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New Procedure to Remove Fibroids Poses Pregnancy Risks, Study Says

Critic says research was based on flawed approach

THURSDAY, Oct. 31, 2002 (HealthDayNews) -- Women who have a relatively new procedure to have their uterine fibroids removed might be putting future pregnancies at risk, a small study by a Philadelphia gynecologist concludes.

However, a Georgetown University Medical Center radiologist who has published studies on the procedure criticizes the methodology of the new research.

Dr. Jay Goldberg, a clinical assistant professor at Jefferson Medical College in Philadelphia, reviewed the case histories of 50 women who had had an uterine artery embolization (UAE) to remove fibroids, and then went on to get pregnant.

He found their rates of miscarriage were triple the rates of women in the general population, the rates of premature delivery were approximately double, and the rates for Caesarean delivery were three times that of women who had not had the procedure.

"For women who aren't interested in future fertility, the UAE is an excellent option to surgery -- the recovery is quicker and it is a safer procedure for those women with medical complications," Goldberg says. "But for women who do plan to get pregnant, they should know that potentially their risks may be greater than they know."

A uterine artery embolization involves blocking the blood vessels that supply the uterine fibroid tumor, so that it shrivels and dies. It is a minimally invasive procedure that is an alternative to surgical procedures such as myomectomies or hysterectomies, doctors say. Goldberg says the procedure is increasingly popular and estimates that approximately 30,000 American women may have had it to remove their fibroids.

The results of his study appear in the November issue of Obstetrics and Gynecology.

However, Dr. James B. Spies, vice chairman and chief of service of radiology at Georgetown University Medical Center, is critical of Goldberg's findings. Women who have fibroid tumors are already at a higher risk for pregnancy complications, he says, and to compare their pregnancy outcomes to women in the general population, most of whom do not have fibroids, is a flawed approach.

"This is a case report, not a study," says Spies, whose hospital is participating in a national data registry to assess the long-term effects of UAE. "The pregnancies of women who have had fibroids are much more likely to result in complications."

You can't compare those outcomes to the outcomes of women in the general population, he adds.

Far more telling, he says, would be to compare the pregnancy outcomes of women who've had UAE to the outcomes of women who opted for a myomectomy, which is surgery to remove fibroids. Another option would be to compare pregnancy outcomes of women who had the UAE procedure to those women who had fibroid tumors but did not treat them, he adds.

"It is entirely possible that UAEs do have risks, and it does give food for thought for future studies," Spies says. "But this study is much too limited to draw conclusions."

Goldberg cites one study that found that women who had myomectomies had a 6 percent rate of premature deliveries, which compares favorably to the 22 percent rate among the women in his study, but acknowledges that his research was limited by the lack of literature on the procedure.

"I hope there will be more studies to look at this," he says.

In his review of the literature, Goldberg found the miscarriage rate for women who'd had an UAE was 32 percent, compared to a 10 percent to 15 percent rate among the general population. The premature delivery rate was 22 percent for women who'd undergone an UAE, compared to 5 percent to 10 percent for the other women. The rate of Caesarean delivery was 65 percent for the women in the UAE group, compared to 22 percent for the general population, and the rate of postpartum hemorrhage was 9 percent for the first group, and 4 percent to 6 percent for the second.

What To Do

For more on uterine fibroid tumors, visit the National Uterine Fibroids Foundation. And the U.S. Food and Drug Administration offers a diagram of how a uterine fibroid embolization works.

SOURCES: Jay Goldberg, M.D., clinical assistant professor, obstetrics and gynecology, Jefferson Medical College, Philadelphia; James B. Spies, M.D., vice chairman and chief of service, radiology, Georgetown University Medical Center, Washington, D.C.; November 2002 Obstetrics and Gynecology
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