Obstetric outcomes after treatment of fibroids by uterine artery embolization: a systematic review

The objective of this review is to compare obstetric outcomes following both uterine artery embolization (UAE) and myomectomy. Medline, Embase and Cochrane Database of Systematic Reviews were searched using relevant medical subject headings, without language restrictions, using strict inclusion and exclusion criteria. Data on obstetric outcomes were extracted independently by two authors using live birth rate as the primary outcome measure. Two by two tables were constructed for each outcome and appropriate chi-square test was applied. There was only one randomized trial comparing the two procedures that has published preliminary results on a small number of women. Hence, results of other observational studies (case series) on UAE were pooled (45 for myomectomy and 11 for UAE). The live birth rate after UAE was 57.8% (137/237) in contrast to 77.4% (1759/2273) after myomectomy (p < 0.001). The proportion of women with ongoing pregnancies was higher in myomectomy group (63.7 vs 77.9%). The risk of miscarriages, placenta previa, placental abruption and preeclampsia after either procedure was similar. However, there was a significantly increased incidence of preterm delivery and postpartum hemorrhage in women who conceived after UAE. More than half of all pregnancies after UAE have resulted in live birth. However, these pregnancies are more likely to be associated with preterm delivery and postpartum hemorrhage. We need more evidence from randomized trials before UAE is offered as a choice of treatment for fibroids in women wishing to preserve their fertility.