Pregnancy outcomes following ultrasound-guided high-intensity focused ultrasound in submucous leiomyomas: a retrospective study

Figures & data

Table 1. Baseline characteristics of the 32 patients with submucous leiomyomas who became pregnant after USgHIFU treatment.

Variables	Value
Age, years	35.5 ± 5.9
BMI, kg/m^2	21.0 ± 2.1
Gravidity (median (Q3–Q1))	3.0 (1.3–4.0)
Parity (median (Q3–Q1))	1.0 (1.0–2.0)
History of miscarriage and (or) sterility, n (%)
Yes	10 (31.3)
No	22 (68.8)
Presentation, n (%)
Hypermenorrhea	20 (62.5)
Miscarriage and (or) sterility	10 (31.3)
Growth of submucous leiomyomas	5 (15.6)
Asymptomatic	3 (9.4)
HGB, g/L	109.0 ± 22.7
Anemia, n (%)
Yes	18 (56.3)
No	14 (43.8)

BMI, body mass index.

Figure 1. A 33-year-old woman, with a history of miscarriage, achieved a successful full-term delivery via cesarean section after USgHIFU treatment for type 2 submucous leiomyoma. The maximum diameter was 4.2 cm, with an effective volume in the uterus cavity of 6.1 cm³ and a volume of submucous leiomyoma of 27.2 cm³. The contrast-enhanced ultrasound revealed no perfusion of uterine lesion immediately after the surgery (arrow pointing in Figure A). One year after USgHIFU treatment, both the effective volume in the uterine cavity and the volume of submucous leiomyoma shrank obviously (arrow pointing in Figure B in the sagittal plane and Figure C in the coronal plane). The maximum diameter was 2.4 cm, with an effective volume in the uterus cavity of 3.0 cm³ and a volume of submucous leiomyoma of 6.0 cm³. After 16 months, pregnancy was achieved. Gestational sac (blue arrow pointing in Figure D) was seen along with the reduced residual submucous leiomyoma, with a maximum diameter of 2.2 cm (white arrow pointing in Figure D). USgHIFU, ultrasound-guided high-intensity focused ultrasound.

Table 2. Characteristics of submucous leiomyomas in 32 patients who became pregnant after USgHIFU treatment.

Variables	Value
Maximum diameter, cm (median (Q3–Q1))	4.4 (3.5–5.8)
Volume, cm^3 (median (Q3–Q1))	33.1 (17.5–61.8)
Effective volume in the uterus cavity (median (Q3–Q1))	8.2 (4.5–13.0)
inner protrusion ratio, % (median (Q3–Q1))	23 (15–35)
Type, n (%)
1	5 (15.6)
2	27 (84.4)
Location, n (%)
Anterior wall	10 (31.3)
Posterior wall	17 (53.1)
Lateral wall	4 (12.5)
Fundus	1 (3.1)
T2 signal of MRI, n (%)
Low	18 (56.3)
Iso	6 (18.8)
High	8 (25.0)

MRI, magnetic resonance imaging.

Table 3. HIFU treatment parameters for submucous leiomyomas in 32 patients who became pregnant.

Variables	Value
Sonication time, s (median (Q3-Q1))	615.5 (407–834)
Energy delivered, J	271825 ± 142556.3
Non-perfused volume ratio, %	82.6 ± 9.8
Gray-scale change, n (%)
Overall gray-scale change	24 (75.0)
Lumpy gray-scale change	8 (25.0)
Adverse events, n (%)
Lower abdominal pain	12 (37.5)
‘Hot’ skin sensation	4 (12.5)
None	16 (50.0)

Table 4. Pregnant characteristics of 32 pregnant women after USgHIFU treatment.

Variables	Value
Maternal age at pregnant, years	36.8 ± 5.6
Time to pregnancy, months (median (Q3–Q1))	11.0 (5.0–19.8)
Outcomes of pregnancies, n (%)
Full term delivery	16 (50.0)
Preterm delivery	1 (3.1)
Termination	15 (46.9)
Subsequent procedures before pregnancy, n (%)
Hysteroscopic myomectomy	3 (9.4)
None	29 (90.6)
Vaginal expulsion of submucous leiomyomas, n (%)
Complete expulsion	3 (9.4)
Partial expulsion	6 (18.8)
None	23 (71.9)
Conversion of myoma type, n (%)
Downgrade	13 (40.6)
Upgrade	9 (28.1)
Stability	10 (31.3)
Shrinkage in volume of submucous leiomyomas, n (%)	32 (100.0)
Shrinkage in effective volume in the uterus cavity, n (%)	32 (100.0)

Table 5. Obstetric characteristics of 17 deliveries after USgHIFU treatment.

Variables	Value
Pregnancy approach, n (%)
Natural	15 (88.2)
Assisted	2 (11.8)
Age at delivery, years	34.9 ± 4.9
Time to pregnancy, months (median (Q3-Q1))	11.0 (5.0–27.5)
Changes of submucous leiomyomas during pregnancy, cm*
Maximum diameter before pregnancy	3.0 ± 1.5
Maximum diameter in early pregnancy	3.3 ± 1.7
Maximum diameter in middle pregnancy	3.4 ± 1.8
Maximum diameter in late pregnancy	3.5 ± 1.9
Pregnancy complications, n (%)	7 (41.2)
Gestational diabetes mellitus	3 (17.6)
Subclinical hypothyroidism	2 (11.8)
Premature rupture of membranes	1 (5.9)
Fetal foramen ovale opening limitation	1 (5.9)
Gestation weeks, weeks	38 ± 1
Mode of delivery, n (%)
Vaginal	6 (35.3)
Cesarean section	11 (64.7)
Indications of Cesarean section, n (%)
Obstetric indications	10 (90.9)
Concerns about the risk of HIFU treatment	1 (9.1)
Amounts of blood loss, ml	300 (250–400)
Postpartum hemorrhage, n (%)
Yes	2 (11.8)
No	15 (88.2)
Birth weight, g	3482 ± 246
Placenta implantation at prior submucous leiomyomas locations, n (%)
Yes	5 (29.4)
No	12 (70.6)
1-min Apgar score, n (%)
10	15 (88.2)
9	2 (11.8)

*p > 0.05, there was no statistical significance.

Data availability statement

The authors support data transparency.