1. PREGNANCY AFTER UTERINE FIBROID EMBOLIZATION (UFE)
PREGNANCY AFTER UTERINE FIBROID EMBOLIZATION (UFE)
João Martins Pisco, MD, PhD
Interventional Radiologist
Marisa Duarte, MD
Tiago Bilhim, MD
Saint Louis Hospital – Interventional Radiology
Lisbon, Portugal
St. Louis Hospital
Faculty of Medical Sciences
New University of Lisbon
SIR 2010

2. UTERINE FIBROIDS
UTERINE FIBROIDS OR MYOMAS ARE THE MOST FREQUENT BENIGN TUMOURS IN FERTILE AGE WOMEN
30% OF WOMEN OLDER THAN 35 YEARS OF AGE
50% OF AFRICANS SAME AGE

3. UTERINE FIBROIDS CLINICAL PRESENTATION
HEAVY MENSTRUAL BLEEDING
PELVIC PAIN
A CAUSE OF INFERTILITY OR SPONTANEOUS ABORTION
ASYMPTOMATIC

4. HOW TO TREAT UTERINE FIBROIDS?
MEDICINE DRUGS:
PILL
ANTI - INFLAMMATORY
HORMONES
SURGERY:
MYOMECTOMY
HYSTERECTOMY
UFE

5. INTRODUCTION
DESIRE FOR FUTURE PREGNANCY, IS A RELATIVE CONTRAINDICATION TO UTERINE FIBROID EMBOLIZATION (UFE)
MIOMECTOMY INDICATED
SOME REPORTED PREGNANCIES
HIGH COMPLICATION RATES
SOME OBSTETRIC RISKS

6. PREGNANCY AFTER UFE
A.C.O.G. (2004) – UFE CONTRAINDICATED IF PT WISHES CONCEPTION
LIMITED DATA ON FERTILITY RATE AND PREGNANCY OUTCOMES AFTER UFE

7. MATERIAL – 743 PATIENTS 82 – PRESERVE FERTILITY 74 WANTED PREGNANCY
NONE COULD GET A SUCCESSFUL PREGNANCY
WOMEN INFORMED OF THE UNCERTAIN EFFECT OF UFE ON FERTILITY AND PREGNANCY
AT LEAST 6 MONTHS BEFORE CONCEPTION

8. CLINICAL DATA OF SUCCESSFUL LIVE BIRTH PREGNANCIES (N=30)
AGE – 27 – 43 YEARS
(MEAN 36.2)
UTERUS SIZE – CC
(MEAN 343)
DOMINANT FIBROID SIZE – CC
(MEAN 151)
SPONTANEOUS ABORTION BEFORE UFE – 11 (5 PATIENTS)

9. UFE (UTERINE FIBROID EMBOLIZATION)
MAY BE THE UNIQUE EFFECTIVE TREATMENT FOR INFERTILE PATIENTS WITH UTERINE FIBROIDS
IN THE FUTURE, UFE MAY BE A FIRST LINE TREATMENT OPTION FOR THESE PATIENTS

10. UFE 1ST - CASE SC, 33 YEARS OLD, WANTED TO GET PREGNANT
SEVERAL UTERINE MYOMAS (THE LARGEST 2 HAD 10 AND 9 CM)
HEAVY BLEEDING (MENSTRUATION WEEKS), EXTREME ANEMIA (NEEDED PERIODICALLY IRON TRANSFUSION), PAIN AND LARGE BELLY
SHE HAD 2 UNSUCCESSFUL MYOMECTOMIES AND 3 IN VITRO FERTILIZATION
HYSTERECTOMY BOOKED!

11. UFE 1ST - CASE UFE: JUNE 24, 2004 BLEEDING AND PAIN FINISHED
THE ANEMIA WAS CURED
HER HUGE BELLY DECREASED
MAY PREGNANCY
FEBRUARY CESAREAN DELIVERY (38 WEEKS OF PREGNANCY); DAUGHTER CATARINA WITH 2.800KG

12. UFE 1ST - CASE
“EMBOLIZATION CHANGED MY LIFE, THE BLEEDING IS FINISHED, I KEEP PART OF MY BODY THAT GYNECOLOGIST WANTED TO BE REMOVED.
SINCE EMBOLIZATION I HAVE A COMPLETELY HEALTHY LIFE.
THE EMBOLIZATION GAVE ME THE BEST PRIZE, MY DEAR DAUGHTER CATARINA”

