A research report submitted to the Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg,
in partial fulfillment of the requirements for the degree of Master of Medicine
in the branch of Obstetrics and Gynaecology
MBBCh (Wits)
Date: 22 September 2015Introduction
Uterine leiomyomas are the commonest benign tumours in women of reproductive age.
Fibroids have a significant impact on the woman’s quality of life as well as her fertility.
Women who have symptomatic fibroids can present with abnormal uterine bleeding, pressure
symptoms, pain, infertility, miscarriage or pregnancy complications. This necessitates
treatment. There are many available options, apart from medical and surgical management,
such as uterine artery embolisation. This alternative to surgical treatment in an African
population, who have a higher risk of fibroids, within a low resource setting is assessed in
this study. Uterine artery embolisation (UAE), is an interventional radiologic procedure that
has developed over the last 10 years and is gaining popularity. It involves occlusion of the
uterine arteries thereby decreasing the blood supply to the fibroid, thus improving symptoms
in patients. The complications and outcomes of this procedure was assessed.
Objectives and Methods
The four objectives in this study were
1. To describe the demographics of the women who have attended the Uterine Artery
Embolisation clinic from January 2004 till December 2011.
2. To describe the presenting complaints of the women attending Uterine Artery
Embolisation clinic.
3. To quantify the response of the fibroid to Uterine Artery Embolisation in terms of
size.
4. To document complications and outcomes associated with the procedure.
There were 100 women in the study sample ultimately who had UAE done after specific
inclusion and exclusion criteria were met. The procedure was performed by interventional
radiologists. This was a longitudinal descriptive study where the data was collected
retrospectively.
Results
The mean age of women in this study was 34.5 years. Thirty four women (46%) had never
conceived. The mean gravidity was 1 but 57 women (70%) were nulliparous. Pain was the
most common symptom experienced, followed by menorrhagia. Fibroids were located
intramurally in 94% of cases. Most patients experienced overall symptomatic relief at
follow-up visits.
The commonest complication immediately post-UAE was pain. Post-embolisation syndrome
occurred in 24% of women. At follow-up visits PV discharge, pain and bleeding were
complications present.
Incidental outcomes which could be defined as adverse events were assessed post-UAE
procedure in a total of 24 patients over the 5 follow-up visits, although the questionnaire
applied to all the women who underwent UAE. Two patients were discharged (8%), 8
patients became amenorrhoeic (33%) and 5 patients became pregnant (21%). Three patients
were referred for hysterectomy (13%) and 5 patients for myomectomy (21%).
The mean height of fundus (HOF) at presentation of women in this study was 17.8cm and
the final mean HOF after UAE was 12.5cm. There was a 5.3cm difference in the mean height
of fundus after treatment which was statistically significant.
The mean area of the dominant fibroid at initial presentation was 109.8cm2 and at final visit
was 71.9cm2. There was a mean area difference of 40.0cm2, this was also statistically
significant.
Conclusion
Symptomatic fibroids occur more commonly in younger African women with more severe
symptoms, that impact on quality of life and have a high disease burden, yet conservative
treatment that preserves the uterus is a sought after alternative. UAE provides a safe and
effective alternative to invasive surgery. After the results shown in this study, patients,
gynaecologists and interventional radiologists should be encouraged to use UAE as a
modality for the conservative management of fibroids in suitable candidates.MT201
