Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

Evaluating pregnancy outcomes in women with uterine fibroids treated with high-intensity focused ultrasound: insights from a single-institution study

OBJECTIVE

This study aims to assess the safety and effectiveness of High-Intensity Focused Ultrasound (HIFU) ablation on pregnancy outcomes among women with uterine fibroids wishing to conceive, focusing specifically on short-term pregnancy outcomes immediately following HIFU treatment.

METHODS

A retrospective analysis was conducted on 210 women who underwent HIFU treatment (Group I) at our institution between January 2018 and December 2022 and subsequently conceived. Pregnancy outcomes were compared with two control groups: 510 patients who delivered vaginally (Group II) and 278 who underwent cesarean sections (Group III) during the same period. Statistical analyses included multivariable logistic regression to adjust for confounding factors. The study only considered outcomes related to the immediate pregnancy following HIFU treatment and did not include data on subsequent pregnancies or long-term effects.

RESULTS

The natural conception rate post-HIFU was 93.81% (197/210), with a miscarriage rate of 19.05% (40/210). Group I had significantly lower rates of gestational diabetes mellitus (8.24%) and precipitate labor (0%) compared to Group II but higher rates of mild anemia (31.18%) and adherent placenta (10.59%). Compared to Group III, Group I had lower rates of gestational diabetes mellitus (8.24% vs. 20.86%) and moderate anemia (4.71% vs. 16.55%) but a higher incidence of premature rupture of membranes (18.82%). Neonates in Group I had lower birth weights compared to Groups II and III (p < 0.05), with no cases of low birth weight in Group I. Multivariable analysis identified fibroid location as a predictor of preterm birth, while maternal age and mode of delivery influenced the risk of incomplete uterine rupture.

CONCLUSION

HIFU ablation is a safe and effective fertility-preserving treatment for women with uterine fibroids, demonstrating favorable short-term pregnancy outcomes. It does not increase perinatal risks, but its impact on pregnancy duration and certain complications suggests that careful patient selection and management are crucial. Future studies should investigate the long-term effects of HIFU on subsequent pregnancies.

Impact of ultrasound-guided high-intensity focused ultrasound for the treatment of uterine fibroids on ovarian reserve and quality of life: a single-center prospective cohort study

BACKGROUND

We aimed to evaluate changes in ovarian reserve and quality of life in women treated with ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids.

METHODS

In this single-center prospective study, a total of 69 patients with uterine fibroids treated with USgHIFU from October 2018 to November 2021 were enrolled. Fibroid volume, anti-Müllerian hormone (AMH) levels, uterine fibroid symptom scores, and uterine fibroid symptoms and quality of life (UFS-QOL) questionnaire scores before and 1, 3, and 6 months after USgHIFU treatment were analyzed. Correlations between AMH levels and age, fibroid type, and fibroid location were assessed.

RESULTS

Data from 54 of the 69 patients included in the present study were analyzed. The UFS-QOL scores at baseline and at 1 month and 6 months after USgHIFU treatment were 70 (50.75-87.50), 57 (44.75-80.00), and 52 (40.75-69.00) points, respectively (p < 0.001). The rate of fibroid volume reduction increased significantly at the 3-month follow-up compared with the 1-month follow-up (p < 0.001), and no significant change was observed between the 3-month and 6-month follow-ups (p > 0.99). The median AMH levels before and at 1, 3 and 6 months after treatment were 1.22 (0.16-3.28) ng/ml, 1.12 (0.18-2.52) ng/ml, 1.15 (0.19-2.08) ng/ml and 1.18 (0.36-2.43) ng/ml, respectively (p = 0.2). Multivariate linear regression analyses revealed that age was independently associated with AMH levels.

CONCLUSIONS

USgHIFU treatment for uterine fibroids can significantly improve quality of life with minimal adverse effects on ovarian function.

The role of VEGF and TGF-β blood levels for fibroid shrinkage, menorrhagia score, and quality of life improvement after uterine artery embolization for uterine fibroids: a study protocol

Uterine leiomyoma is a common condition affecting women that occurs in more than 70% of females. Women with leiomyomas overall have lower quality of life and deficiency in many specific spheres of life including work-related productivity, sexuality, relationships, social-emotional health, and physical well-being that might be present even in pre-and extended throughout early postmenopausal life. Choices for symptomatic fibroid management include medical, interventional radiology procedures, surgical, and expectant management. The uterine artery embolization (UAE) procedure has gained justified popularity for myoma management. Growth factors, vascular endothelial growth factor (VEGF) and tumor growth factor β (TGF-β), hold an important role in leiomyoma progression. However, blood levels of VEGF and TGF-β in patients before and after UAE are not fully investigated and the possible relationship with myoma shrinkage has not been evaluated. Therefore, this study aims to assess menorrhagia score and quality of life improvement after UAE for uterine fibroids and compare blood levels of VEGF and TGF-β in patients with uterine leiomyoma before and after UAE. This cross-sectional study will be performed at the University Medical Center, Astana, Kazakhstan. Women undergoing the UAE procedure for uterine leiomyoma will be involved in the study following the precisely defined inclusion/exclusion criteria. Uterine leiomyoma nodules' structural changes after UAE will be assessed along with the blood levels of growth factors (VEGF and TGF-β), menorrhagia score, and quality of life. An important outcome of this project will be an investigation of the blood levels of growth factors (VEGF and TGF-β) before and after the procedure and their association with leiomyoma shrinkage in correlation with the menorrhagia score and quality of life alterations among patients undergoing UAE.

