Radiofrequency Ablation of Uterine Fibroids and Pregnancy Outcomes: An Updated Review of the Literature

Abstract

Study Objective The purpose of this article is to provide an updated review of pregnancy outcomes after laparoscopic and transcervical radiofrequency ablation of fibroids. Design Literature review using PubMed/Medline. Setting N/A. Patients or Participants Patients were identified from case reports and case series of pregnancies following trials of radiofrequency ablation (RFA) devices for symptomatic uterine fibroids. The pregnancies identified represented large trials of laparoscopic and transcervical ablation from North America, Asia, Europe, and Latin America. Interventions Laparoscopic and transcervical radiofrequency ablation of fibroids. Measurements and Main Results 6 publications met criteria for inclusion, representing 11 clinical trials and 3 reports from real-world settings. 593 patients underwent RFA of fibroids, with 46 total pregnancies identified. The average age of patients was 39 years old and ranged from 27 to 46 years old. The majority of patients had between one and three fibroids ablated, and the size varied from less than 2 centimeters up to 12.5 centimeters. In terms of pregnancy outcomes, among the 46 total pregnancies, there were 4 spontaneous abortions, 7 elective terminations of pregnancy, and 35 term pregnancies with 17 vaginal and 18 cesarean deliveries. The patients who experienced spontaneous abortion were 36 to 38 years old. There was one complication after cesarean delivery presenting as postpartum hemorrhage with resultant expulsion of degenerated myoma with no long-term sequelae. There were no cases of uterine rupture, uterine window, placenta accreta, placental abruption, or fetal growth restriction. Conclusion The majority of patients who had documented pregnancies after radiofrequency ablation of fibroids had full-term deliveries with no maternal or neonatal complications. Given the inherent obstetric risks with myomectomy (e.g., risk of uterine rupture, intrauterine scarring, possible need for cesarean delivery, etc.), these findings add to the growing consensus that radiofrequency fibroid ablation may offer a safe and effective minimally invasive treatment alternative to women seeking uterine-sparing fibroid treatment to preserve fertility. The purpose of this article is to provide an updated review of pregnancy outcomes after laparoscopic and transcervical radiofrequency ablation of fibroids. Literature review using PubMed/Medline. N/A. Patients were identified from case reports and case series of pregnancies following trials of radiofrequency ablation (RFA) devices for symptomatic uterine fibroids. The pregnancies identified represented large trials of laparoscopic and transcervical ablation from North America, Asia, Europe, and Latin America. Laparoscopic and transcervical radiofrequency ablation of fibroids. 6 publications met criteria for inclusion, representing 11 clinical trials and 3 reports from real-world settings. 593 patients underwent RFA of fibroids, with 46 total pregnancies identified. The average age of patients was 39 years old and ranged from 27 to 46 years old. The majority of patients had between one and three fibroids ablated, and the size varied from less than 2 centimeters up to 12.5 centimeters. In terms of pregnancy outcomes, among the 46 total pregnancies, there were 4 spontaneous abortions, 7 elective terminations of pregnancy, and 35 term pregnancies with 17 vaginal and 18 cesarean deliveries. The patients who experienced spontaneous abortion were 36 to 38 years old. There was one complication after cesarean delivery presenting as postpartum hemorrhage with resultant expulsion of degenerated myoma with no long-term sequelae. There were no cases of uterine rupture, uterine window, placenta accreta, placental abruption, or fetal growth restriction. The majority of patients who had documented pregnancies after radiofrequency ablation of fibroids had full-term deliveries with no maternal or neonatal complications. Given the inherent obstetric risks with myomectomy (e.g., risk of uterine rupture, intrauterine scarring, possible need for cesarean delivery, etc.), these findings add to the growing consensus that radiofrequency fibroid ablation may offer a safe and effective minimally invasive treatment alternative to women seeking uterine-sparing fibroid treatment to preserve fertility.