One year symptom severity and health-related quality of life changes among patients undergoing uterine fibroid embolisation

Background: The main aim of treatment of symptomatic fibroids by various modalities including uterine fibroid embolisation is to alleviate symptoms and ultimately improve the quality of life. The efficacy of this modality of treatment in women with significant fibroid burden and large uterine volumes is not clear. Objective: To determine the change in symptom severity and health-related quality of life among patients who have undergone uterine fibroid embolisation for treatment of symptomatic uterine fibroids. Setting: Aga Khan University Hospital, Nairobi Methods: A prospective before and after study (observational) of patients undergoing uterine fibroid embolisation. Prior to embolisation, study participants underwent a pelvic MRI and filled in the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QoL), a disease-specific symptom and health-related quality of life questionnaire for fibroids. The same questionnaire was administered after one year. Outcome measures: The main outcome was change in symptom severity score. Secondary outcome measures were change in health-related quality of life (HRQoL) score, the correlation between age, parity, uterine volume, fibroid number and change in the symptom severity and health-related quality of life scores and the incidence of an additional intervention. Results: Data from 80 study participants were included in the analysis. The mean change (improvement) in the symptom severity score was -29.6(SD±27.1) [95% CI -35.6 to -23.6, P\u3c0.001] with a mean change (improvement) in health-related quality of life score of 35.7(SD±32.7) [95% CI 28.4 to 42.9, P\u3c0.001].There was a significant positive correlation between fibroid number and change in symptom severity score. There was no significant correlation between age, parity, uterine volume and change in symptom severity score. There was a significant positive correlation between parity and change in the health-related quality of life score. There was no significant correlation between age, uterine volume, fibroid number and change in the health-related quality of life score. The incidence of a major and minor surgical intervention during the one year follow-up period was 6.25% and 12.5% respectively.iv Conclusions: UFE is associated with a statistically significant and clinically useful improvement in symptom severity and health-related quality of life in women with symptomatic fibroid disease and is an effective treatment option of symptomatic fibroids in patients with large myoma burden or large uterine volumes

Successful Pregnancy Outcome after Open Strassman Metroplasty for Bicornuate Uterus

Introduction. Müllerian duct anomalies represent a group of congenital malformations that result from failure to complete bilateral paramesonephric duct elongation, fusion, canalization, or septal resorption. These anomalies are rare in the general population with a bicornuate or didelphys uterus being among the common ones. Bicornuate uterine malformations are of clinical significance due to their adverse reproductive outcomes. Metroplasty has been shown to improve reproductive outcomes of bicornuate uterine malformations. We document a case of bicornuate uterus that was managed with Strassman metroplasty and a subsequent successful pregnancy outcome. Case. A Black African lady was seen with a history of six prior miscarriages. Her diagnostic workup revealed a bicornuate uterus for which she had a Strassman metroplasty performed. She later conceived and was followed up to term with a successful live birth. Conclusion. Strassman metroplasty is a rare procedure in Sub-Saharan Africa and this case seeks to add to the body of knowledge on surgical management of Müllerian duct anomalies specifically bicornuate uterus in this region. This case report aims to increase the awareness of Müllerian duct abnormalities specifically bicornuate uterus in cases of recurrent miscarriages and highlight the diagnostic strategies to investigate and to demonstrate management options in low resource settings