Uterine artery embolization for fibroids is associated with an increased risk of miscarriage.
OBJECTIVE
To investigate how uterine artery embolization (UAE) might alter the risk profile for pregnancies complicated by fibroids.


METHODS
Systematic literature review and meta-analysis of existing studies.


METHODS
Academic reproductive medicine unit.


METHODS
Women with fibroids.


METHODS
A systematic literature review, raw data extraction, and data analysis.


METHODS
Rates of miscarriage, preterm delivery, malpresentation, intrauterine growth restriction (IUGR), cesarean delivery, and postpartum hemorrhage (PPH).


RESULTS
Two hundred twenty-seven completed pregnancies after UAE were identified. Miscarriage rates were higher in UAE pregnancies (35.2%) compared with fibroid-containing pregnancies matched for age and fibroid location (16.5%) (odds ratio [OR] 2.8; 95% confidence interval [CI] 2.0-3.8). The UAE pregnancies were more likely to be delivered by cesarean section (66% vs. 48.5%; OR 2.1; 95% CI 1.4-2.9) and to experience PPH (13.9% vs. 2.5%; OR 6.4; 95% CI 3.5-11.7). Rates of preterm delivery (14% vs. 16%; OR 0.9; 95% CI 0.5-1.5), IUGR (7.3% vs. 11.7%; OR 0.6; 95% CI 0.3-1.3), and malpresentation (10.4% vs. 13%; OR 0.8; 95% CI 0.4-1.5) were similar in UAE pregnancies and in control pregnancies with fibroids.


CONCLUSIONS
The risk of miscarriage seems to be increased after UAE. In contrast, apart from an increased risk of abdominal delivery and PPH, critical adverse obstetric sequelae of IUGR and prematurity appear no more likely after UAE.
Department of Obstetrics & Gynaecology, Institute for Women's Health, University College London Hospitals, London, United Kingdom. h.homer@ucl.ac.uk
Hayden
H
Homer
Ertan
E
Saridogan
D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects*