Analysis Of Safety And Pregnancy Outcomes In Nulliparous Women With Uterine Fibroids After Hifu

Uterine fibroids are the most common benign tumor,and the incidence rate is 20%-50%,they are usually born between 30 and 50 years old.The main symptoms of this disease are menorrhagia,prolonged menstrual bleeding and so on.In the literature,5%-10% of patients with uterine fibroids were infertile.Medication can only control the symptoms,myomectomy has a better effect on the pregnancy outcome of patients with submucosal.Uterine artery embolization(UAE)may impairs the blood supply and endometrium function of the ovary and thus not be recommended for patients with fertility requirements.Ultrasound ablation is a non-invasive,retaining uterine treatment,for women with children of uterine fibroids,security,effectiveness,has been widely recognized by and it does not damage the uterine and ovarian endocrine function also provides a new choice for nulliparous women.The purpose of this study is to investigate the safety and efficacy of HIFU for the treatment of uterine fibroids in nulliparous women.High intensity ultrasound(HIFU)ablation of uterine fibroid has been accepted by more and more patients,but evidence of pregnancy effects still needs to be further accumulated.Studied in this paper through the follow-up analysis of myoma patients had no history of birth pregnancies after HIFU treatment,explore the HIFU treatment of uterine fibroids influence on postoperative pregnancy and pregnancy outcome,for the treatment of patients with uterine fibroids with fertility requirements of choice to provide clinical basis.Objectives1.To evaluate the safety of high intensity focused ultrasound ablation of uterine fibroids in nulliparous women.2.To investigate the pregnancy outcomes after high intensity focused ultrasound(HIFU)ablation for uterine fibroids in nulliparous women.Methods1.From Jan.2013 to Dec.2016,229 patients with uterine fibroids in nulliparous women and at the same age group according to 1:1 proportion randomly match with patients who had birth history,and underwent HIFU ablation at the first affiliated hospital of Chongqing Medical University.To evaluate and compare the intraoperative and postoperative adverse reaction of the two groups,and follow-up the improvement of symptoms.2.From Jan.2010 to Dec.2016,423 nulliparous women with uterine fibroids who had underwent HIFU treatment at the first affiliated hospital of Chongqing Medical University.A total of 267 cases were enrolled,then telephone follow-up the pregnancy and relative factors.Results1.These adverse reactions of the two groups were compared.Of 458 patients with uterine fibroids,nulliparous group 229 cases,229 cases of another group.The incidence of pain in the nulliparous group was 55.90%,higher than that in another group(27.51%).In the nulliparous group,the incidence of sacral pain,hip discomfort and skin irradiation was lower than that in the another group,and the difference was statistically significant(P<0.05).Postoperative adverse reactions were more common in the lower abdominal pain,and the incidence of nulliparous group was 43.23%,higher than that of the group(30.13%),and the difference between the two groups was statistically significant.No long-term complications occurred in both groups.2.The scores of health-related quality of life scores were higher than those before surgery,There was statistically significant(P < 0.05).Postoperative uterine fibroid symptoms were improved,and postoperative health related life quality was improved.3.During the median follow-up time was 4 years(range:1-7years),there were 155 cases pregnancy with a total of 157 times among the 267 cases.The average time to pregnancy was(14.1±12.4)months following HIFU,the pregnancy rate was 58.80%(157/267),and the spontaneous conception rate was 93.63%(147/157).106 times successfully delivery with the caesarean section was 69.81%(74/106),and 26 cases were on-going pregnancy.There were 109 newborns,including three pairs of identical twins.Multivariate analysis found that: age?the history of infertility were associated with pregnancy(P<0.05).Conclusions1.It is safe and feasible for nulliparous with uterine fibroids underwent HIFU ablation.2.HIFU can be used safely in women with uterine fibroids who wishing to conceive.Multivariate analysis showed that age and preoperative infertility were the major factors affecting pregnancy,and the changes in the volume of target fibroids and the improvement of symptoms were not statistically significant for postoperative pregnancy.