Jorge Branco

Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization

Purpose To determine pregnancy rates after conventional and partial uterine fibroid embolization (UFE). Materials and Methods The study received institutional review board approval and all patients gave written informed consent. A retrospective analysis of data collected prospectively was performed between June 2004 and June 2014 in a cohort of 359 women (mean age, 35.9 years ± 4.8) with uterine fibroids and/or adenomyosis who were unable to conceive. The median follow-up period was 69 months (range, 6-126 months). Under local anesthesia, both uterine arteries were embolized. In 160 patients, partial embolization was intentionally performed to preserve fertility, which may be decreased after conventional UFE. In partial UFE, only the small arterial vessels to the fibroids were embolized, leaving the large vessels of the fibroids patent. The Kaplan-Meier method and Cox regression were used for the statistical analysis. Results During follow-up, 149 women became pregnant, 131 women had live births, and 16 women had several pregnancies, resulting in a total of 150 live newborns. It was the first pregnancy for 85.5% (112 of 131) of women. Spontaneous pregnancy rates at 1 year and 2 years after UFE were 29.5% and 40.1%, respectively. The probability of successful pregnancy with live birth at 1 year and 2 years was 24.4% and 36.7%, respectively. Clinical success for fibroid-related symptoms was 78.6% (282 of 359). A dominant submucosal fibroid and ischemia greater than or equal to 90% had greater likelihood of spontaneous pregnancy. Complication rates in patients treated with partial UFE (14.6%) were not greater than rates in patients treated with conventional UFE (23.1%, P = .04). Conclusion Conventional and partial UFE may be safe and effective outpatient procedures for women with uterine fibroids who want to conceive.

Vertebral Metrics: Application of a New Mechanical Instrument to Evaluate the Spinal

OBJECTIVE To present the results of the first application of the new technology - Vertebral Metrics - the analysis of the 3D position of the vertex of each spinous process in pregnant women. MATERIAL AND METHODS The Vertebral Metrics was applied to women without associated pathology in four stages of pregnancy (12, 20, 32, 37 weeks gestation). We applied univariate linear models. RESULTS We found that the differences that occur during pregnancy are more significant at the position y (anteroposterior). It was found also that there is a positive correlation between the biomechanical position of the vertex of each of the vertebrae with the homologous position of rest. DISCUSSION/CONCLUSION Through Vertebral Metrics innovative results could be obtained in analyzing biomechanics of the spine. A device that has different applications can be easily adopted in areas such as orthopedics, neurosurgery, pediatrics and rehabilitation. It should also be noted that this instrument is not exhausted in the sample of this research because it can be further applied to the general population.

Biomechanical measurements in the spinal column of pregnant women using vertebral metrics

In modern society, pain is a relevant problem of the population in general and of pregnant women in particular, being a common symptom and frequently referred to in pregnancies without any pathology associated. Studies indicate that from 35 to 76% of pregnant women experience pain during the gestational period. Most researchers attribute the etiology of the pain to biomechanical alterations of the spinal column throughout pregnancy, however an in-depth analysis has been delayed by the fact that the analytical processes involved are invasive and, as such, cannot be applied to pregnant women. On the other hand, non-invasive diagnostic methods only allow partial analyses of the spinal column, not offering a global vision. In face of the limitations mentioned we built Vertebral Metrics – an instrument that allows us to identify the x, y and z positions of each of the vertices of the spinal apophyses (vertebrae), giving us a global evaluation of the spinal column, in a standing position. The present work has the objective of presenting the first application of this equipment to 49 pregnant women at four different moments of pregnancy (12, 20, 32 e 37 weeks of gestation). Analyzing the results we can conclude that Vertebral Metrics – is an innovative instrument in the global evaluation of the spinal column in a standing position, allowing a quantitative analysis of its shape and temporal variations.