Systematic review of reproductive outcomes after High Intensity Focused Ultrasound treatment of uterine fibroids.

Autor: Anneveldt KJ; Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands; Department of Gynecology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands. Electronic address: k.j.anneveldt@isala.nl., van 't Oever HJ; Department of Emergency Medicine, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands., Nijholt IM; Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands., Dijkstra JR; Department of Gynecology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands., Hehenkamp WJ; Department of Gynecology, Amsterdam University Medical Centre, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands., Veersema S; Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands., Huirne JAF; Department of Gynecology, Amsterdam University Medical Centre, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands., Schutte JM; Department of Gynecology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands., Boomsma MF; Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of radiology [Eur J Radiol] 2021 Aug; Vol. 141, pp. 109801. Date of Electronic Publication: 2021 May 27.
DOI: 10.1016/j.ejrad.2021.109801
Abstrakt: Purpose: Myomectomy is currently the gold standard for the treatment of uterine fibroids in women who desire pregnancy. However, this surgical fibroid removal has a long convalescence. Promising alternatives may be non-invasive High Intensity Focused Ultrasound (HIFU) under either MRI (MR-HIFU) or ultrasound guidance (USgHIFU). In this systematic review, an overview is provided of reproductive outcomes after these two relatively new ablation techniques.
Method: A systematic literature search was performed to identify studies reporting reproductive outcomes after HIFU treatment of fibroids. Only peer reviewed, full papers were included. Outcomes included pregnancy-, live-birth- miscarriage and caesarian section rate, time to conceive, reported complications, and possible prognostic factors.
Results: In total 21 studies were included. Fourteen studies reported 124 pregnancies after MR-HIFU. Two placenta previas and no uterus ruptures were reported. Pregnancy rates were only retrospectively collected and ranged between 7% and 36%. Miscarriage rate in the oldest and largest prospective registry was 39%. After USgHIFU 366 pregnancies were reported with one fetal intrauterine death, six placenta previas and no uterus ruptures. The only prospective study reported a pregnancy rate of 47% and a miscarriage rate of 11%. Possible prognostic factors like age were not available in most studies.
Conclusions: Based on the heterogeneous data currently available, reproductive outcomes after HIFU appear non-inferior to outcomes after the current standard of care. However, a (randomized) controlled trial comparing reproductive outcomes after HIFU and standard care is necessary to provide sufficient evidence on the preferred fibroid treatment for women with a pregnancy wish.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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