiol 2011; 23:143-9. [PMID: 21326757 DOI: 10.1055/s-2006-941444] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Uterine fibroid embolization (UFE) is an increasingly popular, minimally invasive treatment option for women with symptomatic fibroid disease. UFE therapy in qualified hands is an effective, well-tolerated procedure that offers relief of fibroid symptoms with a low risk of complications. In the acute postprocedural period, immediate complications may relate to vascular access, thromboembolic events, infection, and pain management. Reported major complications include but are not limited to pulmonary embolus, uterine ischemia, necrosis, sepsis, and death. Non-life-threatening complications include altered ovarian and sexual function, subcutaneous tissue necrosis, expulsion of fibroid tissue, and treatment failure. Awareness of the known complications of UFE may allow more rapid diagnosis and effective therapeutic responses to complications when they occur.
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Affiliation(s)
- Brian E Schirf
- Department of Radiology, Northwestern University, Chicago, Illinois
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37
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Bilbao JI, Martínez-Cuesta A, Urtasun F, Cosín O. Complications of embolization. Semin Intervent Radiol 2011; 23:126-42. [PMID: 21326756 DOI: 10.1055/s-2006-941443] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Embolization is a remarkably versatile procedure used in nearly all vascular and nonvascular systems to treat a wide range of pathology. The published literature is rich with studies demonstrating the enormous therapeutic potential offered by embolization procedures, and the possibilities continue to expand with the advent of new embolization agents and techniques. Unfortunately, with this variety and innovation comes a wide spectrum of potential complications, not always easy to classify and summarize, associated with embolization. This article reviews the procedures and associated complications of arterial and venous embolization procedures, organized by vascular distribution.
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Affiliation(s)
- José I Bilbao
- Department of Radiology, Clínica Universitaria de Navarra, Pamplona, Spain
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38
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Uterine Artery Embolization for Symptomatic Adenomyosis: A New Technical Development of the 1-2-3 Protocol and Predictive Factors of MR Imaging Affecting Outcomes. J Vasc Interv Radiol 2011; 22:497-502. [DOI: 10.1016/j.jvir.2011.01.426] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 12/16/2010] [Accepted: 01/02/2011] [Indexed: 11/23/2022] Open
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39
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Wang Y, Xu B, Dai S, Zhang Y, Duan Y, Sun C. An efficient conservative treatment modality for cervical pregnancy: angiographic uterine artery embolization followed by immediate curettage. Am J Obstet Gynecol 2011; 204:31.e1-7. [PMID: 20889136 DOI: 10.1016/j.ajog.2010.08.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 07/10/2010] [Accepted: 08/26/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to evaluate a conservative treatment modality, angiographic uterine artery embolization (UAE) followed by immediate curettage, in the treatment of cervical pregnancy. STUDY DESIGN Sixteen patients with cervical pregnancy were first treated by UAE to control or prevent vaginal bleeding. Curettage of cervical canal was performed immediately after UAE to remove gestational tissue from the cervix. Clinical outcome assessments include vaginal bleeding, serum β-human chorionic gonadotropin level, cervical mass, menstruation, fertility, and hospitalization time. RESULTS Fifteen patients were successfully treated by UAE followed by immediate curettage. One patient at very early gestational age underwent UAE only. Quick regression of serum human chorionic gonadotropin level and cervical mass, fertility preservation, and a short hospital stay were observed. CONCLUSION UAE followed by immediate curettage is an efficient conservative treatment for cervical pregnancy. This procedure may become a useful alternative to other conservative approaches.
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Affiliation(s)
- YanKui Wang
- Department of Obstetrics and Gynecology, the Affiliated Hospital of Medical College, Qingdao University, People's Republic of China
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40
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41
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Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 2010; 94:324-30. [DOI: 10.1016/j.fertnstert.2009.02.069] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 01/21/2009] [Accepted: 02/25/2009] [Indexed: 10/20/2022]
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42
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Long-term effects of uterine fibroid embolization on ovarian reserve: a prospective cohort study. Fertil Steril 2010; 94:2296-300. [PMID: 20074724 DOI: 10.1016/j.fertnstert.2009.12.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 11/30/2009] [Accepted: 12/01/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether uterine fibroid embolization may advance ovarian follicular depletion in reproductive-aged women with apparently normal baseline ovarian function. DESIGN Prospective cohort study. SETTING University tertiary care center. PARTICIPANT(S) Thirty-six patients aged 26 to 39 years with fibroids, regular menstrual cycles, and day 3 serum FSH levels<10 mIU/mL and 36 matched control women. INTERVENTION(S) Day 3 serum FSH and E2 levels and ultrasound-based antral follicle count and ovarian volume were determined before (baseline) and at 12, 24, 36, 48, and 60 months after embolization and compared with those of the control group. Menstrual status was determined annually on the basis of prospectively recorded menstrual calendars. MAIN OUTCOME MEASURE(S) Longitudinal changes in hormone levels, ultrasound measures, and bleeding patterns. RESULT(S) Although the FSH and E2 levels increased significantly and the antral follicle count and ovarian volume values declined significantly over time within the groups, no significant differences were found between the groups. The cycle remained regular in all but two women (one in the embolization group and one in the control group), who started having cycle irregularity after 24 months and 36 months follow-up, respectively. CONCLUSION(S) This long-term follow-up study suggests that fibroid embolization does not lead to an accelerated decline in ovarian reserve in younger patients.
