Jay Goldberg

Pregnancy after uterine artery embolization

BACKGROUND Uterine artery embolization is an increasingly popular alternative to hysterectomy and myomectomy as a treatment for uterine leiomyoma. Whether this procedure is safe for women desiring future fertility is controversial. CASES A primigravida who had previously undergone uterine artery embolization had premature rupture of membranes at 24 weeks. She had a cesarean delivery at 28 weeks, which was followed by uterine atony requiring hysterectomy. A primigravida who had previously undergone uterine artery embolization delivered appropriately grown dichorionic twins at 36 weeks. An analysis of the 50 published cases of pregnancy after uterine artery embolization revealed the following complications: malpresentation (17%), small for gestational age (7%), premature delivery (28%), cesarean delivery (58%), and postpartum hemorrhage (13%). CONCLUSION Women who become pregnant after uterine artery embolization are at risk for malpresentation, pre‐term birth, cesarean delivery, and postpartum hemorrhage.

Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy.

Purpose of review The management of uterine fibroids in patients requiring treatment who desire future fertility remains controversial. Myomectomy has been the most common operative procedure to improve pregnancy rates and outcomes. Uterine fibroid embolization is an increasingly popular, minimally invasive treatment for fibroids. This review aims to provide critical analysis of available data on pregnancy following myomectomy and uterine artery embolization. Recent findings Patients with distorted uterine cavities due to submucosal fibroids of more than 2 cm have higher pregnancy rates following hysteroscopic resection. Pregnancy rates following myomectomy, both via laparoscopy and laparotomy, are in the 50–60% range, with most having good outcomes. Pregnancy rates following uterine artery embolization have not been established. Pregnancies following uterine artery embolization had higher rates of preterm delivery (odds ratio 6.2, 95% confidence interval 1.4–27.7) and malpresentation (odds ratio 4.3, 95% confidence interval 1.0–20.5) than pregnancies following laparoscopic myomectomy. Summary Both myomectomy and uterine artery embolization are safe and effective fibroid treatments, which should be discussed with appropriate candidates. Pregnancy complications, most importantly preterm delivery, spontaneous abortion, abnormal placentation and postpartum hemorrhage, are increased following uterine artery embolization compared to myomectomy. Although most pregnancies following uterine artery embolization have good outcomes, myomectomy should be recommended as the treatment of choice over uterine artery embolization in most patients desiring future fertility.

Labial Necrosis After Uterine Artery Embolization for Leiomyomata

BACKGROUND Uterine artery embolization is increasingly used as an alternative to myomectomy, hysterectomy, and medical treatment for the management of symptomatic leiomyomata. CASE A woman with an 18‐week–size fibroid uterus who underwent uterine artery embolization developed a 3‐cm, exquisitely tender, hypopigmented, necrotic‐appearing area on the right labium minus. Spontaneous resolution occurred over 4 weeks. CONCLUSION Labial necrosis is a possible complication of uterine artery embolization and may be successfully managed with conservative therapy.

Migraine in pregnancy

The authors explore whether migraine affects pregnancy, how pregnancy alters migraine, and how to treat and prevent migraine in pregnancy

Evaluation of an Electronic Diary as a Diagnostic Tool to Study Headache and Premenstrual Symptoms in Migraineurs

Objective.—To evaluate an electronic diary as a tool to evaluate the occurrence and relationship of headaches and premenstrual syndrome (PMS) symptoms throughout the menstrual cycle in women with migraine.

Cost and Reimbursement for Three Fibroid Treatments: Abdominal Hysterectomy, Abdominal Myomectomy, and Uterine Fibroid Embolization

PurposeTo compare costs and reimbursements for three different treatments for uterine fibroids.MethodsCosts and reimbursements were collected and analyzed from the Thomas Jefferson University Hospital decision support database from 540 women who underwent abdominal hysterectomy (n = 299), abdominal myomectomy (n = 105), or uterine fibroid embolization (UFE) (n = 136) for uterine fibroids during 2000–2002. We used the chi-square test and ANOVA, followed by Fisher’s Least Significant Difference test, for statistical analysis.ResultsThe mean total hospital cost (US

Changes in foot function throughout pregnancy

) for UFE was

Correlation between visual examination of the cervix and digital examination

2,707, which was significantly less than for hysterectomy (

The current controversy regarding power morcellation in gynecologic surgery

5,707) or myomectomy (

False-Positive Cystoscopic Diagnosis of Ureteral Obstruction After Hysterectomy Due to a Nonfunctional Kidney.

5,676) (p < 0.05). The mean hospital net income (hospital net reimbursement minus total hospital cost) for UFE was