Term pregnancy, vaginal delivery possible after uterine fibroid radiofrequency ablation

Key takeaways:

• Live birth rates were similar for women with uterine fibroids who underwent radiofrequency ablation or myomectomy.
• Nearly 50% of pregnancies after radiofrequency ablation resulted in vaginal delivery.

Women who underwent radiofrequency ablation for uterine fibroids had similar rates of full-term pregnancy, vaginal delivery and miscarriage as observed with myomectomy, researchers reported in Obstetrics & Gynecology.

“This new technology can help preserve birthing options for women with fibroids,” Antoinette A. Allen, MD, clinical research fellow in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, told Healio. “With myomectomy, only under strict circumstances is labor recommended. With radiofrequency ablation, we can not only treat symptomatic fibroids, but also, we can achieve full-term vaginal delivery.”

Allen and colleagues conducted an interim analysis of data from 539 premenopausal women older than 21 years with symptomatic uterine fibroids from the Uterine Leiomyoma Treatment with Radiofrequency Ablation (ULTRA) study, an ongoing, multicenter, prospective cohort study started in April 2014. All participants were followed for up to 5 years. Researchers assessed pregnancy incidence and pregnancy outcomes every 6 months for women who underwent radiofrequency ablation or myomectomy.

Overall, 372 women (mean age at first pregnancy, 35.6 years) underwent radiofrequency ablation and 167 (mean age at first pregnancy, 34.24 years) underwent myomectomy with an average follow-up period of 2.5 years.

As of March 2023, 37 women conceived a total of 43 times, the researchers reported. Of these conceptions, 22 occurred after radiofrequency ablation and 21 occurred after myomectomy. Baseline miscarriage rate was 33.3% for all women.

Of pregnancies conceived after radiofrequency ablation, 40.9% resulted in first-trimester miscarriage and 50% in live births. Of pregnancies conceived after myomectomy, 42.9% resulted in first-trimester miscarriage and 57.1% in live births.

Nearly half (45.5%) of live births from women who underwent radiofrequency ablation were delivered vaginally, according to the study.

Both participants in the radiofrequency ablation and myomectomy groups reported gestational diabetes, pregnancy-related high blood pressure and placenta previa, the researchers wrote. In addition, one participant in the radiofrequency ablation group reported uterine rupture.

Researchers observed no differences in average gestational age at the time of miscarriage and at the time of live birth between the two groups. Miscarriage and full-term delivery rates were not significantly different between radiofrequency ablation or myomectomy groups.

According to Allen, uterine rupture was a unique finding and provides researchers a time frame to avoid pregnancy until the patient is completely healed from the procedure.

“Moving forward, we need more longitudinal studies regarding pregnancy outcomes that are parallel with symptomatic fibroid recurrence to demonstrate durability of this procedure,” Allen said. “Data is mixed regarding when to expect fibroid recurrence, but many large-scale studies estimate a 25% recurrence rate at 40 months. By extending analysis to this 4-to-5-year period, we can develop more robust conclusions about [radiofrequency ablation] in comparison to myomectomy.”

For more information:

Antoinette A. Allen, MD, can be reached at antoinette.allen@ucsf.edu.