子宫肌瘤子宫动脉栓塞术后妊娠情况及影响因素分析

目的:探讨子宫肌瘤患者行子宫动脉栓塞术(UAE)后的妊娠结局,以及肌瘤位置对妊娠率和结局的影响。方法:对行子宫动脉栓塞术的84例有生育要求和497例无生育要求的子宫肌瘤患者进行随访,了解其术后妊娠和产科并发症的发生情况。结果:(1)截止2011年4月,本研究中有50例患者60次妊娠。其中有妊娠要求组共30例39次妊娠,无妊娠要求组共20例21次妊娠。(2)有妊娠要求组妊娠结局为分娩26次(自然分娩9次,剖宫产17次),人工流产4次,自然流产5次,异位妊娠1次,宫内死胎3次(同1人);无妊娠要求组均行人工流产;(2)分娩的26例患者中,发现产科并发症7例26.92%(7/26),其中子痫前期1例3.85%(1/26)、胎盘前置状态1例3.85%(1/26)、早产4例15.38%(4/26)、中央性前置胎盘1例3.85%(1/26);(4)有妊娠要求的单发性肌瘤组(黏膜下、肌壁间、浆膜下、不明)和多发性肌瘤组的妊娠率分别为25.00%、59.09%、62.50%、14.29%和27.58%;单发浆膜下肌瘤组无产科并发症发生,黏膜下子宫肌瘤患者的产科并发症发生率高达75%。结论:子宫肌瘤患者在UAE后可正常妊娠,但自然流产率、胎盘异常等的发生率明显增高,特别是黏膜下和多发性子宫肌瘤患者。

Pregnancy and influencing factors after Uterine artery embolization of uterine fibroids patients

Objective:To investigate the pregnancy outcomes of uterine fibroids patients treated by uterine artery embolization(UAE),and whether the location of fibroids is a potential influencing factor.Methods:This study included 84 patients who had birth demand and 497 patients had no desire for fertility who underwent UAE for symptomatic uterine fibroids,and then to learn the pregnancy outcome and obstetric complications.Results:(1)There were 50 patients with 60 pregnancies in this study by the end of April 2011.30 patients with 39 pregnancies in patients who had birth demand,and 20 patients with 21 pregnancies in patients had no desire for fertility.(2)Pregnancy outcomes of who had birth demand were 26 deliveries(9 deliveries were vaginal,and 17 were by caesarean section),4 artificial abortion,5 spontaneous abortion,1 ectopic pregnancy,3 fetal death in utero(in the same patient).All pregnancy patients who had no desire for fertility underwent artificial abortion;(3)In 26 deliveries,the morbidity of obstetric complication is 26.92%(7/26),including 1 pre-eclampsia 3.85%(1/26),1 placenta praevia 3.85%(1/26),4 preterm deliveries 15.38%(4/26),1 placenta previa centralis 3.85%(1/26);(4)Pregnancy rate of single fibroid group(submucosal,intramural,subserosal and unknown)and multiple fibroids group in group of patients had birth demand were 25.00%,59.09%,62.50%,14.29% and 27.58% respectively.The obstetric complication rate of single subserosal fibroid group and submucosal uterine fibroid was 0% vs 75.00%.Conclusion:Patients with uterine fibroids after UAE can have normal pregnancy outcomes.But the rate of spontaneous abortion and placental abnormalities may increased,especially in patients with submucosal uterine fibroids.