Pregnancy Outcome After Magnetic Resonance-Guided Focused Ultrasound Surgery for Conservative Treatment of Uterine Fibroids

Abstract

Uterine fibroids (leiomyomata)—the most common tumors of the female reproductive tract—are associated with impaired fertility and specific complications of pregnancy. The fibroids are found in 20% to 25% in reproductive-age women. Surgical myomectomy is the treatment of choice for women who wish to remain fertile and there is long experience with this procedure. In some patients, however, rare but serious complications have been reported with surgical approaches. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a noninvasive myomaspecific treatment for symptomatic uterine fibroids that employs coagulative necrosis to destroy leiomyoma tissue. More than 4000 women have undergone MRgFUS globally, and the procedure has been reported to be safe and effective. This preliminary report reviews the outcome data of all known pregnancies occurring after MRgFUS recorded in a prospective registry maintained by the manufacturer and reported to the Food and Drug Administration. The database contains information on pregnancy outcomes from 13 sites in 7 countries. Outcome data were examined from 54 pregnancies of 51 mothers who had undergone MRgFUS treatment for symptomatic uterine leiomyomas. The mean time to pregnancy after the procedure was 8 ± 7 months (range, 0-30 months). Of the 54 pregnancies, 22 (41%) resulted in live births and 11 (20%) were ongoing >20 weeks. The spontaneous abortion rate was 27% and the rate of therapeutic abortion was 11%. The mean birth weight was 3.3 kg and 64% of the women had a vaginal delivery. These findings demonstrate that both normal vaginal deliveries and outcomes are possible following MRgFUS, which is reassuring information for pregnant women who wish to conceive after the procedure.