Vaginal delivery outcomes of pregnancies following ultrasound-guided high-intensity focused ultrasound ablation treatment for uterine fibroids

Figures & data

Figure 1. Flow chart.

Table 1. Baseline characteristics of 81 pregnant women at the time of ultrasound-guided HIFU ablation treatment.

Variables	Values
Age (years)	31.1 ± 3.8 (24–41)
Parity
Nulliparous	73 (90.1%)
Multiparous	8 (9.9%)
Symptoms before HIFU
Asymptomatic	14 (17.3%)
Menorrhagia	26 (32.1%)
Pelvic pressure	25 (30.9%)
Pelvic pain	1 (1.2%)
Spontaneous abortion history	14 (17.3%)
Infertility history	1 (1.2%)
Symptom remission after HIFU
Yes	60 (89.6%)
No	7 (10.4%)
Number of fibroids ablated
Single	63 (77.8%)
Multiple	18 (22.2%)
Diameter of largest fibroid ablated (cm)	5.9 ± 1.6 (2.6–9.6)
Volume of largest fibroid ablated (cm^3)	90.0 ± 76.9 cm^3 (6.1–344.2)
Type of largest fibroid ablated
Subserosal	10
Intramural	56
Submucosal	15
NPV (cm^3)	81.3 ± 68.0 (4.8–285.7)
NPV ratio (%)	89.9 ± 0.1 (39.0–100)
Volume shrinkage (%)	72.5 ± 20.7 (30.5–100)

HIFU: high-intensity focussed ultrasound; NPV: none perfusion volume.

Figure 2. Images for a 28-year-old woman with two vaginal deliveries after ultrasound-guided HIFU ablation treatment for a fibroid. (a) Contrast-enhanced ultrasound (CEUS) obtained before treatment showed enhancement of the fibroid (white arrow) on the posterior wall of the uterus. (b) Immediate CEUS obtained after treatment showed a non-enhanced region (53.7 cm³). The margins of the non-enhanced region (white arrow) were shown at the ablated region. (c) and (d) Sagittal view of MRI obtained before treatment showed enhancement of the fibroid (red arrow) on the posterior wall of the uterus. (e) and (f) Sagittal view of an MRI obtained 3 months after ultrasound-guided HIFU ablation showed a decreased size of the fibroid (red arrow). The volume of the fibroid was 35.5 cm³. The woman was pregnant after 6 months and 24 months following treatment and gave birth to two healthy babies weighing 3.3 kg and 3.0 kg, respectively.

Table 2. Clinical characteristics and obstetric outcomes of 19 women achieving successful vaginal delivery after ultrasound-guided HIFU ablation treatment with summary statistics.

Patient No.	Pregnancy No.	Age at treatment, years	Gravidity and parity	No. of fibroids	No. of fibroids treated	Fibroid FIGO type	Fibroid diameter, cm	Fibroid volume, cm^3	NPV ratio, %	Volume shrinkage of fibroids at the end of follow-up, %	Time to conception from HIFU, months	Gestation, weeks	Birth weight, kg	1-min Apgar score
1	1	29	G1P0	1	1	6	4.6	31.9	100.0	93.7	33	38	3.6	10
2	2	29	G0P0	1	1	1	2.6	5.6	85.7	100.0	17	38	3.5	10
3	3	31	G2P0	1	1	1	9.0	262.1	74.6	91.1	29	38	3.5	10
4	4	31	G1P0	1	1	4	5.0	50.3	90.0	87.1	27	38	3.0	10
5	5	29	G0P0	1	1	3	5.8	91.2	100.0	93.2	6	38	3.0	9
6	6	28	G0P0	1	1	4	5.7	73.0	88.1	54.0	3	39	3.1	10
7	7	28	G0P0	1	1	1	6.9	173.2	92.0	100.0	35	38	3.5	10
8	8	27	G1P0	1	1	6	6.8	131.6	99.6	90.5	18	38	3.3	10
9	9, 10	27	G0P0	1	1	4	7.4	177.9	84.9	97.6	16, 28	38, 40	3.0, 3.4	10, 10
10	11	25	G0P0	1	1	3	6.7	108.9	99.5	97.2	30	38	3.3	9
11	12	31	G0P0	1	1	3	4.2	33.0	90.0	87.9	22	38	3.1	10
12	13	34	G0P0	1	1	2	4.3	36.7	100.0	100.0	24	39	3.4	10
13	14, 15	29	G0P0	1	1	4	4.2	29.0	91.0	70.0	8, 23	38, 39	3.5, 3.8	10
14	16	29	G0P0	1	1	6	3.9	24.1	99.6	58.5	14	38	3.2	10
15	17	24	G0P0	1	1	4	6.5	111.5	100.0	87.4	5	38	3.3	10
16	18	33	G0P0	2	2	4, 4	7.2, 3.8	95.1, 22.8	90.0, 100.0	74.0, 88.5	12	38	3.5	10, 10
17	19	33	G0P0	1	1	1	4.2	21.0	83.0	91.4	46	38	3.3	10
18	20	34	G0P0	1	1	3	5.0	44.5	100.0	94.4	50	38	3.4	10
19	21	34	G1P1	1	1	1	5.2	64.9	100.0	100.0	40	39	3.3	10
Mean ± SD or median		29.7 ± 3.0					5.5 ± 1.6	50.3	92	91.4	23.1 ± 13.2	38	3.3 ± 0.6	10
Range		24–34					2.6–9.0	5.6–262.1	74.6–100.0	54.0–100.0	3–50	38–40	3.0–3.8	9–10
N		19					20	20	20	20	21	21	21	21

Table 3. Clinical characteristics and obstetric outcomes of 5 women who experienced failed vaginal delivery after ultrasound-guided HIFU ablation treatment with summary statistics.

Patient No.	Pregnancy No.	Age at treatment, years	Gravidity and parity	No. of fibroids	No. of fibroids treated	Fibroids FIGO type	Fibroids diameter, cm	Fibroids volume, cm^3	NPV ratio, %	Volume shrinkage of fibroids at the end of follow-up, %	Time to conception from HIFU, months	Gestation, weeks	Birth weight	1-min Apgar score
20	22	33	G0P0	1	1	4	8.9	292.2	65.0	39.0	16	39	3.3	9
21	23	35	G1P0	1	1	2	2.9	6.2	100.0	84.0	17	38	3.2	10
22	24	28	G0P0	1	1	5	5.3	47.3	77.1	76.0	5	39	3.2	9
23	25	25	G0P0	1	1	1	4.8	48.3	100.0	100.0	12	39	3.9	10
24	26	29	G0P0	1	1	6	6.3	85.5	90.2	83.6	3	42	3.3	10
Mean ± SD or median		30.0 ± 4.0					5.6 ± 2.2	48.3	90.2	83.6	10.6 ± 6.3	39	3.4 ± 0.3	10
Range		25–35					2.9–8.9	6.2–292.2	65.0–100.0	39.0–100.0	3–17	38–42	3.2–3.9	9–10
N		5					5	5	5	5	5	5	5	5