Management of Uterine Fibroids and Sarcomas: The Palermo Position Paper

BACKGROUND

Uterine fibroids are benign monoclonal tumors originating from the smooth muscle cells of the myometrium, constituting the most prevalent pathology within the female genital tract. Uterine sarcomas, although rare, still represent a diagnostic challenge and should be managed in centers with adequate expertise in gynecological oncology.

OBJECTIVES

This article is aimed to summarize and discuss cutting-edge elements about the diagnosis and management of uterine fibroids and sarcomas.

METHODS

This paper is a report of the lectures presented in an expert meeting about uterine fibroids and sarcomas held in Palermo in February 2023.

OUTCOME

Overall, the combination of novel molecular pathways may help combine biomarkers and expert ultrasound for the differential diagnosis of uterine fibroids and sarcomas. On the one hand, molecular and cellular maps of uterine fibroids and matched myometrium may enhance our understanding of tumor development compared to histologic analysis and whole tissue transcriptomics, and support the development of minimally invasive treatment strategies; on the other hand, ultrasound imaging allows in most of the cases a proper mapping the fibroids and to differentiate between benign and malignant lesions, which need appropriate management.

CONCLUSIONS AND OUTLOOK

The choice of uterine fibroid management, including pharmacological approaches, surgical treatment, or other strategies, such as high-intensity focused ultrasound (HIFU), should be carefully considered, taking into account the characteristics of the patient and reproductive prognosis.

Uterine rupture in a term pregnancy after a previous uterine artery embolization to manage a large fibroid. A case report

Uterine artery embolization (UAE) is an effective minimally invasive alternative to surgery for the treatment of symptomatic uterine fibroids. Uterine rupture is an obstetrical emergency that requires early diagnosis and prompt management to improve perinatal and maternal outcomes. A 33-year-old woman at 37 weeks of gestation who had had previous two uncomplicated vaginal deliveries at term presented with abdominal pain and rupture of membranes. The patient had undergone UAE for the management of a large anterior wall uterine fibroid three years prior to conception. Vaginal examination revealed cord prolapse and ultrasound showed negative fetal heart. Intrauterine fetal demise with cord prolapse was diagnosed. After admission the patient developed vaginal bleeding and features of hypovolemic shock. Urgent laparotomy revealed a ruptured uterus with a large hemoperitoneum and dead fetus in the abdominal cavity. Obstetricians should be attentive to the possibility of a spontaneous uterine rupture in pregnant women who have previously undergone UAE for the management of a uterine fibroid.

Update on Endovascular Therapy for Fibroids and Adenomyosis

Uterine fibroids and adenomyosis are prevalent benign neoplasms that can lead to serious deleterious health effects including life-threatening anemia, prolonged menses, and pelvic pain; however, up to 40% of women remain undiagnosed. Traditional treatment options such as myomectomy or hysterectomy can effectively manage symptoms but may entail longer hospital stays and hinder future fertility. Endovascular treatment, such as uterine artery embolization (UAE), is a minimally invasive procedure that has emerged as a well-validated alternative to surgical options while preserving the uterus and offering shorter hospital stays. Careful patient selection and appropriate techniques are crucial to achieving optimal outcomes. There have been advancements in recent times that encompass pre- and postprocedural care aimed at enhancing results and alleviating discomfort prior to, during, and after UAE. Furthermore, success and reintervention rates may also depend on the size and location of the fibroids. This article reviews the current state of endovascular treatments of uterine fibroids and adenomyosis.

Occurrence of adverse events after magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) therapy in symptomatic uterine fibroids-a retrospective case-control study

OBJECTIVES

Our study aims at the comprehensive analysis of adverse events (AEs) in patients with symptomatic uterine fibroids (UFs) who underwent magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) in the last 6 years in one of the major Polish centers performing this type of therapy.

METHODS

The presented retrospective case-control study was conducted in the Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów in cooperation with the Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw. The study enrolled 372 women with symptomatic UFs who underwent MR-HIFU and reported AEs during or after the procedure. The occurrence of particular AEs was analyzed. Statistical comparison of two cohorts (patients with and without AEs) was conducted based on epidemiological factors, UF characteristics, fat layer thickness, the presence of abdominal scars and technical parameters of the procedure.

RESULTS

The overall mean occurrence rate of AEs was 8.9% (n = 33). No major AEs were reported. The only statistically significant risk factor of AEs was the treatment of type II UFs according to Funaki (OR 2.12, CI 95%, p = 0.043). Other investigated factors did not have a statistically significant influence on AE occurrence. Abdominal pain was the most common AE.

CONCLUSION

Our data showed that MR-HIFU seemed to be a safe procedure. The AE rate after the treatment is relatively low. According to the obtained data it seems that the occurrence of AEs does not depend on the technical parameters of the procedure and the volume, position and location of UFs. Further prospective, randomized studies and with long follow-up are necessary to confirm the final conclusions.