Reply of the authors:

Abstract

The letter from Doctor Vashisht and colleagues, reporting another case of uterine artery embolization (UAE) for fibroids followed by a normal pregnancy and a normal baby delivered by cesarean section, is interesting. It is difficult to draw exact parallels between UAE and ligation of iliac and ovarian arteries, since the mechanisms of collateral blood supply are likely to be different and the same applies to comparisons with animal experiments. In the latter the blood supply is interrupted during the course of pregnancy. Acute experiments of this type cannot be extrapolated to women who have undergone UAE or vessel ligations prior to pregnancy. Comparisons with species like rats in which the anatomy and physiology are so different are especially difficult to interpret. Since our paper submission (1Ravina J.H Vigneron N.C Aymard A Le Dref O Merland J.J Pregnancy after embolization of uterine myoma report of 12 cases.Fertil Steril. 2000; 73: 1241-1243Abstract Full Text Full Text PDF PubMed Scopus (205) Google Scholar), we have seen five more pregnancies in four more women. Three cases ended with normal pregnancies and normal babies, one delivered by elective cesarean section, the two others vaginally. One woman had an early spontaneous abortion and one woman chose to have an elective abortion. The data in Table 1 of this letter summarize the current literature. In addition to our own experience, 11 pregnancies were observed following UAE. Three pregnancies were seen following embolization for arteriovenous fistula (cases 1, 2, 7). Four pregnancies followed embolization for cervical pregnancies (cases 3, 4, 5, 6). Three pregnancies occurred after embolization that was done primarily for molar pregnancy (cases 8, 9, 10), and one pregnancy after embolization for fibroids (case 11). In six of the cases we have precise data concerning the pregnancy outcomes. Nine terminated in vaginal deliveries, one terminated with a cesarean section, and one ended in an elective abortion. (Table-Literature review) None of these cases showed any subsequent complications due to the prior UAE. Based on our own experience (1Ravina J.H Vigneron N.C Aymard A Le Dref O Merland J.J Pregnancy after embolization of uterine myoma report of 12 cases.Fertil Steril. 2000; 73: 1241-1243Abstract Full Text Full Text PDF PubMed Scopus (205) Google Scholar), the literature review (Table 1; see page 1248), and the case reported by Vashisht, it seems that UAE is not harmful for subsequent pregnancies. In addition it is reassuring that another team from another country arrives at the same good results as we did in UAE for fibroids. These data suggest that this relatively new technique has a place in the therapeutic armamentarium of the operating surgeon and should be destined to a good future.TABLE 1Literature review.legendPVA = polyvinyl alcohol;, legendCiraru-Vigneron. Pregnancy subsequent to uterine artery embolization. Fertil Steril 2001.CasesAuthor referenceYearEmbolizationMiscarriages/pregnanciesReasonProcedureAge (yrs)Time to pregnancy (months)Outcome1a= embolization with non-resorbable micro particles; A.V.F. = arteriovenous fistula; IUP = intrauterine pregnancy.POPPE1987A.V.F.uterine arteries256VaginalAm. J. Obstet. Gynecol.(Congenital)PVA—Thrombine35 wks1987;156:1179–802600 g2a= embolization with non-resorbable micro particles; A.V.F. = arteriovenous fistula; IUP = intrauterine pregnancy.TACCHI1988A.V.F.Two procedures292C. sectionBr. J. Obstet. Gynaecol.(molar pregnancy)1st left int. iliac, left pudendal30 wks1988;95:814–7left and right uterines1400 gPVA2nd left and right int. iliac arteriesPVA-Coils3.4.5.FRATES1994CervicalUterine arteriesNP24Elective abort.Radiologypregnanciesmaterial: NPNP36Vaginal1994;191:773–5NP14Vaginal6PATTINSON1994CervicalUterine arteries358miscarriagesAust. N. Z. Journalpregnancymaterial: NP39 wksObstet. Gynaecol.3600 g1994;34:492–37GAENS1996A.V.F.uterine arteries27334 wksJ. Belge de Radiologie(5 curettages)Acrylic glue1966;79:210Lipiodol8a= embolization with non-resorbable micro particles; A.V.F. = arteriovenous fistula; IUP = intrauterine pregnancy. 9a= embolization with non-resorbable micro particles; A.V.F. = arteriovenous fistula; IUP = intrauterine pregnancy. 10a= embolization with non-resorbable micro particles; A.V.F. = arteriovenous fistula; IUP = intrauterine pregnancy.Mc IVOR1996MolarUterines and br. of ant. and post trunkNP15VaginalBr. J. of RadiologypregnanciesUterine arteriesNP30Vaginal1996;69:624–9Twice:right ant. trunk, left uterineNP9Vaginalthen right ut. and main trunkPVA11a= embolization with non-resorbable micro particles; A.V.F. = arteriovenous fistula; IUP = intrauterine pregnancy.BRADLEY/REIDY1998FibroidUterinesNP1VaginalBr. J. of Obst-GynaecolPVA1998;105:235–4012-23a= embolization with non-resorbable micro particles; A.V.F. = arteriovenous fistula; IUP = intrauterine pregnancy., bPregnancies 12–23 represent those 12 pregnancies in 9 patients who had uterine artery embolization procedures for uterine fibroids (Ravina et al., Fertil Steril 2000;73:1241–3—Table 1).RAVINA/CIRARU2000FibroidsUterines5 earlyFertil SterilPVA3612miscarriages2000;73:1241–37 deliverieslegend PVA = polyvinyl alcohol;a = embolization with non-resorbable micro particles; A.V.F. = arteriovenous fistula; IUP = intrauterine pregnancy.b Pregnancies 12–23 represent those 12 pregnancies in 9 patients who had uterine artery embolization procedures for uterine fibroids (Ravina et al., Fertil Steril 2000;73:1241–3—Table 1).legend Ciraru-Vigneron. Pregnancy subsequent to uterine artery embolization. Fertil Steril 2001. Open table in a new tab