Pregnancies and deliveries after MR-guided focused ultrasound surgery (MRgFUS) for the conservative treatment of symptomatic uterine fibroids. For the MRgFUS study group

Abstract

OBJECTIVE: Uterine fibroids can impair fertility and pregnancy outcome. Currently, myomectomy is the treatment of choice for clinically significant uterine fibroids for women who desire fertility. MR-guided focused ultrasound surgery (MRgFUS) is a method for the conservative non-invasive treatment of clinically significant uterine fibroids. The aim of the current study was to characterize pregnancies that occurred after MRgFUS treatment.DESIGN: Prospective follow-up of all reported pregnancies.MATERIALS AND METHODS: We report all known pregnancies following MRgFUS for uterine fibroids to centers world-wide. Each center contacted the relevant patient and obtained information about her pregnancy course, delivery and complications.RESULTS: Forty-five pregnancies occurred in 42 subjects (mean age: 37 + 4.6 years, time to conception: 0 to 30 months after MRgFUS). to date, eighteen (40%) healthy infants were delivered at term with a mean birth weight 3330 + 377 g. Nine additional pregnancies (20%) are on-going. Twelve first trimester spontaneous abortions (27%) and six induced abortions (13%) occurred in thirteen women. Of the eighteen women who already delivered, eleven (60%) had vaginal deliveries. Four significant postpartum complications occurred, two after vaginal delivery one case each of uterine revision and endometritis and two following cesarean section, a severe postpartum hemorrhage and ARDS following intraoperative myomectomy and a neonatal lung collapse.CONCLUSIONS: This first report on reproductive outcomes following MRgFUS demonstrates that women who undergo MRgFUS treatment for clinically significant uterine fibroids can achieve successful pregnancies and deliver healthy babies at term. Future studies will further examine the role and the long-term safety of MRgFUS. These results suggest that the self-imposed initial limitation on MRgFUS for women who plan future pregnancies should be reevaluated. OBJECTIVE: Uterine fibroids can impair fertility and pregnancy outcome. Currently, myomectomy is the treatment of choice for clinically significant uterine fibroids for women who desire fertility. MR-guided focused ultrasound surgery (MRgFUS) is a method for the conservative non-invasive treatment of clinically significant uterine fibroids. The aim of the current study was to characterize pregnancies that occurred after MRgFUS treatment. DESIGN: Prospective follow-up of all reported pregnancies. MATERIALS AND METHODS: We report all known pregnancies following MRgFUS for uterine fibroids to centers world-wide. Each center contacted the relevant patient and obtained information about her pregnancy course, delivery and complications. RESULTS: Forty-five pregnancies occurred in 42 subjects (mean age: 37 + 4.6 years, time to conception: 0 to 30 months after MRgFUS). to date, eighteen (40%) healthy infants were delivered at term with a mean birth weight 3330 + 377 g. Nine additional pregnancies (20%) are on-going. Twelve first trimester spontaneous abortions (27%) and six induced abortions (13%) occurred in thirteen women. Of the eighteen women who already delivered, eleven (60%) had vaginal deliveries. Four significant postpartum complications occurred, two after vaginal delivery one case each of uterine revision and endometritis and two following cesarean section, a severe postpartum hemorrhage and ARDS following intraoperative myomectomy and a neonatal lung collapse. CONCLUSIONS: This first report on reproductive outcomes following MRgFUS demonstrates that women who undergo MRgFUS treatment for clinically significant uterine fibroids can achieve successful pregnancies and deliver healthy babies at term. Future studies will further examine the role and the long-term safety of MRgFUS. These results suggest that the self-imposed initial limitation on MRgFUS for women who plan future pregnancies should be reevaluated.