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Meta-Analysis
. 2023 Mar 2;20(5):4480.
doi: 10.3390/ijerph20054480.

Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

Ayazhan Akhatova  1 , Gulzhanat Aimagambetova  2 , Gauri Bapayeva  3 , Antonio Simone Laganà  4 , Vito Chiantera  4 , Peter Oppelt  5 , Antonio Sarria-Santamera  6 , Milan Terzic  2   3   7
Affiliations
Meta-Analysis

Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

Ayazhan Akhatova et al. Int J Environ Res Public Health. .

Abstract

Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods-UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques.

Keywords: MRgHIFU; UAE; USgHIFU; leiomyoma; pregnancy; transcervical radiofrequency ablation; uterine fibroids.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flow-chart diagram of studies selection.
Figure 2
Figure 2
Summary of studies selected by treatment approaches and study types.
Figure 3
Figure 3
Forest plot for pregnancy outcomes after UAE [26,37,38,39,40,41,54].
Figure 4
Figure 4
Forest plot for pregnancy outcomes after USgHIFU [28,42,43,44,45,46].
Figure 5
Figure 5
Forest plot for pregnancy outcomes after MRIgHIFU [27,47,48,55,56,57].
Figure 6
Figure 6
Forest plot for pregnancy outcomes after TFU [31,49,50,51,52,53].
Figure 7
Figure 7
Funnel plot for assessing publication bias.
See this image and copyright information in PMC

References

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