Uterine artery embolization for fibroids is associated with an increased risk of miscarriage

Objective: To investigate how uterine artery embolization (UAE) might alter the risk profile for pregnancies complicated by fibroids. Design: Systematic literature review and meta-analysis of existing studies. Setting: Academic reproductive medicine unit. Patient(s): Women with fibroids. Intervention(s): A systematic literature review, raw data extraction, and data analysis. Main Outcome Measure(s): Rates of miscarriage, preterm delivery, malpresentation, intrauterine growth restriction (IUGR), cesarean delivery, and postpartum hemorrhage (PPH). Result(s): Two hundred twenty-seven completed pregnancies after UAE were identified. Miscarriage rates were higher in UAE pregnancies (35.2%) compared with fibroid-containing pregnancies matched for age and fibroid location (16.5%) (odds ratio [OR] 2.8; 95% confidence interval [CI] 2.0-3.8). The UAE pregnancies were more likely to be delivered by cesarean section (66% vs. 48.5%; OR 2.1; 95% CI 1.4-2.9) and to experience PPH (13.9% vs. 2.5%; OR 6.4; 95% CI 3.5-11.7). Rates of preterm delivery (14% vs. 16%; OR 0.9; 95% CI 0.5-1.5), IUGR (7.3% vs. 11.7%; OR 0.6; 95% CI 0.3-1.3), and malpresentation (10.4% vs. 13%; OR 0.8; 95% CI 0.4-1.5) were similar in UAE pregnancies and in control pregnancies with fibroids. Conclusion(s): The risk of miscarriage seems to be increased after UAE. In contrast, apart from an increased risk of abdominal delivery and PPH, critical adverse obstetric sequelae of IUGR and prematurity appear no more likely after UAE. (Fertil Steril (R) 2010; 94: 324-30. (C) 2010 by American Society for Reproductive Medicine.)