13. WHAT IS UFE?
UTERINE FIBROID EMBOLIZATION (UFE) IS A MINIMALLY INVASIVE PROCEDURE
TINY NICK IN THE SKIN, THE CATHETER IS GUIDED BY X-RAYS TO THE UTERINE ARTERY AND BLOCKS BLOOD SUPPLY TO UTERINE FIBROIDS
WITHOUT BLOOD THE MYOMA WILL SHRINK AND DIE
CAN BE PERFORMED AS OUTPATIENT PROCEDURE

15. WHO PERFORMS UFE? AN INTERVENTIONAL RADIOLOGIST
PERFORMS THE MOST ADVANCED AND LEAST INVASIVE TREATMENTS THAT REPLACE SURGERY
LESS RISK, LESS PAIN, LESS RECOVERY TIME
NO SCAR JUST A BANDAID

16. WHAT IS AN INTERVENTIONAL RADIOLOGIST
ARE BOARD CERTIFIED PHYSICIANS WHO SPECIALIZE IN MINIMALLY INVASIVE TARGETED TREATMENTS
USING CATHETERS GUIDED BY IMAGING EQUIPAMENT

17. HOW TO PERFORM UFE IF PATIENT WANTS TO GET PREGNANT?
LOW X-RAY TIME
EMBOLIZE THE LEAST POSSIBLE (ONLY TUMOR VESSELS)
KEEP THE UTERINE ARTERIES PERMEABLE
POLYVINYL ALCOHOL (PVA)
EMBOZENE MICROSPHERES

18. IF I DON’T WANT TO DO A SURGERY PROPOSED BY GYNECOLOGIST WHAT TO DO?
GET A 2ND OPINION WITH AN INTERVENTIONAL RADIOLOGIST
INTERVENTIONAL RADIOLOGISTS ARE WIDELY AVAILABLE THROUGHOUT THE USA

19. WHY TO TREAT FIBROIDS BEFORE PREGNANCY
UTERINE FIBROIDS:
MAY BE A CAUSE OF INFERTILITY
MAY INDUCE SPONTANEOUS ABORTION
INCREASE IN SIZE DURING PREGNANCY
HOWEVER, AFTER UFE, IN CASE OF PREGNANCY, THE FIBROIDS CONTINUE TO DECREASE IN SIZE

20. UFE MAY BE THE SINGLE EFFECTIVE TREATMENT
AFTER UNSUCCESSFUL MYOMECTOMY OR IN VITRO FERTILIZATION
HUGE OR MULTIPLE FIBROIDS
HYSTERECTOMY (UTERUS REMOVAL) THE ONLY OFFERED TREATMENT
MYOMECTOMY BUT EVENTUAL HISTERECTOMY CAN NOT BE RULED OUT

21. OUR RESULTS OF PREGNANCY AFTER UFE
PREGNANCIES – SPONTANEOUS (WITHOUT ASSISTED REPRODUCTION TECHNIQUES) IN 43 OF 74 WOMEN WHO WANT TO CONCEIVE (58.1%)
36 FINISHED PREGNANCIES (83.7%)
30 SUCCESSFUL LIFE BIRTHS (83.3%)
PRE TERM (36 WEEKS) 2 (6.6%)
5 ABORTIONS (13.8%)
1 INDUCED
4 SPONTANEOUS (13.3%)
1 STILLBIRTH (AFTER 5 MIOMECTOMIES, + 1 IVF CESAREAN AT 36 WEEKS)
7 ONGOING PREGNANCIES (16.3%)

22. TREATMENT PERFORMED OR OFFERED TO OUR PREGNANT WOMEN
MYOMECTOMY 16 (1-4) – 6 PATIENTS
FIV 7 (1-3) – 3 PATIENTS
OFFERED:
HISTERECTOMY – 9 PATIENTS
MIOMECTOMY – 11
HISTERECTOMY COULD NOT BE EXCLUDED IN 5 PATIENTS

23. 5 PREGNANT WOMEN. WHOSE PREGNANCY WAS POSSIBLE ONLY AFTER UFE

25. PREGNANCY AFTER UFE – CONCLUSION
UFE IS NOT A CONTRAINDICATION TO PATIENTS WHO WANT TO CONCEIVE
UFE MAY BE THE SINGLE EFFECTIVE TREATMENT FOR SUCCESSFUL PREGNANCIES IN SOME PATIENTS WITH UTERINE FIBROIDS
OUR RESULTS OF SUCCESSFUL PREGNANCIES AFTER UFE ARE COMPARABLE TO THOSE OF MIOMECTOMY
PATIENTS SHOULD BE ABLE TO CHOOSE BETWEEN SURGICAL OPTIONS AND UFE