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Uterine Artery Embolisation May Adversely Affect Future Pregnancies

A paper to be published in The Obstetrician & Gynaecologist (TOG) examines the evidence on pregnancy outcomes following uterine artery embolisation (UAE), a treatment for fibroids.1 The authors underline the potential reproductive risks of UAE, and urge caution in recommending this treatment to women who wish to become pregnant in the future.

Uterine artery embolisation is a relatively new method for treating uterine fibroids.2 With the prevalence of fibroids being as high as 20-40% among women of reproductive age, this is a pressing issue as many women in the treatment population may not have completed their families.

The authors reviewed retrospective data and two small prospective trials of UAE versus surgical intervention (laparoscopic myomectomy). The results showed an increased risk of miscarriage, preterm birth, caesarean section, malpresentation and postpartum haemorrhage in pregnancies following UAE. Furthermore, the review found significantly higher miscarriage rates following UAE treatment for fibroids, than for women with untreated fibroids.

The authors note that the available data on pregnancy following UAE is limited. Nevertheless, in the absence of more robust evidence, they call for caution in recommending UAE to women still planning to become pregnant.

Co-author, Ertan Saridogan, consultant in reproductive medicine and minimal access surgery at Elizabeth Garrett Anderson Hospital, said "Uterine artery embolisation is a relatively new treatment option for uterine fibroids. Although a large number of women have already undergone this procedure, there is relatively limited information on its impact on a woman's future reproductive function.

"Our review on the outcome of pregnancies arising following uterine artery embolisation showed that they could be at increased risk for complications, especially miscarriage. Caution should be exercised when considering this treatment modality among women desirous of future pregnancies, particularly if alternative therapeutic options exist."

Jason Waugh, editor-in-chief of TOG, said "Studies have suggested that UAE is a safe and effective alternative to hysterectomy for alleviating fibroid-related disorders such as menorrhagia (heavy menstrual bleeding) and pressure symptoms. However, this study underlines the need for caution among women who still want to become pregnant.

"Patients with fibroids may experience painful symptoms and heavy, prolonged periods. Further research is needed in order to provide women with comprehensive information about the risks and benefits of available treatment options."

Notes

The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricans and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer-reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology. TOG is hosted online by Stanford University's HighWire Press at: http://onlinetog.org.

1 Uterine fibroids are benign tumours of the uterus. Symptoms caused by fibroids include abnormal bleeding, pelvic pressure and pain, and reproductive problems. Fibroids are common and are the most frequent reason for a woman to have a hysterectomy.

2 Uterine artery embolisation (UAE) is an alternative to hysterectomy for fibroids. It is a relatively new, nonsurgical treatment option. The procedure is performed under conscious sedation, and both uterine arteries are blocked with particles injected via the femoral and uterine arteries. This causes the fibroids to shrink.
News Source: medical news today



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