Date of Graduation

8-15-2009

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Mark Pedemonte, MD

Second Advisor

Rob Rosenow PharmD, OD

Third Advisor

Annjanette Sommers MS, PA-C

Abstract

Introduction: As a prevalent disease in women of childbearing age, treatment of leiomyoma is an area with many options. Hysterectomy is a common and definitive treatment but is not appropriate in women wishing to attempt pregnancy. Myomectomy surgically removes fibroids, and is the first line treatment for women wishing to preserve the uterus. Uterine Artery Embolization (UAE) is an emerging treatment option with an uncertain effect on fertility. As a less invasive procedure with good relief of symptoms and a shorter recovery period, UAE is appealing. The purpose of this review is to evaluate the current standing of UAE as a possible treatment option for women with leiomyoma wishing to preserve fertility.

Methods: This literature review focuses on studies published within the last ten years which report on pregnancies after UAE in women treated for uterine fibroids.

Results: Of the nine studies included, there are increased rates of spontaneous abortion, pre-term delivery, post-partum hemorrhage and abnormal placentation in a subset of the studies. These results might be due to UAE or may perhaps be explained by the advanced maternal age of the subjects, or other subfertility factors not addressed in the studies.

Conclusion: The effects of UAE on subsequent pregnancy are still unclear. The paucity of large randomized controlled trials and the small number of reported cases of pregnancy (less than 200) limits the quality of the evidence. Until larger randomized trials are completed comparing myomectomy and UAE, myomectomy will continue to be the first line therapy for women who intend to become pregnant.

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