Fibroid treatment may cause pregnancy problems

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A minimally invasive procedure called uterine artery embolization is an increasingly popular treatment for fibroids, common benign growths in the uterus. However, new research suggests that this procedure may make future pregnancies more difficult by increasing the risk of preterm delivery.

Typically, only fibroids that cause symptoms are treated. Such fibroids can be removed with an operation called myomectomy. The growths can also be “shrunk” with uterine artery embolization, which involves the injection of tiny particles to cut off the fibroid’s blood supply. These days, myomectomy is often performed with “keyhole,” or laparoscopic, surgery.

Women seeking treatment for fibroids and who want to become pregnant at a later date should be counseled about the possible risks associated with uterine artery embolization, lead author Dr. Jay Goldberg, from Jefferson Medical College in Philadelphia, and colleagues note.

The findings, which appear in the American Journal of Obstetrics and Gynecology, are based on a comparison of 53 pregnancies that occurred after uterine artery embolization and 139 that occurred after laparoscopic myomectomy. The researchers looked at a variety of complications, such as spontaneous abortion, preterm delivery, and an abnormally positioned fetus.

Compared with myomectomy, treatment with uterine artery embolization raised the risks of preterm delivery and an abnormally positioned fetus by 6.2- and 4.3-fold, respectively. Uterine artery embolization was also linked to higher rates of postpartum bleeding and spontaneous abortion, but these differences may have simply been a chance finding.

The investigators note that a forward-looking study directly comparing uterine artery embolization with myomectomy is needed before embolization can be considered a safe treatment for patients who plan to have children.

SOURCE: American Journal of Obstetrics and Gynecology, July 2004.

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