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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 www.hospstlouis.com.

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PREGNANCY AFTER UTERINE FIBROID EMBOLIZATION ( UFE)

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Pregnancy after uterine fibroid embolization ufe l.jpg

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

      www.hospstlouis.com

St. Louis Hospital

Faculty of Medical Sciences

New University of Lisbon


Uterine fibroids l.jpg

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 l.jpg

UTERINE FIBROIDSCLINICAL PRESENTATION

  • HEAVY MENSTRUAL BLEEDING

  • PELVIC PAIN

  • A CAUSE OF INFERTILITY OR SPONTANEOUS ABORTION

  • ASYMPTOMATIC


How to treat uterine fibroids l.jpg

HOW TO TREAT UTERINE FIBROIDS?

  • MEDICINE DRUGS:

    • PILL

    • ANTI - INFLAMMATORY

    • HORMONES

  • SURGERY:

    • MYOMECTOMY

    • HYSTERECTOMY

  • UFE


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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


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PREGNANCY AFTER UFE

  • A.C.O.G. (2004) – UFE CONTRAINDICATED IF PT WISHES CONCEPTION

  • LIMITED DATA ON FERTILITY RATE AND PREGNANCY OUTCOMES AFTER UFE


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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


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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 l.jpg

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


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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!


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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


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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”


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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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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


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WHAT IS AN INTERVENTIONAL RADIOLOGIST

  • ARE BOARD CERTIFIED PHYSICIANS WHO SPECIALIZE IN MINIMALLY INVASIVE TARGETED TREATMENTS

  • USING CATHETERS GUIDED BY IMAGING EQUIPAMENT


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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


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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


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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


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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


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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%)


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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


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5 PREGNANT WOMEN. WHOSE PREGNANCY WAS POSSIBLE ONLY AFTER UFE


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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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