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44
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Uterine fibroid embolization imaging: interventionalist's perspective. Ultrasound Q 2009; 25:185-94. [PMID: 19956051 DOI: 10.1097/ruq.0b013e3181c47de4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Uterine fibroid embolization (UFE) is a minimally invasive and well-accepted form of treatment for patients with symptoms from fibroids. Imaging is routinely performed before the procedure for various reasons and after the procedure in cases with either complications or incomplete response to UFE. The interventionalists performing the procedure require specific information from these imaging studies. This article describes the imaging workup of patients referred for UFE, specifically the information from these imaging examinations before the procedure that are necessary to the interventionalist and the complications seen after the procedure.
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45
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Ezzati M, Norian JM, Segars JH. Management of uterine fibroids in the patient pursuing assisted reproductive technologies. WOMEN'S HEALTH (LONDON, ENGLAND) 2009; 5:413-21. [PMID: 19586433 PMCID: PMC3444289 DOI: 10.2217/whe.09.29] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Uterine leiomyomas are present in 30-70% of women of reproductive age. In addition to causing menstrual disorders and pain, uterine fibroids negatively affect fertility and pregnancy outcome for patients pursuing assisted reproduction. The two questions that have to be addressed are: which fibroids should be treated and how should they be treated? Submucosal fibroids are associated with a 70% reduction in delivery rate. Intramural fibroids had a lesser effect and reduced the delivery rate by approximately 30%. By contrast, studies have demonstrated that subserosal fibroids did not negatively impact fertility. Furthermore, both submucosal and intramural fibroids were associated with an increased risk of spontaneous miscarriage. Myomectomy is considered the treatment of choice to alleviate these detrimental effects. Further research is needed before alternative treatments can be recommended.
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Affiliation(s)
- Mohammad Ezzati
- Department of Obstetrics & Gynecology, Washington Hospital Center, Washington, DC, USA.
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46
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Pinto Pabón I, Magret JP, Unzurrunzaga EA, García IM, Catalán IB, Cano Vieco ML. Pregnancy after uterine fibroid embolization: follow-up of 100 patients embolized using tris-acryl gelatin microspheres. Fertil Steril 2008; 90:2356-60. [DOI: 10.1016/j.fertnstert.2007.10.074] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 10/30/2007] [Accepted: 10/30/2007] [Indexed: 11/25/2022]
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47
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Bratby M, Belli AM. Radiological treatment of symptomatic uterine fibroids. Best Pract Res Clin Obstet Gynaecol 2008; 22:717-34. [DOI: 10.1016/j.bpobgyn.2008.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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48
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Vidal L, Michel ME, Gavillon N, Derniaux E, Quereux C, Graesslin O. [Pregnancy after uterine-artery embolization for symptomatic fibroids: a case of placenta accreta with uterine rupture]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2008; 37:811-4. [PMID: 18653292 DOI: 10.1016/j.jgyn.2008.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Revised: 06/17/2008] [Accepted: 06/18/2008] [Indexed: 10/21/2022]
Abstract
The evolution of pregnancies following uterine-artery embolisation (UAE) for symptomatic fibroids remains uncertain. We report a case of pregnancy after UAE, complicated of adherent placenta with uterine rupture, in a context of uterine leiomyomata with a prior cesarean delivery. Through a recent review of the literature, we discuss the main obstetrical complications following UAE. Appropriate management of these high-risk pregnancies, notably in case of risk of adherent placenta, seems to be necessary.
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Affiliation(s)
- L Vidal
- Service de gynécologie-obstétrique, institut Mère-Enfant-Alix-de-Champagne, centre hospitalier universitaire, 1-5, rue de l'Université, 51092 Reims cedex, France
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Laurent A, Pelage JP, Wassef M, Martal J. Fertility after bilateral uterine artery embolization in a sheep model. Fertil Steril 2008; 89:1371-83. [PMID: 17531994 DOI: 10.1016/j.fertnstert.2007.03.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 03/16/2007] [Accepted: 03/16/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the impact of bilateral uterine artery embolization (UAE) upon fertility in sheep. DESIGN Prospective study. SETTING University-based interventional radiology, pathology, and reproductive physiology units. ANIMAL(S) Nineteen control ewes, 10 ewes embolized with polyvinyl alcohol particles (PVA group), and 10 ewes embolized with Tris-acryl gelatin microspheres (TGMS group). INTERVENTION(S) Bilateral UAE was performed with 600- to 1,000-mum PVA particles or 700- to 900-mum TGMS particles. Animals of three groups were synchronized and naturally inseminated. MAIN OUTCOME MEASURE(S) For each ewe, a hormonal follow-up was performed throughout the gestation. Gestation duration, number and weight of newborns, and fertility and gestation rates were recorded. RESULT(S) Mean number of estrus before insemination and gestation duration were not different between groups. There were 47 living newborns: 26 control, 9 PVA, and 12 TGMS. Overall birth weight of newborns was 3.7 +/- 0.9 kg for controls, 3.6 +/- 1.1 kg for TGMS, and 2.2 +/- 0.7 kg for PVA (which was statistically significant vs. control). In the PVA group, there was a statistically significant decrease of fertility rate and gestation rate vs. controls, but this was not the case in the TGMS group. CONCLUSION(S) Particles of PVA decrease fertility in sheep and lead to intrauterine growth retardation.
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Affiliation(s)
- Alexandre Laurent
- Department of Interventional Neuroradiology, Lariboisière Hospital, Paris, France.
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50
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Manchanda R, Palep-singh M, Prentice A. Can uterine artery embolisation affect endometrial perfusion and function. J OBSTET GYNAECOL 2008; 28:246-8. [DOI: 10.1080/01443610801967000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R. Manchanda
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
| | - M. Palep-singh
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
| | - A. Prentice
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
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