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Predictors of Uterine Rupture and Recurrence after Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Uterine fibroids are the most common benign tumors of the female reproductive tract. Despite several medical and other non-medical management options for symptomatic fibroids, myomectomy remains the most common approach in women desiring fertility or preservation of their uterus or both. Uterine rupture (UR), defined as a complete disruption of the uterine wall, is rare but is one of the fearful complications associated with a myomectomy during a subsequent pregnancy and represents an obstetric emergency as it can be catastrophic, causing serious morbidity and mortality for the mother and unborn child. If UR occurs, the risk of a hysterectomy can be as high as 12%. In developed countries, UR is almost exclusively observed in the setting of a previous surgery on the uterus.
Hormonal Regulation in the Treatment of Fibroids
Published in John C. Petrozza, Uterine Fibroids, 2020
Victoria Fitz, Steven L. Young
Ulipristal is a SPRM that is currently approved for use in the United States as an emergency contraceptive but not yet for fibroid treatment. It has been studied as a therapy for uterine fibroids in a series of large clinical trials [36]. When taken daily for 3 months at 5 or 10 mg doses, ulipristal treatment led to amenorrhea in 70%–80% of patients and 30%–42% decrease in fibroid volume. Ulipristal was non-inferior to leuprolide acetate in reducing bleeding associated with fibroids prior to surgery. Patients taking ulipristal maintained normal serum estradiol levels in the midfollicular phase range and did not experience hot flashes with the same frequency as patients treated with GnRH agonist (11% of ulipristal group compared with 40% of patients treated with leuprolide). Notably, the reduction of leiomyoma volume after taking ulipristal was sustained for 6 months post-treatment compared to 1 month in patients treated with leuprolide acetate. Although not approved for treatment of fibroids in the United States, approval for short-term use for this purpose has been given in Canada and Europe. Furthermore, longer-term intermittent therapy seems to increase efficacy and maintain safety with the longest study including eight 3-month-long courses, with each course separated by one menses [37].
Investigations in infertility
Published in David J Cahill, Practical Patient Management in Reproductive Medicine, 2019
Ultrasound scanning (if not done at the first visit) of the ovaries and uterus. If the initial ultrasound scan was suggestive of uterine fibroids, then further investigation by MRI scanning of the pelvis will determine the number and extent of the fibroids. Antral follicle count (AFC), a relatively new method to assess the numbers of follicles between 2–6 mm in the first week after menstruation (16), has been compared to AMH to determine which is a better indicator of ovarian reserve – AMH would appear to be marginally better than AFC (11).
Feasibility of the novel vascular disrupting agent C118P for facilitating high-intensity focused ultrasound ablation of uterine fibroids
Published in International Journal of Hyperthermia, 2023
Yue Li, Jinyong Zhang, Changlian Lu, Mingrui Guo, Jue Zhang, Gang Huang, Yicheng Ni, Yini Chen
Animal studies of the HIFU treatment of uterine fibroids is difficult. First, although the animals used for studying uterine fibroids include guinea pigs, rats, mice [15], miniature pigs [16], rhesus macaques [17] and other experimental animals, HIFU equipment for small animals has not been fully developed. Second, uterine fibroids are benign tumors. Animal models of malignant tumors can be established in a short time by tumor cell transplantation, but animal models for benign tumors cannot be established in this manner. Moreover, bladder filling is required for ultrasound localization of the uterus, even if uterine fibroids are successfully developed; although humans can voluntarily perform urine retention, animals cannot. To circumvent these challenges, this study evaluated the efficacy of HIFU in treating uterine fibroids based on its ablative efficacy in other muscle tissues. Herein, the leg muscle tissues of rabbits (instead of uterine fibroids) were selected as ablation sites, and changes in uterine blood vessels and peripheral blood perfusion were evaluated to determine the feasibility of C118P-assisted HIFU for the treatment of uterine fibroids.
High-intensity focused ultrasound treatment for symptomatic uterine fibroids: a systematic review and meta-analysis
Published in International Journal of Hyperthermia, 2022
Ling Yan, Huimin Huang, Jingwen Lin, Ruimei Yu
There are various ways to treat uterine fibroids. Although traditional surgical treatments can resolve the clinical symptoms, they have many disadvantages, such as relatively large trauma, high chances of postoperative complications and long operation time. In recent years, owing to its noninvasive properties, HIFU has attracted a lot of attention for uterine fibroid treatment. Many studies have reported that it offers high treatment efficacy while being safe with few adverse effects. Łozinski et al. [10] conducted a single-center retrospective cohort study with 276 patients and reported that HIFU resolved clinical symptoms of patients with uterine fibroids without increasing spontaneous abortion and other pregnancy-related complications. Moreover, a prospective observational open-label multicenter study conducted by Qu et al. [33] showed that the AMH levels did not significantly change after HIFU treatment with 6-month follow-up, suggesting that HIFU does not affect ovarian function. In 2020, a review conducted by Ciebiera et al. prompted that HIFU is a relatively safe, noninvasive method and is not detrimental to fertility [34]. These properties make HIFU an attractive option for young women with fibroids who wish to plan a pregnancy in the future. However, to know if HIFU is superior to other treatment methods needs further study.
Long-term risk of uterine malignancies in women with uterine fibroids confirmed by myomectomy: a population-based study
Published in Journal of Obstetrics and Gynaecology, 2022
A case-control study found that women with uterine fibroids have an increased risk of uterine malignancies (Fortuny et al. 2009). In Fortuny et al’s U.S. population-based case-control study, uterine fibroids were independently related to increased endometrial cancer risk. Uterine fibroids are just one of the conditions related to obesity associated with endometrial cancer. A Danish registry-based cohort study reported a positive association of uterine fibroids with the risk of uterine cancer, especially sarcomas (Brinton et al. 2005). In a large prospective study of black women in the U.S., a history of uterine fibroids was related to a 40% increased risk of endometrial cancer (Wise et al. 2016). In these two studies, uterine cancer was diagnosed 1 to 2 years after the diagnosis of uterine fibroids, and there is a possibility that the existing uterine cancer could be mistaken for uterine fibroids (Brinton et al. 2005; Wise et al. 2016).