Uterine Artery Embolisation May Adversely Affect Future Pregnancies

A paper to be published in The Obstetrician & Gynaecologist (TOG) examines the evidence on pregnancy outcomes following uterine artery embolisation (UAE), a treatment for fibroids.1 The authors underline the potential reproductive risks of UAE, and urge caution in recommending this treatment to women who wish to become pregnant in the future.


Uterine artery embolisation is a relatively new method for treating uterine fibroids.2 With the prevalence of fibroids being as high as 20-40% among women of reproductive age, this is a pressing issue as many women in the treatment population may not have completed their families.


The authors reviewed retrospective data and two small prospective trials of UAE versus surgical intervention (laparoscopic myomectomy). The results showed an increased risk of miscarriage, preterm birth, caesarean section, malpresentation and postpartum haemorrhage in pregnancies following UAE. Furthermore, the review found significantly higher miscarriage rates following UAE treatment for fibroids, than for women with untreated fibroids.


The authors note that the available data on pregnancy following UAE is limited. Nevertheless, in the absence of more robust evidence, they call for caution in recommending UAE to women still planning to become pregnant.


Co-author, Ertan Saridogan, consultant in reproductive medicine and minimal access surgery at Elizabeth Garrett Anderson Hospital, said "Uterine artery embolisation is a relatively new treatment option for uterine fibroids. Although a large number of women have already undergone this procedure, there is relatively limited information on its impact on a woman's future reproductive function.


"Our review on the outcome of pregnancies arising following uterine artery embolisation showed that they could be at increased risk for complications, especially miscarriage. Caution should be exercised when considering this treatment modality among women desirous of future pregnancies, particularly if alternative therapeutic options exist."


Jason Waugh, editor-in-chief of TOG, said "Studies have suggested that UAE is a safe and effective alternative to hysterectomy for alleviating fibroid-related disorders such as menorrhagia (heavy menstrual bleeding) and pressure symptoms. However, this study underlines the need for caution among women who still want to become pregnant.


"Patients with fibroids may experience painful symptoms and heavy, prolonged periods. Further research is needed in order to provide women with comprehensive information about the risks and benefits of available treatment options."


Notes


The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricans and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer-reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology. TOG is hosted online by Stanford University's HighWire Press at: onlinetog.


1 Uterine fibroids are benign tumours of the uterus. Symptoms caused by fibroids include abnormal bleeding, pelvic pressure and pain, and reproductive problems. Fibroids are common and are the most frequent reason for a woman to have a hysterectomy.


2 Uterine artery embolisation (UAE) is an alternative to hysterectomy for fibroids. It is a relatively new, nonsurgical treatment option. The procedure is performed under conscious sedation, and both uterine arteries are blocked with particles injected via the femoral and uterine arteries. This causes the fibroids to shrink.


Reference


Homer H, Saridogan E. Pregnancy outcomes after uterine artery embolisation for fibroids. The Obstetrician & Gynaecologist 2009;11: 265-270.

Source
The Obstetrician & Gynaecologist

With A Doctor's Help Obese Women With PCOS Can Lose Weight

Simple weight-loss advice from a physician and regular follow-up helped obese women with polycystic ovary syndrome lose a substantial amount of weight, a new study found. The results were presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C.



Polycystic ovary syndrome, or PCOS, is a common hormone imbalance in young women that raises the risk of infertility, obesity, type 2 diabetes and heart disease. Past research shows that modest weight loss - at least 5 percent of body weight - can significantly improve PCOS symptoms and reduce the risk of diabetes and heart disease.



However, medical management of obesity tends to be neglected, said study co-author Jean-Patrice Baillargeon, MD, MSc, an endocrinologist with the University of Sherbrooke Faculty of Medicine, Sherbrooke, Quebec, Canada.



"Research shows that primary care physicians are usually reluctant to manage their patients' obesity because they feel poorly equipped to do so and their success is limited," Baillargeon said. "But our study demonstrates that it is possible, with a doctor's weight-loss advice and follow-up, for obese women with PCOS to achieve clinically significant and sustained weight loss."



Baillargeon stressed that this study did not involve multidisciplinary care from a team of different health care specialists, which many doctors view as the most effective approach to weight loss but which is costly. Instead, as is usually the case in real life, study patients saw only a doctor. The physician gave them general advice on losing weight and on diet and exercise.



The investigators reviewed the medical records of 117 obese women with PCOS who had an initial doctor's visit and follow-up care for at least 2 months at the medical center's reproductive endocrinology clinic between May 2002 and September 2008. These women had an average weight of 231 pounds (104 kilograms) and an average body mass index, or BMI, of 38.7, which is close to morbidly obese. Follow-up visits, usually every 6 months, consisted of PCOS management as well as a weigh-in and discussion of weight loss, which Baillargeon said helped maintain patients' motivation.



Of the 74 women who had 6 to 12 months of follow-up, 32 patients (43.2 percent) lost 5 percent or more of their body weight, which is considered clinically significant, the authors reported. Among 35 women with 3 years of follow-up or longer, 16 (nearly 46 percent) lost that much weight, and seven (20 percent) lost at least 10 percent of their body weight.



