Zhao Min, Wang Dan, Zhang Yong, Wang Ligang
Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, Sichuan, China.
Reprod Health. 2024 Dec 18;21(1):184. doi: 10.1186/s12978-024-01930-x.
This study aims to assess the safety and effectiveness of High-Intensity Focused Ultrasound (HIFU) ablation on pregnancy outcomes among women with uterine fibroids wishing to conceive, focusing specifically on short-term pregnancy outcomes immediately following HIFU treatment.
A retrospective analysis was conducted on 210 women who underwent HIFU treatment (Group I) at our institution between January 2018 and December 2022 and subsequently conceived. Pregnancy outcomes were compared with two control groups: 510 patients who delivered vaginally (Group II) and 278 who underwent cesarean sections (Group III) during the same period. Statistical analyses included multivariable logistic regression to adjust for confounding factors. The study only considered outcomes related to the immediate pregnancy following HIFU treatment and did not include data on subsequent pregnancies or long-term effects.
The natural conception rate post-HIFU was 93.81% (197/210), with a miscarriage rate of 19.05% (40/210). Group I had significantly lower rates of gestational diabetes mellitus (8.24%) and precipitate labor (0%) compared to Group II but higher rates of mild anemia (31.18%) and adherent placenta (10.59%). Compared to Group III, Group I had lower rates of gestational diabetes mellitus (8.24% vs. 20.86%) and moderate anemia (4.71% vs. 16.55%) but a higher incidence of premature rupture of membranes (18.82%). Neonates in Group I had lower birth weights compared to Groups II and III (p < 0.05), with no cases of low birth weight in Group I. Multivariable analysis identified fibroid location as a predictor of preterm birth, while maternal age and mode of delivery influenced the risk of incomplete uterine rupture.
HIFU ablation is a safe and effective fertility-preserving treatment for women with uterine fibroids, demonstrating favorable short-term pregnancy outcomes. It does not increase perinatal risks, but its impact on pregnancy duration and certain complications suggests that careful patient selection and management are crucial. Future studies should investigate the long-term effects of HIFU on subsequent pregnancies.
本研究旨在评估高强度聚焦超声（HIFU）消融术对希望怀孕的子宫肌瘤女性妊娠结局的安全性和有效性，特别关注HIFU治疗后立即出现的短期妊娠结局。
对2018年1月至2022年12月期间在本机构接受HIFU治疗（第一组）并随后怀孕的210名女性进行回顾性分析。将妊娠结局与两个对照组进行比较：同期经阴道分娩的510名患者（第二组）和剖宫产的278名患者（第三组）。统计分析包括多变量逻辑回归以调整混杂因素。该研究仅考虑与HIFU治疗后立即妊娠相关的结局，不包括后续妊娠或长期影响的数据。
HIFU术后自然受孕率为93.81%（197/210），流产率为19.05%（40/210）。与第二组相比，第一组的妊娠期糖尿病发生率（8.24%）和急产发生率（0%）显著较低，但轻度贫血发生率（31.18%）和胎盘粘连发生率（10.59%）较高。与第三组相比，第一组的妊娠期糖尿病发生率（8.24%对20.86%）和中度贫血发生率（4.71%对16.55%）较低，但胎膜早破发生率较高（18.82%）。与第二组和第三组相比，第一组新生儿出生体重较低（p<0.05），第一组无低出生体重病例。多变量分析确定肌瘤位置是早产的预测因素，而产妇年龄和分娩方式影响不完全子宫破裂的风险。
HIFU消融术是一种对子宫肌瘤女性安全有效的保留生育功能的治疗方法，显示出良好的短期妊娠结局。它不会增加围产期风险，但其对妊娠持续时间和某些并发症的影响表明，仔细的患者选择和管理至关重要。未来的研究应调查HIFU对后续妊娠的长期影响。
