Bilateral uterine artery embolization (UAE) has long been performed by interventional radiologists to control postpartum hemorrhage. More recently, UAE has protocol been used as an alternative procedure for treating large symptomatic fibroids in women who are not pregnant and, most importantly, do not desire future fertility.7 A recent prospective study reported that UAE performed immediately after cesarean delivery in women with uterine fibroids may be effective in decreasing postpartum blood loss and minimizing the risk of myomectomy or hysterectomy by inducing shrinkage of the fibroids.60 Although not recommended, there are several reports of successful and uneventful pregnancies after UAE for uterine fibroids.60�C63 Conclusions Uterine fibroids are a very common finding in women of reproductive age.

The majority of fibroids do not change their size during pregnancy, but one-third may grow in the first trimester. Although the data are conflicting and most women with fibroids have uneventful pregnancies, the weight of evidence in the literature suggests that uterine fibroids are associated with an increased rate of spontaneous miscarriage, preterm labor, placenta abruption, malpresentation, labor dystocia, cesarean delivery, and postpartum hemorrhage. Pain is the most common complication of fibroids during pregnancy. The symptoms can usually be controlled by conservative treatment, but may require definitive surgical resection in rare instances. Some women with a previous myomectomy may need to be delivered by elective cesarean delivery prior to the onset of labor, particularly if the uterine cavity was entered.

Women with a previous myomectomy should probably be delivered by cesarean prior to the onset of labor, particularly if the uterine cavity was entered. UAE is an alternative procedure to operative intervention for the treatment of symptomatic fibroids, but is absolutely contraindicated in pregnancy and in women desiring future fertility. Main Points Uterine fibroids are very common in women of reproductive age. Most are asymptomatic; however, severe localized abdominal pain can occur if a fibroid undergoes so-called ��red degeneration,�� torsion, or impaction. Pain is the most common complication of fibroids in pregnancy, and is seen most often in women with fibroids > 5 cm during the second and third trimesters of pregnancy.

Approximately 10% to 30% of women with fibroids develop complications during pregnancy, although these adverse pregnancy outcomes have been reported in incomplete settings with selection bias, small and differing populations, varying inclusion criteria, low occurrence of adverse outcomes, GSK-3 and inadequate confounding variables. In early pregnancy, spontaneous miscarriage rates are greatly increased in pregnant women with fibroids compared with those without fibroids (14% vs 7.6%, respectively), and bleeding is significantly more common if the placenta implants close to the fibroid.