If needed, women received the diabetes drug metformin, which is often used to treat problems related to PCOS. Although past studies of whether metformin affects weight loss have shown mixed results, women in this study who took metformin lost more weight than those who did not.



"Medical management of these women is an opportunity to improve their future metabolic health," Baillargeon said. "Any physician who sees obese women with PCOS should at least discuss the importance of weight loss and lifestyle modifications."



This study was presented by Lysanne Pelletier, MD, a trainee at the University of Sherbrooke.



Source:
Aaron Lohr


The Endocrine Society

Beyond The Abstract - The Effect Of Age On Outcomes Of Sling Surgery For Urinary Incontinence

UroToday - This study demonstrates the need for caution when performing slings on older women with stress incontinence. We found that older women were not only more likely to fail surgery and require another procedure for stress incontinence, but also were more likely to experience emptying difficulty and new urge incontinence after a sling. These findings suggest a need for thorough pre-operative counseling of older women undergoing sling surgery, as their risk of surgical morbidity is higher than for younger women.





Jennifer Anger, MD, MPH, as part of Beyond the Abstract on UroToday. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.


Link to Full Abstract


UroToday - the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.


To access the latest urology news releases from UroToday, go to:
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Catholic Bishops Should Stop 'Harassing' Giuliani, Other Catholic Politicians, Letter To Editor Says

Former New York City Mayor Rudy Giuliani (R) and other Roman Catholic politicians who have said they "oppose abortion but do not wish to impose that view on the entire polity have support in Catholic teaching," and Catholic bishops should "cease harassing" them, Daniel Maguire, a professor of moral theology at Marquette University, writes in a New York Times letter to the editor (Maguire, New York Times, 6/29).

Some church leaders have said they are disturbed by Catholic politicians such as Giuliani, who is running for the Republican presidential nomination. Bishop Thomas Tobin, head of the Roman Catholic Diocese of Providence, R.I., in a recent column for the diocese's newspaper, the Rhode Island Catholic, said Giuliani's "public proclamations on abortion are pathetic and confusing," adding, "Even worse, they're hypocritical." Tobin also said that he never would support a candidate who supports abortion rights.

According to Tobin, Catholics are "required to be pro-life, to cherish and protect human life as a precious gift of God from the moment of conception until the time of natural death." Tobin is the first bishop to challenge Giuliani on his abortion-rights position. At a recent debate, Giuliani was prompted by moderator Wolf Blitzer of CNN to respond to Tobin's comments. He said, "My view on abortion is that it's wrong but that ultimately government should not be enforcing that decision on a woman" (Kaiser Daily Women's Health Policy Report, 6/25).

According to Maguire, Sts. Augustine and Thomas Aquinas both favored legalization of commercial sex work because they thought "greater evils" would occur if it were banned. Legislators who "truly think abortion immoral could vote to keep it legal since greater evils" -- including "multiple deaths of women" from "botched abortions as seen before Roe v. Wade," the 1973 U.S. Supreme Court case that effectively barred state abortion bans -- "would follow," Maguire writes (New York Times, 6/29).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Applying Internal Stitches To Support Vagina, Other Internal Organs Reduces Incontinence In Women After Surgery, Study Says

A procedure that applies two permanent, internal stitches from each side of the vagina to ligaments in the pelvis can help reduce incontinence by 80% in women who have had surgery to correct pelvic prolapse -- a condition that occurs when the pelvic organs weaken and drop into or through the vaginal opening -- according to a study published in the April 13 issue of the New England Journal of Medicine, the Chicago Tribune reports. About 200,000 women in the U.S. annually undergo surgery to correct pelvic prolapse, after which up to 60% of the women experience "urinary stress incontinence," which can be caused by laughing, coughing, exercising or other actions, according to the Tribune (Kotulak, Chicago Tribune, 4/13). Linda Brubaker, an OB/GYN professor at Loyola University, and colleagues enrolled 322 women in the study, which was funded by NIH (Marchione, AP/Houston Chronicle, 4/12). Physicians on half of the participants performed the routine surgery for pelvic prolapse, which repositions the vagina and other internal organs, in conjunction with the Burch colposuspension procedure, which applies four internal stitches to support the bladder. The other half of participants underwent only the routine surgery, the Tribune reports. The study finds that performing the additional surgery helped to alleviate the pressure on the bladder's urinary opening and decreased the risk of urinary leakage (Chicago Tribune, 4/13). According to the study, 6% of women who underwent the Burch procedure in conjunction with the routine surgery reported urinary control problems three months later, compared with 25% of the participants who did not have the additional procedure (AP/Houston Chronicle, 4/12).

Reaction
Pelvic prolapse is a "very common problem in women, and this is the first time we've been able to demonstrate that an operation can actually prevent urinary incontinence,' Brubaker said (AP/Houston Chronicle, 4/12). Despite some "limitations" in the study, including a short follow-up period, it demonstrates that performing the Burch procedure along with the routine prolapse surgery results in improved urinary control, Rebecca Rogers, an OB/GYN at the University of New Mexico, writes in a related editorial in the journal (Rogers, NEJM, 4/13).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.