Uterine Fibroid Embolization in a Series of Women Older Than 50 Years: An Observational Study.

Objective: Women older than 50 years, and in particular postmenopausal, are not usually considered candidate for uterine artery embolization (UAE). We reviewed the outcome of UAE in a series of women older than 50 years, who presented with different symptoms of uterus enlargement. Population: Women referred to the radiologist from gynecologists in the United Kingdom with minimal age over 50 years. Methods: This is a retrospective observational study. The clinical criteria are women older than 50 years with symptoms related to large fibroids affecting their quality of life, who underwent UAE over a 4-year period at Royal Surrey Foundation Trust Hospital and London Clinic between 2012 and 2016. We retrieved the information from the patients' hospital notes and respective images, including magnetic resonance and ultrasound of the pelvis, and from questionnaires and telephone reviews. Main Outcome Measures: We measured the reduction of uterine size, complications, and overall satisfaction of patients. Results: The overall reduction of uterine size 8 weeks following UAE was between 50% and 64% in 12 out of 23 patients. Thirty-five percent of patients (8/23) experienced a reduction of over 65% of overall uterine volume. Only on 2 occasions, the reduction was below 50%. We asked the patients if they would recommend this operation. Twenty out of 23 would recommend it. Improvement of symptoms was measured with a scale between 0 and 5. Twelve out of 23 had total resolution of symptoms-no change in 1 case. One patient underwent a hysterectomy as symptoms persisted. Conclusions: In our series of women older than 50 years, UAE was an effective alternative to surgery, with reduction in fibroid size and improvement of symptoms.

Decidualisation of ovarian endometriomas in pregnancy: a management dilemma. A case report and review of the literature.

INTRODUCTION: Increased progesterone levels during pregnancy may cause decidualisation of endometriomas mimicking malignancies on radiology and causing management dilemmas. CASE: An ovarian cyst was detected in a 33-year-old woman at her routine 12-week gestation ultrasound scan. By 18 weeks, the unilocular mass was increasing in size with features suggestive of early ovarian malignancy. The cyst was monitored throughout pregnancy and caesarean section at 38 weeks delivered a healthy male. Histology confirmed a decidualised endometrioma and benign dermoid cyst with no evidence of malignancy. LITERATURE REVIEW: The evidence for decidualised ovarian endometriomas in pregnancy was explored; 14 papers were identified, which reported 26 cases, excluding our index case. Of the 27 cases, 19 (70%) were managed surgically, 4 of which were delayed till caesarean section with concomitant cyst excision; 8 cases were managed conservatively through serial monitoring of the cyst, which spontaneously regressed following delivery. CONCLUSION: Surgical management of the cyst provides histological diagnosis but may introduce risks to mother and fetus; a conservative approach may cause anxiety but limits interventions. Elective caesarean section following monitoring throughout pregnancy may bridge the gap between surgical and purely conservative approaches if appropriate. Limited available evidence makes a definitive decision regarding management difficult. Decidualisation should be considered as a differential for suspicious ovarian lesions in pregnancy.

Synchronous uterine artery embolization and laparoscopic myomectomy for massive uterine leiomyomas.

Uterine leiomyomas remain the commonest cause of menorrhagia and frequently cause pressure symptoms. Management of leiomyomas depends on the presenting symptoms, size, location, number of myomas, and the patient's desire to retain her uterus, fertility, or both. We present the first case of laparoscopic myomectomy for a fibroid measuring 30cm in maximum diameter.

Magnetic resonance imaging (MRI) analysis of fibroid location in women achieving pregnancy after uterine artery embolization.

The purpose of this study was to evaluate the fibroid morphology in a cohort of women achieving pregnancy following treatment with uterine artery embolization (UAE) for symptomatic uterine fibroids. A retrospective review of magnetic resonance imaging (MRI) of the uterus was performed to assess pre-embolization fibroid morphology. Data were collected on fibroid size, type, and number and included analysis of follow-up imaging to assess response. There have been 67 pregnancies in 51 women, with 40 live births. Intramural fibroids were seen in 62.7% of the women (32/48). Of these the fibroids were multiple in 16. A further 12 women had submucosal fibroids, with equal numbers of types 1 and 2. Two of these women had coexistent intramural fibroids. In six women the fibroids could not be individually delineated and formed a complex mass. All subtypes of fibroid were represented in those subgroups of women achieving a live birth versus those who did not. These results demonstrate that the location of uterine fibroids did not adversely affect subsequent pregnancy in the patient population investigated. Although this is only a small qualitative study, it does suggest that all types of fibroids treated with UAE have the potential for future fertility.

Pregnancy after uterine artery embolization for leiomyomata: a series of 56 completed pregnancies.

OBJECTIVE: This study was undertaken to evaluate the incidence and outcome of pregnancies after uterine artery embolization (UAE) for symptomatic uterine fibroids. STUDY DESIGN: A retrospective analysis of all pregnancies after UAE by a single interventional radiologist. RESULTS: Fifty-six completed pregnancies were identified in approximately 1200 women after UAE. One hundred eight patients were attempting to become pregnant and 33 of these became pregnant. Thirty-three (58.9%) of the 56 pregnancies had successful outcomes. Six (18.2%) of these were premature. Seventeen (30.4%) pregnancies miscarried. There were 3 terminations, 2 stillbirths, and 1 ectopic pregnancy. Of the 33 deliveries, 24 (72.7%) were delivered by cesarean section. There were 13 elective sections and the indication for 9 was fibroids. There were 6 cases of postpartum hemorrhage (18.2%). CONCLUSION: Compared with the general obstetric population, there is a significant increase in delivery by cesarean section and an increase in preterm delivery, postpartum hemorrhage, miscarriage, and lower pregnancy rates. When taking into account the demographics of the study population, these results can be partly explained. There were no other obstetric risk identified.

Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata.

Uterine artery embolization (UAE) is assuming an important role in the treatment of women with symptomatic uterine leiomyomata worldwide. The following guidelines, which have been jointly published with the Society of Interventional Radiology in the Journal of Vascular and Interventional Radiology, are intended to ensure the safe practice of UAE by identifying the elements of appropriate patient selection, anticipated outcomes, and recognition of possible complications and their timely address.

Persistent vaginal discharge after uterine artery embolization for fibroid tumors: cause of the condition, magnetic resonance imaging appearance, and surgical treatment.

OBJECTIVE: The purpose of this study was to establish the cause of and treatment for chronic vaginal discharge after uterine artery embolization. STUDY DESIGN: This was a retrospective review of the diagnosis and treatment of the procedure at 3 months. RESULTS: In 94% of patients, the condition either completely resolved or diminished to a nonproblematic level. CONCLUSION: The persistent discharge in these patients was due to a superficial cavity within the infarcted fibroid tumor that was communicating with the endometrial cavity through a hole in the endometrium. This situation is indicated by a specific appearance on TII sagittal magnetic resonance images. Hysteroscopic resection of the necrotic fibroid tumor cavity was usually curative.