PREGNANCY AFTER UTERINE
FIBROID EMBOLIZATION
(UFE)
João Martins Pisco, MD, PhD
Interventional Radiologist
St. Louis Hospital
• Marisa Duarte, MD
– Interventional Radiologist
• Tiago Bilhim, MD
– Interventional Radiologist
Saint Louis Hospital – Interventional
Radiology
Lisbon, Portugal
www.hospstlouis.com
Faculty of Medical Sciences
New University of Lisbon
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
UTERINE FIBROIDS
CLINICAL PRESENTATION
• HEAVY
MENSTRUAL
BLEEDING
• PELVIC PAIN
• A CAUSE OF
INFERTILITY OR
SPONTANEOUS
ABORTION
• ASYMPTOMATIC
HOW TO TREAT UTERINE
FIBROIDS?
• MEDICINE DRUGS:
– PILL
– ANTI - INFLAMMATORY
– HORMONES
• SURGERY:
– MYOMECTOMY
– HYSTERECTOMY
• UFE
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
PREGNANCY AFTER UFE
 A.C.O.G. (2004) – UFE CONTRAINDICATED IF
PT WISHES CONCEPTION
 LIMITED DATA ON FERTILITY RATE AND
PREGNANCY OUTCOMES AFTER UFE
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
CLINICAL DATA OF SUCCESSFUL
LIVE BIRTH PREGNANCIES (N=30)
 AGE – 27 – 43 YEARS
(MEAN 36.2)
 UTERUS SIZE – 69 - 1450 CC
(MEAN 343)
 DOMINANT FIBROID SIZE – 39 - 1280 CC
(MEAN 151)
 SPONTANEOUS ABORTION BEFORE UFE – 11 (5
PATIENTS)
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
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 2 - 3 WEEKS),
EXTREME ANEMIA (NEEDED PERIODICALLY IRON
TRANSFUSION), PAIN AND LARGE BELLY
• SHE HAD 2 UNSUCCESSFUL MYOMECTOMIES AND 3
IN VITRO FERTILIZATION
• HYSTERECTOMY BOOKED!
UFE 1ST - CASE
• UFE: JUNE 24, 2004
– BLEEDING AND PAIN FINISHED
– THE ANEMIA WAS CURED
– HER HUGE BELLY DECREASED
• MAY 2006 - PREGNANCY
• FEBRUARY 2007 - CESAREAN DELIVERY (38
WEEKS OF PREGNANCY); DAUGHTER
CATARINA WITH 2.800KG
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”
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
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
• www.sirweb.org
WHAT IS AN INTERVENTIONAL
RADIOLOGIST
• ARE BOARD
CERTIFIED
PHYSICIANS WHO
SPECIALIZE IN
MINIMALLY INVASIVE
TARGETED
TREATMENTS
• USING CATHETERS
GUIDED BY IMAGING
EQUIPAMENT
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
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
• WWW.SIRWEB.ORG
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
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
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%)
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
5 PREGNANT WOMEN. WHOSE PREGNANCY WAS
POSSIBLE ONLY AFTER UFE
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