Karlsen K, Hrobjartsson A, Korsholm M, Mogensen O, Humaidan P, Ravn P
Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kløvervænget 10, 10.sal, 5000, Odense C, Denmark.
Center for Evidence-Based Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Arch Gynecol Obstet. 2018 Jan;297(1):13-25. doi: 10.1007/s00404-017-4566-7. Epub 2017 Oct 20.
The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE.
We searched for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before-after trials, cohort studies, case-control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control intervention was included. The PRISMA guideline was used to do a systematic review using the main outcomes pregnancy rate and miscarriage rate. Risk of bias was assessed by the Cochrane risk of bias tool or by ROBINS-I. The quality of evidence was assessed by the GRADE approach.
We included 17 studies (989 patients): 1 RCT, 2 cohort studies, and 14 case series. Pregnancy rates after UAE were 50% in the RCT and 51 and 69% in the cohort studies. Among the case series median pregnancy rate was 29%. Miscarriage rates were 64% in the RCT. Miscarriage rates at 56 and 34% were found in the cohort studies after UAE. The median miscarriage rate was 25% in the case series.
Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base. Systematic review registration number: CRD42016036661.
子宫动脉栓塞术（UAE）用于减轻子宫肌瘤对生育影响的效果尚不清楚。我们调查了UAE治疗子宫肌瘤后报道的妊娠率和流产率。
我们在PubMed和Embase中检索了相关信息，以查找随机对照试验（RCT）、对照临床试验、前后对照比较试验、队列研究、病例对照研究和病例系列，这些研究涉及对绝经前女性进行UAE治疗子宫肌瘤且包含对照干预措施。采用PRISMA指南，以妊娠率和流产率作为主要结局指标进行系统评价。采用Cochrane偏倚风险工具或ROBINS-I评估偏倚风险。采用GRADE方法评估证据质量。
我们纳入了17项研究（989例患者）：1项RCT、2项队列研究和14项病例系列。RCT中UAE后的妊娠率为50%，队列研究中为51%和69%。病例系列中的妊娠率中位数为29%。RCT中的流产率为64%。UAE后队列研究中的流产率分别为56%和34%。病例系列中的流产率中位数为25%。
发现UAE后的妊娠率低于子宫肌瘤剔除术后，流产率高于子宫肌瘤剔除术后。然而，我们发现关于评估结局的证据质量非常低，所报道的比例也不确定。需要改进前瞻性随机研究以改善证据基础。系统评价注册号：CRD42016036661。
