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PREGNANCY AFTER UTERINE FIBROID EMBOLIZATION (UFE) João Martins Pisco, MD, PhD Interventional Radiologist Marisa Duarte, MD –Interventional Radiologist.

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Presentation on theme: "PREGNANCY AFTER UTERINE FIBROID EMBOLIZATION (UFE) João Martins Pisco, MD, PhD Interventional Radiologist Marisa Duarte, MD –Interventional Radiologist."— Presentation transcript:

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

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

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 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 MATERIAL – 743 PATIENTS

8 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) CLINICAL DATA OF SUCCESSFUL LIVE BIRTH PREGNANCIES (N=30)

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 “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” UFE 1ST - CASE

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

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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 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 UFE MAY BE THE SINGLE EFFECTIVE TREATMENT

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 PERFORMED: –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

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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


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