Table 14:
Pregnancy Case Reports After MRgHIFU Treatment of Uterine Fibroids
| Country, Author, Year | Case Detail | Pregnancy Outcomes |
|---|---|---|
| United States, Bouwsma E et al, 2011 (118) | 37-year-old Asian woman having had a prior miscarriage at 6 weeks underwent clomiphene citrate cycles following successful MRgHIFU and spontaneously conceived. | Fetal growth was normal and uterine fibroids remained stable in size and at 40 weeks after uneventful labour, she delivered a 3,450-g baby girl with Apgar scores of 7 and 9. |
| United States, Gavrilova-Jordan L et al, 2007 (119) | 38-year-old nulligravid woman conceived 18 months following MRgHIFU treatment for a single uterine fibroid. | At 39 weeks she underwent labour induction for gestational hypertension with vacuum-assisted vaginal delivery of a healthy baby boy. Postpartum recovery of both mother and neonate was uneventful. |
| United States, Hanstede M et al, 2007 (120) | 40-year-old woman with 3 full-term deliveries, a history of secondary infertility, and a 10-year history of uterine fibroids underwent MRgHIFU for treatment of symptomatic uterine fibroids. | Conception occurred a year and a half following MRgHIFU treatment. Pregnancy was complicated with first-trimester vaginal bleeding until 16 weeks gestation and diagnosed with diabetes mellitus type 1. The uterine fibroids remained stable and normal fetal development occurred. Labour was induced at 39 weeks and she delivered a full-term 3,170-g baby boy after an uneventful labour and vaginal delivery. |
| Japan, Morita Y et al, 2007 (123) | 29-year-old nulligravid woman underwent MRgHIFU rather than myomectomy for a single large (6.8 × 8.0 × 7.9 cm) fibroid | She conceived 3 months following HIFU; repeated ultrasounds throughout pregnancy showed normal fetal development, normal placental insertion in the posterior uterine wall, and no change in size of the treated fibroid. At 39 weeks she had an uneventful labour and vaginal delivery of a healthy baby boy with normal weight (3,212 g) and Apgar scores of 8 and 9. Postpartum recovery was uneventful. |
| Israel, Rabinovici J et al, 2006 (125) | 36-year-old woman gravida 1 without prior miscarriages was initially diagnosed with uterine fibroids, later diagnosed by MRI as having focal adenomyosis with infertility secondary to menometrorrhagia; she successfully underwent MRgHIFU rather than myomectomy. | She conceived spontaneously 3 months following MRgHIFU with an uneventful pregnancy course with normal fetal development, normal placental insertion in posterior uterine wall, and normal uterine anatomy. Birth was a full-term 3,050-g healthy baby girl after an uneventful labour and vaginal delivery. Placental separation was delayed and the placenta was manually extracted. Postpartum recovery was uneventful. |
| Korea, Yoon S-W et al, 2010 (124) | 31-year-old woman with 2 intramural fibroids underwent 2 separate MRgHIFU treatments for frequent urination and bulk symptoms. | Spontaneous conception occurred 4 months following HIFU and pregnancy was carried to term. At 39 weeks, a 3,190-g baby girl was born through a vaginal delivery. Labour and postpartum recovery were uneventful. |
| United Kingdom, Zaher S et al, 2010 (121) | 39-year-old woman with 1 prior pregnancy resulting in a premature delivery at 28 weeks, attributed to fibroids, presented with menorraghia and urinary pressure symptoms including frequency and nocturia. 5 fibroids were identified, the largest being a fundal intramural fibroid, and she underwent a successful MRgHIFU treatment after a pretreatment course of GnRHa injections. | Spontaneous conception occurred 10 months following HIFU. Repeated ultrasounds throughout pregnancy revealed normal fetal growth with cephalic presentation and an anterior placenta which was not low lying. No fibroids were visible at the 40-week scan. Delivery was induced at 41-weeks and a healthy 3,589-g baby girl was born with Apgar scores of 8 and 9 after an uncomplicated vaginal delivery. |
| United Kingdom, Zaher S et al, 2011 (122) | 45-year-old woman para 0+1 with a known history of fibroids had undergone 4 prior IVF cycles, 3 with egg donations and 1 with her own egg. 2 years prior to presenting with fibroid-related menorrhagia, she had 1 pregnancy resulting in a first-trimester miscarriage. An infertility work-up identified the fibroid as the likely obstacle to pregnancy. She underwent HIFU for a single large (9 × 6.2 × 7.1 cm) intramural fibroid. | 10 months following HIFU the patient underwent IVF treatment and became pregnant after the first cycle. Repeated ultrasound scans revealed normal fetal development with cephalic presentation. At 39 weeks the patient presented in spontaneous labour but due to persistently suboptimal cardiotocograph, delivery was by emergency Caesarean section which was uncomplicated and involved a blood loss of 100 ml. A healthy 3,050-g baby boy with Apgar scores of 9 and 10 was delivered without placental delivery problems. Postpartum recovery was uneventful. |
Abbreviations: GnRHa; gonadotropin-releasing hormone analogue; HIFU; high-intensity focused ultrasound; IVF, in vitro fertilization; MRgHIFU, MR-guided high-intensity focused ultrasound; MRI, magnetic resonance imaging.